CQC Searches & Protocols FAQ
CQC inspection teams use a set of searches which have been designed to help them to understand how a Practice manages their patient population, and to identify clinical situations which should not be happening.
Primary Care IT has adapted these searches to help Practices understand what might need to be addressed before a CQC inspector finds it.
FAQ
PrimaryCare IT's searches mimic the CQC's very own searches, with work-to-do reports and additional helper searches built by us.
Drug de-prescribed or dose decreased, Why is my patient still appearing on the alert?
First ensure the patient is no longer appearing in the searches. A decision to keep the alert for the following three months after de-prescribing was made by our clinicians. This will act as a reminder to your team that the patient was on a potentially dangerous course of the drug, and they might still have supply left over at home. This should be considered alongside any ongoing holistic review.
Please note, we adjusted the time period for the majority of "lower risk" drugs in version 2.0.0 and above of our CQC alert, so the alert will immediately disappear after de-prescribing or adjusting medication.
I have coded "Patient review" but CQC alert is still coming up.
There's several reasons why this might occur.
- The first thing to do is make sure the patient is no longer appearing in the CQC searches. If they are, this is likely a coding issue.
- The next thing to try is to double-click the alert and make sure any essential codes are added. These will be marked with an asterisk. Make sure to scroll down to the bottom of the template to check all sections are completed. After doing this save & close the patient and load them again for the alert to refresh.
If this does not sort the issue, raise a ticket with us and we'll let you know what's going on.
The patient's medication is managed elsewhere such as secondary care, but the search and alert is still flagging them.
CQC has designed the searches so that these patients will still be picked up. Because our alert follows the same logic, the alert will flag this too. We cannot cause the alert to disappear for this reason, however the alert can be used to demonstrate to CQC that your team is aware of these patients.
Potential new diagnosis report picking up patients with results in the past or non-consecutive (HbA1c etc.).
The CQC could flag these patients during a review. Official guidance from the CQC states the following:
CQC have deliberately selected to use two or more HbA1c readings of 48 or more to identify people who should have been diagnosed with diabetes, either currently or in the past. These patients should be having regular monitoring and have been appropriately coded in their clinical records.
A patient should be coded as having diabetes if they have had two consecutive HbA1c readings in the diabetic range (and there aren’t other factors that would mean the HbA1c should not have been used for diagnosis such as haemoglobinopathies, pregnancy, on steroids etc). The patient should also have been referred for appropriate screening (eye screening, foot checks etc), regular monitoring and reviews and to educational programmes for advice at the time of diagnosis.
If the Hba1c levels subsequently improve and the patient meets the criteria set out by The Primary Care Diabetes Society (PCDS) and Association of British Clinical Diabetologists (ABCD) position statement for diagnosing ‘diabetes in remission’, the code for diabetes should remain on their clinical records, but additional codes may then be added as appropriate, for example diabetes in remission and/or prediabetes. The PCDS and ABCD strongly recommended that “diabetes resolved” clinical codes should not be employed in clinical practice but that “diabetes in remission” codes should preferentially be adopted."
Our suggested approach here is to ensure continued monitoring of these patients and record this monitoring in a way that CQC will see. Use of our combined alert+template will assist here.
How do I action the alert for patients who may be inappropriate to action (e.g. Palliative Care register)?
The CQC searches will always flag all patients who are at-risk according to their specification, regardless of if they are on the Palliative Care register. However, PrimaryCare IT have changed the CQC alert so it will not appear for patients coded at GSF Stage Amber or Red due to a shorter prognosis. Earlier stages will still appear, as a clinician would need to make the call on appropriate management with a longer prognosis. We are continuing to take on feedback around inappropriate patients so if you feel like your patient should not be flagged let us know.
We have declined some patient/s but they have not disappeared from the searches, what can we do?
A decision was made by CQC to still include these patients, so there is unfortunately no way to resolve a patient by just declining them. The argument from CQC is they expect you to be aware of these patients and take every step to try to protect them, so they always remain in the search. Some searches will remove the patient if they are contraindicated where appropriate.
However, the PrimaryCare IT CQC alert will either disappear, or inform you that the patient has declined. We are continually looking into areas where our customers do not find the alert to be useful, so let us know if you would like to see more (or less) information in the alert.
Known Issues
The following issues are all known issues with the original CQC searches which PrimaryCare IT cannot resolve.
Zeros
Trelegy & Trimbow - but no ICS issue
We are aware that patients on triple therapy medication are being flagged as not having an Inhaled corticosteroid (ICS) in our Zeros searches. This is because these drugs are not currently included in the CQC search. The CQC inspection team's own search will identify these patients, so it would be prudent to pre-empt any discussion by demonstrating that the patient is in fact on triple therapy. If the inspector does not look into each record, the higher number of patients may reflect poorly on the Practice.
We are unsure why this exclusion would be the case, and assume this is a mistake in the search. We have raised this with CQC via enquiries@cqc.org.uk.
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