CQC Hotspots – November 2017

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Reviewing a further sample of 107 CQC dental inspection reports published in November highlighted a number of compliance breaches and warnings which can easily be avoided, but which are still catching out some practices.

Of the 107 practices sampled, only 7 practices were issued with breach notifications, which is a big improvement on previous samples. Clearly the majority of practices are getting things right, which is great news. All notices reviewed this month were again issued for breaches within the “Well Led” standard, with just one other issued in respect of “Safe”.

It is very clear from this, and several previous samples, that the “Well Led” standards are still causing problems for many practices, despite most being fully compliant in the many other aspects of good practice management.

The “Well Led” standard is inspected under the following broad areas:

  • Governance Arrangements (management structure and responsibilities/delegation)
  • Leadership, Openness and Transparency
  • Learning & Development/Continuous Improvement
  • Seek and Act on Feedback from staff and the public/patients

In the spirit of continuous improvement and to try and help 100% of practices achieve a clean pass, here are some of the key-findings and recommendations from these very recent inspections, which might just keep another practice out of trouble.

Interesting to note that a number of the issues picked up by inspectors in recent reports have been flagged up in previous bulletins and all are easily resolved once identified.

  • Don’t let the basic Infection Control procedures slip – remember that your Infection Control Audits and HTM01-05  should be at the forefront of everyone’s mind.
  • Inspectors are still picking up evidence of audits being undertaken and filed with no subsequent action planning or attempt to resolve identified issues. Remember that once you have identified a risk, the practice is responsible for pro-actively resolving and/or reducing the risk to an acceptable level. Always document timescales, responsibility and follow-up plans.
  • Medical Emergency procedures have caused problems for some practices. Remember to rehearse these regularly (keeping records), involve all staff, check that you have the essential drugs/equipment readily available as recommended by Resuscitation UK, British National Formulary, GDC and make sure that nothing in your emergency kit goes out of date.
  • As with all policies and procedures, Safe-Guarding and Whistle-blowing procedures must be personalised to your own practice and reflect local contacts and procedures. Inspectors still find many examples of generic policies/procedures which bear no resemblance to what actually happens locally,
  • Practices are still being picked up for inadequate recruitment procedures. Always follow simple, readily available checklists and procedures to demonstrate that you are doing things correctly and keep records readily available in staff files. This includes employment references, DBS certificate numbers, qualification certificates, photo i.d. and proof of residency/home address.
  • Ensure you are receiving, checking and taking action on relevant MHRA/CAS patient safety alerts. Dental practices don’t receive many but there must be a robust system in place to show that you identify and respond to any that are published.
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  • Management of sharp injuries are regularly checked. Ensure procedures are in place and communicated to all the team. Endo files need to be risk assessed if used.
  • Incident/Accident Reporting records must be updated for any significant events, including Sharps injuries..
  • COSHH records not held or maintained/reviewed. Practices work with a lot of high-risk substances. Essential that you have information sheets and risk summaries for all, including routine cleaning materials. Immediate access to this information will be vital in the event of an accident. Also make sure that anything within your COSHH records is safely and securely stored to reflect the increased risk. Don’t forget to log and register  those new materials you keep trying out if they are a COSHH risk.
  • Make sure your clinical and domestic waste records are fully up to date and that appropriate waste audits have been completed accurately by yourself and your waste handlers.
  • Check your drugs and materials for storage guidelines, ensure refrigerated where required and regularly check for out-of-date supplies.
  • Make sure that your clinical team have up to date Hep B immunity records confirmed and available for checking, before working in risk areas. Take care to ensure all impacted staff have reached the minimum level of vaccine effectiveness.
  • Inspectors continue to come across missing or partially-completed, mandatory risk assessments including Legionella, Sharps, Clinical Waste and COSHH. Make sure that any actions required to minimise risks are documented and implemented.
  • Staff reviews/appraisals must be available to show evidence of performance, learning needs, “general well-being” and future training/development plans. Something is better than nothing, so don’t delay or wait for “perfection”.  So often, inspectors are told that appraisals “are in hand” but not yet done.
  • Interpretation services must be made available for patients who do not speak English, either in house or through an external third party service.
  • Don’t forget to have an up to date Disability Discrimination Audit available along with plans for improvements or reasons why changes cannot reasonably be made.
  • More practices are now making use of CCTV – make sure this is documented in your Data Protection records and that both staff and patients are given adequate notice of why CCTV is being used and that they have a right to view footage.
  • Take care with “Off the Shelf” or “In a Box” Policy and Procedure packs. They are an essential and valuable source of material for many practices, but each policy/procedure must be reviewed and personalised to the practice and the way you work.

