Site visits give us an opportunity to talk to people using your services, your staff and other professionals, to find out about their experiences. They allow us to understand how you deliver care and to see how people’s needs are managed.
Where services are managed from one location across multiple sites, we are likely to visit a number of the sites during an inspection.
Gathering evidence during the site visit
To structure the site visit, the inspection team refers to the key lines of enquiry (KLOEs) in the assessment framework for health care services. They also look at any concerns identified beforehand through our monitoring activity. This enables them to focus on specific areas of concern or potential areas of outstanding practice. They collect evidence against the KLOEs using a variety of methods.
People who use services
We will gather the views of your patients, their family and carers, by:
- speaking with them individually
- using information from our 'Give feedback on care' service
- using information from complaints and concerns sent through our website
- speaking with a member of your patient participation group or patient reference group.
Your staff
On inspections, we may speak to the following members of staff:
- GP partners
- other GPs employed, including locums and trainee GPs
- practice managers
- practice nurses
- healthcare assistants
- other clinical staff
- administrative staff.
Gathering information in other ways
As well as the evidence we collect as part of the site visit, we will usually collect some evidence through other methods. These include:
- virtual interviews with staff
- evidence requests
- accessing your clinical systems while off site (read our guidance Accessing medical records during inspections)
- tracking a patient’s journey through their care pathway
- reviewing records
- reviewing operational policies and supporting documents.
We recognise that there are particular sensitivities about medical records held by GP practices. The relationship between GPs, practice nurses and their patients is often a close and long-lasting one, with a very strong expectation of confidentiality. Records may include very private and personal information, including information about relationships, mental health and sexual health. We ensure reports do not contain details that may identify people. A GP, nurse or pharmacy professional from the inspection team will usually review medical records.
Read our information describing why and how we look at medical records during our inspections.
The start of the visit
At the start of each inspection the inspector will meet with your registered manager. If the registered manager is not available the inspector can meet with another senior member of staff, for example a partner. This short introductory session will introduce the inspection team and explain:
- the scope and purpose of the inspection, including the powers we have
- the plan for the day
- how we will escalate any concerns that we identify during the inspection
- how we will communicate our findings.
We want you to be open and share your views with us about where you are providing good care, and what you are doing to improve in areas that you know are not so good.
If we find that you have not been open with us about issues of concern that you already know about, this will be reflected when we assess the well-led key question.
The inspection team will review the emerging findings together at least once during the inspection. This keeps the team up-to-date with all issues and allows them to shift the focus of the inspection if they identify new areas of concern. It also enables the team to identify which further evidence they might need in relation to a line of enquiry and what relevant facts might still be needed to corroborate a judgement.
Feedback on the visit
At the end of the inspection visit, the lead inspector will meet with your registered manager and other appropriate members of staff to provide feedback. This is high-level initial feedback only, illustrated with some examples.
At the meeting, the inspector will:
- tell you about any issues that were escalated during the visit or that require immediate action
- tell you if we need additional evidence or if we need to seek further specialist advice to make a judgement
- tell you about any plans for follow-up or additional visits (unless they are unannounced)
- explain how we will make judgements against the regulations
- explain the next steps, including how we process the draft inspection report
- answer any questions from the practice.
We will carry out further analysis of the evidence before we can reach final judgements on all the issues and award ratings.