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

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

Your Dental Manager Embraces South West England

We are delighted to announce that from 1st May 2017, Your Dental Manager has expanded its reach into the South West of England through an exciting and valuable alliance with well known Plymouth dentist Charlie Fox and practice business manager Edd Jones.

Charlie and Edd will be delivering a wide range of strategic and business management support, coaching and mentoring under the Your Dental Manager umbrella, to independent dental practices across the South West and we welcome them warmly into the YDM family.

Charlie and Edd’s experience, skills and knowledge, combined with those of the established Your Dental Manager team and resources, will quickly bring added benefit to existing and new client practices.

Dr. Charlie Fox BDS (U Birm.) LDSRCS (Eng.)

Charlie has been a dentist for 27+ years, having qualified via the Royal Navy in 1990.

Charlie initially worked in Scotland after leaving the  Navy in 1995. He moved to the South West in 1999, where he continued to work in various practices.

Charlie bought his own dental  practice in Plymouth in 2003, Hartley Dental.

Since owning Hartley, Charlie has built a fantastic environment for his patients, offering the highest levels of care and customer service.

Ensuring that his Practice is profitable, without compromising customer experience, is the key to Hartley Dental’s success

Charlie@yourdentalmanager.co.uk

Edd Jones

Edd came into the dental industry with extensive business and customer-service management experience.

This experience  includes working within the security, gaming and leisure Industry, all of which are  highly  competitive and customer-service driven industries.

Edd prides himself on offering simple, effective and measurable business, operational management and customer service advice, specifically designed to help your business grow and move onto the next level.

Edd has a proven track record of increasing profitability, reducing costs and effectively managing teams of people during his career and is a nominee for 2017 Practice Manager of the Year.

Edd@yourdentalmanager.co.uk

“Charlie and Edd of C & E Consult are delighted to have joined with Your Dental Manager.

We will make full use of the extensive business management resources and experience of YDM to bring maximum benefit to our clients in the YDM South West region.

We look forward to working closely with YDM and practices across the South West to help your business grow.”

On-line booking of introductory calls and practice visits is now available for Charlie and Edd to discuss their work and availability in the South West, or contact them directly by e-mail.

For appointments and enquiries in the rest of the UK and Ireland, please continue to book your appointments through the main on-line calendar or e-mail mark@yourdentalmanager.co.uk.

We all look forward to supporting many more practices across the thriving independent UK dental sector.

Your Dental Manager Embraces South West England

CQC Hotspots – March 2017

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Reviewing a further sample of 56 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 56 practices sampled, 5 practices were issued with breach notifications. Clearly the vast majority of practices are still getting things right, which is great news. All notices reviewed this month were issued for breaches within the Well Led standard.

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.

  • Every month, two or three practices are being picked up on inadequate recruitment and staff induction procedures. Follow simple 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 externally validated by professionals/suppliers in addition to the recommended routine/daily/weekly checks you are required to undertake.
    dreamstime_xs_43893109
  • Audits are still seen without essential evidence of learning and action points. Don’t treat audits as a box-ticking exercise, use them to identify and resolve short-comings.
  • X-ray audits for quality and justification should be undertaken for each dentist, not on an individual surgery/equipment basis, as this could leave some dentists unchecked. Records should show all dentists are regularly audited.
  • 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.
  • 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.
  • Check your electrical system inspections and certificates are all in place and up to date including Portable Appliance Testing. Frequency of re-test will be confirmed during each visit/inspection. More details from the Health & Safety Executive here.
  • 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.
  • Collecting and responding to patient feedback and comments is essential. Don’t just rely on the NHS Family & Friends test, which is just one specific measure.
  • Make sure that the Registered Manager/CQC lead has adequate time to complete all their duties and responsibilities. Practices have been picked up where the Principal dentist/owner has day to day responsibility but is in surgery for the majority of the week.
  • 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.
  • Make sure that all the named individuals/leads in your policies/procedures still actually work at the practice. Update and replacement is essential.
  • The practice is responsible for overseeing CPD training – make sure you keep records of where everyone is within their CPD training cycle.
  • Keep on top of your fire log book and mandatory checks of fire equipment including  alarms and emergency lighting.
  • Ensure your fire procedures make provision for evacuation of patients with disabilities.
  • 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.

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 – March 2017

CQC Hotspots – February 2017

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Reviewing a further sample of 54 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 54 practices sampled, 6 practices were issued with breach notifications. Clearly the vast majority of practices are still getting things right, which is great news. All notices reviewed this month were issued for breaches within the Safe and Well Led standards.