As always, remember that if something is not recorded or evidenced, in the eyes of the CQC and other external bodies such as the NHS, it didn’t happen, even though you may know full well that it did! This continues to catch practices out, leading to frustration and avoidable stress for all!

Findings from previous inspection reviews can be found here:  CQC Hotspots

There is plenty of help out there to plug any management gaps including Your Dental Manager, so please do get in touch if you have any concerns or want to further improve the overall management/efficiency of your practice: info@yourdentalmanager.co.uk or check our on-line calendar to book a complimentary chat.

CQC Hotspots – November 2017

CQC Hotspots – June 2017

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Reviewing a further sample of 67 CQC dental inspection reports published over recent weeks, highlighted a number of compliance breaches which can easily be avoided, but which are still catching out some practices.

Of the 67 practices sampled, 9 practices were issued with breach notifications. Clearly the majority of practices are still getting things right, which is great news. All notices reviewed this month were again issued for breaches within the “Well Led” standard, with just one other issued in respect of “Safe”.

It is very clear from this, and several previous samples, that the “Well Led” standards are still causing problems for many practices, despite most being fully compliant in the many other aspects of good practice management.

The “Well Led” standard is inspected under the following broad areas:

  • Governance Arrangements (management structure and responsibilities/delegation)
  • Leadership, Openness and Transparency
  • Learning & Development/Continuous Improvement
  • Seek and Act on Feedback from staff and the public/patients

In the spirit of continuous improvement and to try and help 100% of practices achieve a clean pass, here are some of the key-findings and recommendations from these very recent inspections, which might just keep another practice out of trouble.

Interesting to note that several of the issues picked up by inspectors have been flagged up in previous bulletins and are all easily resolved once identified.

