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19 April 2016

An inspector calls and the practice is festooned with green “I Am Clean” stickers

I became wary of staying still for any length of time lest I, too, should be doused and dried, and have a green sticker slapped in the middle of my forehead.

By Phil Whitaker

We’ve been preparing for months. We cleared two skiploads of superannuated junk from store cupboards. Clinical rooms were decluttered and reorganised. Every item of disposable kit was checked to ensure it hadn’t passed its expiry date. The whole building was given a health and safety once-over. All so that, when the Care Quality Commission (CQC) came a-calling, it would find our surgery to be clean, efficient, and safe for the delivery of patient care.

We eventually got the email a couple of weeks ago informing us of our inspection date. The CQC is to health care what Ofsted is to education, and inspectors have the power to put practices into special measures – or even close them down – if they judge them to be failing. Rumours from other parts of the country did little to soothe our nerves. Carpets are unhygienic, apparently; but there was no way we could refloor the entire surgery. Curtains around examination couches should be disposable; we hoped a laundry rota would suffice. Cork noticeboards supposedly represent an infection hazard, but where else to pin the legion phone numbers indispensable for navigating today’s NHS?

As inspection day drew near, our wonderful practice manager disappeared beneath an avalanche of protocols and policies, nothing but a huge mound of paperwork where once her desk had been. From time to time her muffled voice could be heard, plaintively requesting another piece of documentation to prove some staff member was immune to hepatitis B. She was evidently still able to use her computer: emails pinged repeatedly into my in-box, asking me to check innumerable summaries and analyses of our performance data.

One of our nurses, Andrea, got hold of a pad of lurid green stickers, each bearing the legend I AM CLEAN. Returning to my consulting room after home visits, I found every piece of equipment – thermometer, stethoscope, ear torch – festooned with green squares as she swept through the building like an infection-control whirlwind. I became wary of staying still for any length of time lest I, too, should be doused and dried, and have a green sticker slapped in the middle of my forehead.

The surgery’s mercury sphygmomanometers (used to measure blood pressure) were a particular source of contention. We docs rather like them, with their old-school ambience, but Andrea removed them from the consulting rooms, saying we’d be shut down on the spot if the CQC saw them. Then our senior nurse reminded us – to everyone’s relief – that we are, in fact, the proud owners of a mercury spillage kit, and have a detailed protocol for handling breakages, should one ever occur. The sphygs were duly returned, but the argument smouldered right up until the CQC’s arrival.

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I kicked off the inspection with a presentation about the practice, what we think we do well and where we intend to improve. The CQC team then fanned out and set about interviewing all staff, and a fair few patients as well. My own conversations felt even-handed and collaborative, but various colleagues emerged from theirs looking shell-shocked.

Cracks began to appear. Some staff were behind in updating mandatory training. The write-up of the significant event analysis the CQC picked to discuss couldn’t be located. The spokesman for our patient participation group – a genial gentleman of advanced years – flatly denied ever having been part of such a thing (he will be screened for dementia shortly). By the end, my practice manager was close to tears.

We got verbal feedback at the close of the day. Of course we need to rectify the deficiencies that had come to light, but what the CQC had heard repeatedly was what fantastic care our patients say they receive, and what a cohesive and dedicated team we have working here. The lead investigator finished by saying she’d be very happy to sign up as a patient. In our tick-box, protocol-fixated and policy-obsessed culture, the values that matter are somehow hanging on in there. 

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