My reflections of my time as a CQC Inspector for Primary and Integrated Care
30 October 2018 | Zara Head QN
After being a general practice nurse (GPN) in a very busy but supportive GP Practice for many years, I felt I needed a change, a whole new challenge. I’d spotted an advert on the Care Quality Commission (CQC) website (accidentally, while I was looking for regulatory advice about the use of carpets in consulting rooms) and after much thought and deliberation I decided to apply.
I was successful in the first stage of the application process and this led to me doing an online assessment. I was also successful in this step and was invited to attend an interview and written assessment. The interview day was eventful; I was unable to attend the nearest assessment day in Leeds so it was arranged for my assessment to be held in Preston. After getting very lost on a one way system, I finally found the hotel with minutes to spare.
I sat a written assessment under exam conditions and was then whisked into a room with two enthusiastic inspection managers where I had to give a presentation on how I would incorporate the values of the CQC into my work as an Inspector. It was a very intense day, but I have to admit, I did really enjoy it. I was successful in the final selection process and was offered the chance to be an Inspector for Primary and Integrated Care.
I had massively underestimated the incredible sadness I would feel on my last day at the surgery, I made friends for life there, some of them as close (if not closer) than family. These colleagues had been there for me through some very difficult times and I was leaving them. To say I cried would be an understatement, I sobbed buckets. I was very worried that I was making the wrong decision and that I was risking my happiness.
I needn’t have worried.
Working as an inspector for the CQC was very different to any other role that I’d ever had or any role I’d ever imagined I’d do. This isn’t a role people generally think of when asked about nursing roles.
The biggest difference was the time alone. As nurses we usually have lots of people around us, members of multi disciplinary teams, patients, public: we rarely work in silence. Even in autonomous roles, we still have our patients.
Working for the CQC, I was home based, so for the majority of the time, during the day, I was alone. I was initially concerned that I’d struggle with this, as I’m definitely a “people person” but I found it very useful and I was able to work effectively and well. I had to try and be very disciplined with myself not to work too long (I wasn’t very good at this) and I had to make a very conscious effort to walk around often and not sit still while I was writing a report.
One day, whilst working on a very challenging report, I was shocked to see that I’d done less than 100 steps by late afternoon! I’d had no one to distract me, I hadn’t even had a drink, I wanted so much to get my report done, I’d just engrossed myself in it. This was a real eye opener and I made a strong effort in future to make sure that this unhealthy behaviour didn’t happen again. I’d make an effort to walk from the office to pop a load of washing in or if the weather was nice, go for a walk at lunchtime.
The initial training involved much time in London; for a country mouse, this was both exciting and a little scary. I never lost the feeling of awe as I arrived in Kings Cross Station. There was lots of studying to do and so much to learn, but I do enjoy a challenge. Although I thought I had an understanding of the Health and Social Care Act, I still had a great deal to learn about the legal aspects, inspection processes and skills and enforcement actions.
The cohort that I undertook all this training with acted as a support network; we learned and developed together. Only a couple of us were nurses, others had backgrounds in practice management or other regulatory bodies such as Environmental Health. We complimented each other well; we had mixed experience and knowledge and this led to some very interesting conversations and challenges.
Although, working from home, spending much time alone, in the virtual world I was surrounded by a fabulous team. We spoke to each other regularly and our manager brought us together in conference calls at least every week. There was a very supportive team structure and staff well-being was of high importance. We also physically met up often, in team meetings and regional and national events. This gave a great feeling of belonging and being valued which is important for the resilience of any team. This teamwork resilience was vital as the work could be very intense.
Inspecting a GP practice for compliance against the Health and Social Care Act, in a single day, was both mentally and physically tiring, both for the Inspector, their team and the practice staff. Following the Key Lines of Enquiry (KLOEs) so many things were looked at and much evidence sought and seen. All this evidence was collected ready for writing the report and then (usually for me, the next morning) the writing began.
Depending on the evidence (or lack of it), the inspector puts forward a recommendation on the rating the practice would receive. This rating was usually very personal to the staff, a judgement on their work. Therefore it was vital to ensure that the rating was as accurate as possible. For this reason, reports went through several quality checks.
If there were concerns and breaches of the Health and Social Care Act, the rating might be ‘Requires Improvement’. In that scenario, the report had to be presented, challenged and discussed at Regional Panel. If there was a recommendation of a rating of either ‘Outstanding or ‘Inadequate’, then the report was to be presented at National Panel, where often it was Professor Steve Field who would challenge and ask questions. This was really daunting but ensured that my reports were always of the highest standard possible! By the time my reports were written and had gone through every quality step – I knew them almost off by heart.
I used to introduce myself as a practice nurse who also happened to be a CQC Inspector. I could understand the pressures that practices faced; I could see things from their point of view. I saw so many examples of great care, as well as examples where improvements could, and indeed were, made.
I enjoyed the role and learned a huge amount, but I felt I wasn’t using my nursing skills enough – I missed being able to advise people, but as an inspector, this wasn’t really my role. I could signpost people to guidance but as a kinaesthetic learner myself, I enjoy doing rather than talking about things. It wasn’t until later, when I was in my next role, that on reflection I saw just how much of my nursing skills I had put into my work at the CQC. Skills I had learned over the years – communication skills, de-escalation skills, empathy – I used them all.
Then one day, I spotted an advert for a CCG Lead Nurse for Primary Care Quality. It was just what I’d hoped for: I could be supportive, advise and help practices, not only to meet regulatory requirements but also how to evidence and show where they have outstanding levels of work… This is where the next chapter begins!