  • Team members will usually be asked about the “Duty of Candour” which relates to a culture of open and honest communication amongst the team and with patients. This includes apologising to patients when things go wrong and staff feeling comfortable with raising issues and concerns. There should be a “no-blame” culture clearly evident.
  • Inspectors are still picking up evidence of audits being undertaken and filed with no subsequent action planning or attempt to resolve identified issues. Remember that once you have identified a risk, the practice is responsible for pro-actively resolving and/or reducing the risk to an acceptable level. Always document timescales, responsibility and follow-up plans.
  • Policies and procedures not signed, reviewed, circulated or updated. Your policies and procedures are essential working documents, which your team must be familiar with.
  • Infection Control Audits, apparently completed, but not reflecting what is actually happening. Simple box-ticking is ineffective, a waste of everyone’s time and a real risk to the practice and patients. Remember that audits are intended to drive continuous improvement and change.
  • Staff indicating that certain actions have taken place or resolved, but with no documentary evidence. Always make sure your efforts and hard work are recognised by keeping notes and records of what you are doing to improve the practice.
  • Dental records (electronic or written) must be clear, concise and complete, with regular audits for each clinician. Feedback and monitor for improvements if necessary.
  • Practices are still being picked up for inadequate recruitment and staff induction procedures. Follow simple, readily available checklists and procedures to demonstrate that you are doing things correctly and keep records in staff files.
  • Ensure you are receiving, checking and taking action on relevant MHRA/CAS patient safety alerts. Dental practices don’t receive many but there must be a robust system in place to show that you identify and respond to any that are published.
  • Ensure that all sterilisation and clinical equipment is fully maintained in accordance with manufacturer guidelines, externally validated by professionals/suppliers and that recommended routine/daily/weekly checks are undertaken diligently. Even more important is to have evidence and documents to support your checks and maintenance!
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  • Prescription and controlled medicines/drugs must be locked away and closely monitored.
  • Management of sharp injuries are regularly checked. Ensure procedures are in place and communicated to all the team. Incident/Accident Reporting records must be updated for each event.
  • COSHH records not held or maintained/reviewed. Practices work with a lot of high-risk substances. Essential that you have information sheets and risk summaries for all, including routine cleaning materials. Immediate access to this information will be vital in the event of an accident.
  • Make sure that your clinical team have up to date Hep B immunity records confirmed and available for checking, before working in risk areas.
  • When appointing Fire Marshalls, First Aiders and other “appointed” roles, make sure that they are adequately trained and know that they have been appointed to the role! Inspectors have talked with staff who are unaware of their responsibilities.
  • Information Governance is becoming increasingly important, and high-profile as evidenced by recent events within the NHS. Make sure your team have been trained, with evidence, and are following your reviewed and updated IT security policies.
  • The practice Health & Safety risk assessment must be kept up to date and where new or changed risks are identified, actions put in place to resolve quickly. Don’t delay as once identified, you have a responsibility to correct.
  • Inspectors continue to come across missing or partially-completed, mandatory risk assessments including Sharps, Fire, Clinical Waste, COSHH and Manual Handling.
  • Remember to date and review all of your practice policies and procedures at least annually. If nothing has changed simply re-date to show that you have been there.
  • Don’t forget that associate dentists, therapists and hygienists should also have annual appraisals to review performance and identify training requirements.
  • Appraisals are generally expected to show evidence of performance, learning needs, “general well-being” and future training/development plans. Something is better than nothing, so don’t delay or wait for “perfection”.  So often, inspectors are told that appraisals “are in hand” but not yet done.
  • Collecting and responding to patient feedback and comments is essential. Even more important is to evidence what action has been taken in response to feedback. Inspectors will always ask for specific examples, so be prepared.
  • Take care with “Off the Shelf” or “In a Box” Policy and Procedure packs. They are an essential and valuable source of material for many practices, but each policy/procedure must be reviewed and personalised to the practice and the way you work.
  • Missing or out of date Accessibility Audits, which are required under the Equality Act 2010 along with action plans and explanations for not implementing best practice. One practice was picked up for not having a hearing loop on reception – something which can be reasonably implemented as required under equality legislation.
  • The practice is responsible for overseeing CPD training – make sure you keep records of where everyone is within their CPD training cycle.
  • For multi-site practices, make sure that their is a responsible person at each site – don’t just rely on a “roving” practice or compliance manager.
  • Don’t forget to book regular team meetings into the diary – ideally monthly – and keep records of agendas, minutes and action points from each. It is not enough for staff to say that everything is discussed and resolved informally during the working day. Also remember to keep absent staff (holidays, part-time or sickness) fully up to date with evidence.

As always, remember that if something is not recorded or evidenced, in the eyes of the CQC and other external bodies such as the NHS, it didn’t happen, even though you may know full well that it did! This continues to catch practices out, leading to frustration and avoidable stress for all!

Findings from previous inspection reviews can be found here:  CQC Hotspots

There is plenty of help out there to plug any management gaps including Your Dental Manager, so please do get in touch if you have any concerns or want to further improve the overall management/efficiency of your practice: info@yourdentalmanager.co.uk or check our on-line calendar to book a complimentary chat.

CQC Hotspots – June 2017

JOB OPPORTUNITY – DENTAL HYGIENIST, OXFORD

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Self-employed Hygienist Required for Private Oxford Practice

2 days per week

One of my dental clients in Oxford has an excellent opportunity for an experienced and ambitious Hygienist to join a thriving practice.

This vibrant and successful, primarily private, dental practice operates from state of the art premises on the outskirts of Oxford being fully computerised with well-equipped, modern surgeries, digital x-rays and training facilities.

