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29 January 2019 0 Comments
Posted in Health & Social Care, Opinion

CQC considers regulation of dental practices in the well-led domain.

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While the workings of the Care Quality Commission (CQC) can seem like a mystery to many dental professionals, understanding how CQC works will help your service shine during its inspection.

Dental practice

When inspecting a dental practice, CQC looks at five “key questions” or “domains” including whether the service is safe, effective, caring, responsive and well-led.  It is the well-led domain that is usually the key to a successful inspection.

CQC use their Key Lines of Enquiry (KLOEs) to ascertain whether a service meets these five key standards. They have also developed a set of standard questions, called “prompts,” which they ask when they are trying to determine if these five key standards have been met.  The KLOEs and prompts are published on CQC’s website under its guidance for providers.  We recommend that providers and practice managers review the KLOEs and prompts so they will know what CQC are looking for when they come to inspect.

If you think about it, it makes sense that the well-led domain is the most important area that CQC investigates. Good management is the key to the smooth operation of any organisation.CQC’s recent guidance indicates that the well-led domain is more determinative of an inspection outcome than the four other key questions (whether the service is safe, effective, caring and responsive).

Unfortunately, CQC’s inspections in 2017/2018 indicate that dental practices are struggling to meet the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (“the Regulations”) in the well-led domain. Where CQC have taken enforcement action against dental practices, it is most often due to a breach of the Regulations in the well-led domain.

Out of the 1,336 dental practices inspected during 2017-2018, 10% were determined to be in breach, resulting in either a regulatory requirement or enforcement action in the well-led domain.  In comparison, only 2% required similar action for breaches falling within the safe domain and there were no breaches of the regulations at all in the effective, caring and responsive domains.

The most frequent problems found during inspections appear to be staffing issues, a poor leadership culture, poor communication, a failure to act when things go wrong, and an inability to take prompt and decisive action to address issues. Poor leadership impedes the prospects of the practice and the quality of the care.

When challenging draft inspection reports on behalf of our clients, we regularly see an overlap between problems in one of the key areas, most often in the safe domain, and the well-led domain. In other words, for CQC, a safety issue is often also a management issue. CQC are likely to say that record-keeping and governance systems (under well-led) must be improved in order to improve safety. From CQC’s perspective, your practice cannot be deemed to be well-led if improvements are required in order to make it safe.

If your dental practice has recently been inspected and has been found to be in breach of the Regulations or you disagree more generally with negative findings in the draft report, contact our Health and Social Care team.  We can help you decide whether it is worth challenging the factual accuracy of your draft report and advise on how to deal with any potential regulatory compliance action that CQC may impose.  You will only have 10 working days to raise any queries with CQC so time is of the essence.  Once the 10 working days have elapsed, if no issues are raised with them, CQC will publish the report.

Photo by Michael Browning on Unsplash

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