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Why risk CQC enforcement action?

20 June 2016

Why risk CQC enforcement action?

On 6 June the CQC inspectors published reports on 18 dental practices in England.

As you know, the CQC doesn’t rate dental practices. Instead, 12 practices were marked as ‘Dental Compliant’. Six practices were accorded the description ‘Dental Breach’. So one third didn’t come sufficiently close to the CQC’s fundamental standards to gain a pass mark. That failure rate is typical.

With England having about 10,000 dental practices, that suggests more than 3,000 would fail a CQC inspection. The CQC is committed to inspecting only 10 per cent of practices, even so in excess of 300 could get the thumbs down.

What are the consequences?

The CQC has an enforcement policy with which to: ‘Hold registered providers and managers to account for failures in how the service is provided.’ The CQC document Enforcement decision tree (February 2015) summarises the steps the steps the CQC will go through. This document states:

  • Any concerns identified during an inspection should be looked at in more detail before decisions are made.

It goes on: ‘Where these initial enquiries do not provide sufficient assurance that people using regulated services are reasonably protected from harm, or that a provider or individual may need to be held to account, escalation to enforcement should be considered.’

As far as I know, no enforcement action has been taken against any dental practice following a breach identified during a CQC inspection. So far. This is probably because despite the breaches, patients are not thought to be at risk.

Most common breach

In most but not all published overviews of CQC inspections, each of the five fundamental standards is given a green tick or a black cross – their meanings being obvious. In the cases of a dental breach I have looked at, the overwhelming majority have a black cross against ‘Well-led’ with the words ‘improvements required’. The full inspection report details the findings and, at the end, there is a list of ‘requirement notices – action we have told the provider to take’.

The regulated activity and relevant regulation or regulations not being met are listed and the provider must send the CQC a report that says what action they are going to take to meet these requirements. In the case of not being ‘Well-led’, the regulation concerned is Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 17 Good governance.

What is required?

Quoting from the CQC Regulations for service providers and managers: ‘To meet this regulation; providers must have effective governance, including assurance and auditing systems or processes. These must assess, monitor and drive improvement in the quality and safety of the services provided, including the quality of the experience for people using the service. The systems and processes must also assess, monitor and mitigate any risks relating the health, safety and welfare of people using services and others. Providers must continually evaluate and seek to improve their governance and auditing practice.

In addition, providers must securely maintain accurate, complete and detailed records in respect of each person using the service and records relating the employment of staff and the overall management of the regulated activity.

As part of their governance, providers must seek and act on feedback from people using the service, those acting on their behalf, staff and other stakeholders, so that they can continually evaluate the service and drive improvement.’

Be warned. The CQC can prosecute for a breach of part of this regulation if a provider fails to submit a report as mentioned above when requested.

So what?

The so what of all this is that around 30 per cent of practices are failing a CQC inspection, most often deemed as not being well led. They have to submit a report (effectively an action plan) and there are dire consequences if they don’t. Those practices will no doubt be inspected again.

To save time, resources and anguish, it surely makes sense to put some effort into passing the well-led aspect of the inspection first time – together with the other fundamental standards, of course.

Remember also that the Department of Health is keen for patients to be aware of how well (or otherwise) healthcare providers, including dentists, are performing. NHS Choices already allows members of the public to read reviews by patients but doesn’t include CQC inspection information (yet?). However, if you Google ‘dentists rated uk’, this brings up a search list which includes the dentists page on the CQC website. It states: ‘Unlike other types of service we regulate, we don't publish ratings on dentists’ but includes a link to the latest inspections and this list includes green ticks and black crosses against each of the five fundamental standards for virtually all practices.

So not only would your dental breach be in the public domain, any minimally tech-savvy potential patient is quite likely to see it. So much for all the money and energy you expended on marketing and PR!

And here’s the answer

To achieve a green tick for ‘Well-led’ requires practice owners and managers to have an understanding of key management principles and know how to implement them. Such principles as The Triangle of Success (J. Edsel Edmunds) and the Five Dysfunctions of a Team (Patrick Lencioni).

There’s not room here to go into detail or, of course, to assess what developments may be required in your particular practice. Which is why I suggest you attend my seminar on Friday 8 July in Sheffield.

For more information and to find out if you are eligible for a 20% discount on the £150 fee, contact me on or 01482 872491.

About the author

Nicki Rowland, a multiple award winner as a practice manager, now runs Practices Made Perfect dental consultancy and training organisation. She shares her extensive knowledge to help practices survive and grow.

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