The practice has a strong preventive dentistry ethos and demand for hygiene services is increasing.

The successful applicant will enjoy excellent working conditions, competitive fee payments, access to an established patient list and the benefits of a strong and efficient management/support team.

You will need to have a minimum of 2 years post-qualification experience with excellent communication skills.

To apply for this opportunity or for more information please send your c.v. and a covering letter to oxford@yourdentalmanager.co.uk

JOB OPPORTUNITY – DENTAL HYGIENIST, OXFORD

Boosting Your Patient Recalls

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Effective and reliable patient recalls are a critical part of your practice for many reasons:

  • Essential for ongoing patient care
  • Keep patients to recommended intervals and avoid slipping, often by many months
  • Minimise future pain and treatment through preventative care
  • Patient education
  • Relationship-building
  • Identification and discussion of patient needs, aspirations and future treatments
  • Practice cash-flow
  • Forward planning
  • Diary management
  • Minimise the time spent by back-office staff trying to fill white space

Here are some thoughts and suggestions to help improve and streamline your approach

  • Always encourage patients to pre-book their next 3, 6 12 month appointment
    • Significantly reduces the volume of recalls to manage on a monthly basis
    • Allows patients to choose convenient appointments which may not be available to them nearer the time
    • Appointments can be changed as necessary subject to your 24/48 hour cancellation policy
    • Make good use of the automated reminder services within your practice software and use firm but friendly wording about the importance of attendance within the reminders
  • Replace the word “routine”  with “essential” or “vital”
  • Replace the phrase “check-up” with “comprehensive dental review” or “consultation”
  • Make full use of the automated recall systems within your practice software
    • This will take care of maybe 80% or more of your routine recalls
    • Typical recall schedule for a June recall is:
      • Automated reminder in May
      • Automated reminder in June for those still outstanding
      • Automated “Overdue” reminder in July, which is more detailed,
        • Highlights the importance of regular attendance
        • Benefits of ongoing, preventative care
        • List of the many aspects of oral health care covered during a recall
          • Create/make use of a 16 to 20 point bulleted Dental Health Review summary, based on all the checks undertaken
      • Automated reminder after 12 months, which is more of a reactivation approach
        • Details of what is included in the “essential” recall using your Dental Health Review summary mentioned earlier
        • Highlight importance of ongoing care
        • Ask for contact to enable records to be updated
        • Seek confirmation if no longer wishing to remain as a patient so that their place can be given to others on the waiting list
  • Review and personalise your automated recall letters carefully:
    • Firm but friendly letter which reflects your practice ethos/image/brand
    • Highlight benefits and importance of regular attendance
  • Practice staff focus their time and effort on contacting patients, by telephone, who have not responded or booked their next appointment after the third, “Overdue” automated reminder
    • In the above example, practice staff would be making phone calls in June to patients who are still overdue for a recall from April 2017 (2 months ago)
    • Phone call should be on a patient-care/concern over missed recall approach
    • Check that patient records/contact details are up to date
    • Build relationship with the patient and establish a good rapport
    • Understand patient preferences/needs
    • Respond to any questions or concerns
    • Update records and close off if patients have moved away or no longer wish to be a patient
    • Book an appointment
  • Keep your dental records up to date with each attempt at contact and with feedback or comments from patients so that you can follow up and pick up on previous discussions. This also avoids multiple contact to the same patient within a short period of time
  • Use your practice software “follow-up” lists to diarise patients who ask for a call-back, or more time
  • Use your practice software to help track and monitor progress with recalls. Most will now produce comprehensive, interactive and visual reports to help
  • Build regular “treatment blocks” into your diary to ensure days are not fully blocked with recalls, leaving no time for longer treatments

In summary:

  • Review your recall messages/letters and make them firm, friendly and compelling
  • Promote the benefits of regular attendance
  • Highlight and summarise the many checks completed during your “Comprehensive Dental Reviews”
  • Make good use of automation for the majority of recalls
  • Keep records of all contact
  • Plan out your diary and create treatment blocks
  • Focus on the much smaller list of patients who are still overdue after 2 months and speak with them
  • Follow-up and persevere
Boosting Your Patient Recalls

Job Opportunity – Associate Dentist Leeds

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Church View Dental Care, Crossgates, LEEDS

Self-employed Associate Dentist Required

2,000 UDA’s + good private opportunities

2 or 3 days per week including Fridays but some flexibility with other days

Due to continued growth, Church View Dental Care in Crossgates, Leeds, has an excellent job opportunity for an enthusiastic associate dentist to join a thriving practice in a busy high street location with great transport/road links.