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.

  • Check to make sure that your recruitment policies and procedures are in place, up to date and followed closely. Particularly with regards to DBS checks, references and evidence of right to work in the UK
  • Ensure you are receiving, checking and taking action on relevant MHRA/CAS patient safety alerts
  • Ensure that patients don’t have access to empty surgeries, which should ideally be locked when not in use, or access restricted
  • Make sure prescription pads are kept securely and not left unattended
  • Always make sure that screens of unattended PCs are locked to avoid unauthorised access and switched off when not required
  • Check your training records are complete and up to date, particularly individual training records for Infection Control, Information Governance, Safeguarding and Health & Safety
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  • Dental materials must be kept securely and not accessible to patients
  • Don’t forget to record and keep vaccination records, including Hep B records, up to date for all clinical staff
  • X-Ray equipment should always be switched off at the master switch when not in use
  • General cleaning equipment should be stored securely, colour coded and segregated from clinical cleaning
  • Audits are still seen without essential evidence of learning and action points. Don’t treat audits as a box-ticking exercise, use them to identify and resolve short-comings
  • Make sure you implement recommendations from any risk assessments e.g. regular water temperature checks as part of your Legionella report
  • Remember to clearly define and respect “clean” and “dirty” zones within surgeries and decontamination units
  • All Lab work returned to practice should be disinfected before placement and evidenced on Lab records
  • 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.
  • Make sure that staff and patients have the opportunity to provide feedback and express concerns. Just as importantly, do something about the feedback and show you have listened
  • Check that dental records are being updated contemporaneously – ie during or immediately after the appointment
  • Some practices still don’t have a Radiation Protection Adviser appointed – this is mandatory
  • Make sure quality and safety audits are carried out on x-ray equipment in line with RPA/manufacturer recommendations
  • Back to basics – don’t forget daily testing and recording of your autoclave equipment
  • The practice is responsible for overseeing CPD training – make sure you keep records of where everyone is within their CPD training cycle
  • Keep on top of your fire log book and mandatory checks of fire equipment including  alarms and emergency lighting
  • Don’t forget to book regular team meetings into the diary – ideally monthly – and keep records of agendas, minutes and action points from each

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 – February 2017

CQC Hotspots – December 2016

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Reviewing a further sample of 52 CQC dental inspection reports published in December, highlighted a number of compliance breaches which can easily be avoided.

Of the 52 practices sampled, 5 practices were issued with breach notifications. Clearly the vast majority of practices are still getting things right, which is great news.

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 from these very recent inspections, which might just keep another practice out of trouble.

  • Always have evidence of checking and taking action on MHRA/CAS safety alerts
  • Have a system in place re RIDDOR reporting requirements for significant incidents
  • Policies and procedures should also be personalised and made relevant to your practice – don’t just leave them as generic operating procedures
  • Check your training records are complete and up to date, particularly individual training records for Infection Control, Information Governance, Complaints and Health & Safety
  • Details of local, external contacts for adult/child safeguarding concerns are up to date and readily available
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  • Medical Emergency procedures should be tested and rehearsed
  • At least two CPR trained members of staff should be on-site whenever patients are in practice
  • Don’t forget to record and keep Hep B records up to date for all clinical staff
  • Please allow trainee nurse assessors access to surgery, with patient agreement, to enable them to supervise your trainee staff
  • Audits are regularly seen without essential evidence of learning and action points.
  • Remember that carpets should never be seen in any clinical/patient areas
  • When testing your basin water temperatures, don’t ignore when minimum temperatures are not being reached
  • Unclear or incomplete patient records continue to feature including the need to show evidence of health advice/best practice and compliance with NICE/FGDP/DH guidelines
  • Evidence compliance with a preventative approach to dental care in line with DH publication “Delivering Better Oral Health” in patient records
  • When radiography equipment is relocated or newly installed, local rules must be updated and the equipment tested by your RPA
  • Mental Capacity Act 2005 and Gillick competency requirements are almost always tested – make sure procedures are in place and well understood by the team
  • Check you have a detailed practice information leaflet, which is up to date and in line with NHS England/CQC requirements
  • Opening hours of the practice should always be on display to patients
  • CCTV is becoming more common – remember that there must be a policy in place, information notices provided for patients and use of CCTV must be registered with the Information Commissioners Office (ICO)

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 – December 2016