This vibrant and successful mixed private/NHS dental practice operates from modern and spacious premises on the outskirts of Leeds being fully computerised with well-equipped surgeries and a committed, experienced team of dental professionals.

The successful applicant will enjoy excellent working conditions, competitive private fee payments/UDA rates, generous contribution to lab fees, access to an established NHS patient list, excellent private practice opportunities, strong peer/referral support and the benefits of a strong and efficient management/support team.

The right candidate will be an existing NHS performer with excellent communications, skills, a strong team player with a commitment to professional and personal development.

Practice website: www.churchviewdentalcare.co.uk

To apply for this opportunity or for more information please send your c.v. and a covering letter to Leeds@yourdentalmanager.co.uk

 

Job Opportunity – Associate Dentist Leeds

Ready for the Unexpected?

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A robust Business Continuity Plan (BCP) is essential for any businesses and a Care Quality Commission requirement for all the right reasons. A BCP is also required under the terms of an NHS contract.

Your practice BCP helps to ensure that in the event of a “crisis”, “disaster” or “serious incident”, the team respond effectively, patients are impacted as little as possible and the business is able to professionally restore service by following a set of pre-planned guidelines.

Paper with words BCP Business Continuity Plan

Importantly, your BCP is prepared when all is going well and you have the time to think plans through methodically and logically for all kinds of “what-if” scenarios.

In the event of something going seriously wrong e.g. floods, loss of power, fire, IT or even something as simple as a telephone failure, the whole team can go straight to this document and have access to the right people along with guidelines on how to minimize disruption, danger and risk.

The BCP should be written to clearly and simply outline how the practice can realistically recover from a wide range of failures or disasters and will be different for each practice dependent on local and available resources.

Always appoint a named individual to be responsible for maintaining the BCP and hold primary responsibility for leading any crisis. Also name a couple of deputies to cover absences.

Maintain an accurate list of contact details for all team members within the BCP, including mobile phone and e-mail, so that you can quickly keep everyone up to date with developments and ask for support or keep people away.

Think about how you will make contact with patients booked in for appointments if you are unable to access computer files. Some practices print off patient contact lists each evening for the next morning’s appointments and keep in a safe place.

An up to date and accurate list of key support contacts, reference/contract numbers and any agreements for support is an essential part of the BCP so that you can react and implement quickly. This should include:

  1. Practice Insurance Company
    1. Claim and Help Lines
    2. Policy numbers
  2. Your Contingency site
    1. “Buddy” up with a local dental practice and agree to provide temporary accommodation/shelter and facilities to each other in the event of a crisis
    2. Confirm this agreement in writing annually
  3. NHS Local Area Team (if applicable)
    1. Any decision made to reduce or stop NHS services, must be communicated to the Local Area Team who will also update the NHS Helpline 111
  4. Care Quality Commission
  5. IT Support Team(s)
    1. Server/network support
    2. Data back-up/recovery arrangements
  6. Gas emergency telephone number
  7. Electricity emergency telephone number
  8. Water emergency telephone number
  9. Temporary heating facilities e.g. gas/electric heaters
  10. Security alarm engineers
  11. Fire alarm engineers
  12. Telephone and Broadband providers/support teams
  13. Plan Providers
    1. Can assist with patient contact details
  14. Essential tradesmen
    1. Electrician
    2. Plumber
    3. Heating engineer
    4. Builder
    5. Joiner
    6. Roofer

Crisis Recovery Concept

Within the BCP, consider various scenarios and outline how you want each to be handled and who is to be contacted. Many scenarios can be considered including:

  1. Inability to access or enter the premises for any reason e.g. police/fire incident/cordon
    1. Contingency sites
    2. Communication with team, patients and suppliers
  2. Loss of computer systems including viruses and server failure
    1. Have a back-up “paper” system ready, including template forms/records for clinicians and front of house/reception staff
    2. Robust back-up and recovery processes, preferably through an external third party provider
  3. Loss of telephone/Internet services
    1. Call diversions
    2. Use of mobile phones
  4. Loss of electricity
    1. Basic checks such as fuse box/trip switches
    2. External problems and timescales
    3. Can the practice safely remain open?
    4. Understand what will be impacted e.g. server may have short-term battery back-up
  1. Loss of gas supply
    1. Safety impact and timescales
    2. Gas leaks
      1. Location of shut-off valve
  2. Loss of water supply
    1. Safety impact and timescales
    2. Floods/escape of water
      1. Location of main/external shut-off valves
  3. Loss of fire/security systems
    1. Safety impact and timescales
    2. Additional security/surveillance
  4. Fire
    1. Incorporate your full Fire safety/evacuation procedures
    2. Fire exits and routes
  5. Unexpected loss of key suppliers/essential supplies
    1. Laboratories
    2. Dental materials/drugs
    3. Maintain an up to date list of contact details for all key suppliers
  1. Loss of dental records
    1. Back-up and recovery arrangements
    2. Safety and protection of paper and electronic records
  1. Serious injury or death of registered clinicians
  2. Serious injury or death of key staff members
  3. Simple, clear and effective communication plans in the event of any serious incident
    1. Emergency services
    2. Practice team and immediate families
    3. Patients
    4. NHS Local Area Teams (if applicable)
    5. Care Quality Commission
    6. Media relations

Remember to share your BCP with all members of the team and make it readily available within the practice – a red cover can effectively highlight its importance.

Key members of the team should have a copy of the BCP available at home for “out of hours” emergency use.

Hopefully your practice will never need to make use of the BCP, but if the unexpected and unwelcome does happen, you and the rest of your team will appreciate the clear guidelines and quick access to known people who can help you through.

A well thought through and written BCP will help minimise disruption, focus the mind, deliver a professional response to future crises and could one day even be a lifesaver.

There is plenty of help out there to plug any management gaps including Your Dental Manager, so please do get in touch if you have any concerns or want to further improve the overall management/efficiency of your practice: info@yourdentalmanager.co.uk or check our on-line calendar to book a complimentary chat.

Ready for the Unexpected?

Job Opportunity – Practice Manager, Leeds

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This Position is now filled

My client in Guiseley, Leeds is looking for an experienced, well-organised and professional part-time Practice Manager to join and help lead an established, friendly family dental practice for 3 days per week.

The practice is within easy commuting distance of Leeds and Bradford, with excellent transport links

The successful applicant will support the Principal Dentist and team to deliver increasingly high standards of customer care, ensure all systems and procedures are kept updated and adhered to whilst maximising business opportunities and enhancing team performance.

Previous dental experience is preferred but not essential. Strong management, people and organisational skills are. If you have proven leadership skills, have successfully managed a team of people in the past and looking for a part-time position, we would like to talk with you.

Salary range is £20k – £22k (pro-rata) dependent on experience

Key Responsibilities:

  • To guide, direct and successfully manage an existing team of motivated and happy people
  • To ensure all non clinical systems within the practice run smoothly and efficiently, constantly improving these
  • To ensure we always give practical support and care to our patients, ensuring their experience is constantly improving
  • To enhance the financial performance of the practice
  • To manage compliance within all regulatory requirements using established processes and procedures

The successful applicant will be required to undertake an enhanced DBS check

If you would like to apply for this position, please forward your CV and a covering letter outlining how you think you can help the practice to leeds@yourdentalmanager.co.uk.

Job Opportunity – Practice Manager, Leeds