CQC IR(ME)R inspection programme of chiropractic practices

The Care Quality Commission's Ionising Radiation (Medical Exposure) Regulations IR(ME)R team will be undertaking compliance inspections of chiropractors with X-ray facilities in England over the next few months. 

The inspections will be a sample of chiropractor practices and will not be inspecting every chiropractor working with x-rays as part of their care arrangements for their patients. The inspection programme is not responding to any incident or general concern raised by patients. 

It is important to note that all practices with x-ray facilities are subject to an IR(ME)R inspection. This advance notice helps ensure that practices maintain excellent awareness of the requirements of these regulations and can identify any gaps at this early stage in advance of any visit.  

Key aspects of IR(ME)R 

• Appointment of a specialist expert, the Medical Physics Expert (MPE), to give specialist advice on a range of matters. The MPE may also be, in practice, a 'Radiation Protection Advisor' – with responsibilities for the IRR'2017 regulations)
• Training records concerning the practical aspects of imaging 
• Setting and review of diagnostic reference levels
• Carrying out Quality Assurance tests on the X-Ray set
• Mandatory documentation in place, including IR(ME)R procedures and protocols
• Evidence of clinical audit activities

What do I need to know?

The CQC recommends that you use this opportunity to review your compliance arrangements with your MPE. They will likely have some experience of an IR(ME)R inspection from other work within the NHS acute sector or elsewhere.

In advance of an inspection visit

If you are selected for an inspection visit, the CQC will first email you and propose a preliminary phone or Teams discussion to agree on a time and date for the inspection. They will ask you to provide a small amount of information within a short timescale, generally within 48 hours. 

Inspections will be face-to-face and only in exceptional circumstances via Teams or Zoom.

What happens during an inspection visit?

CQC's IR(ME)R Inspectors carry identification and warrant cards. They have the authority to inspect without prior notice, especially if concerns have been raised. An inspection itself lasts approximately two hours. 

The inspectors will want to examine and discuss the documentation you've shared in advance and follow their key lines of enquiry. They will encourage you to take note of suggestions and comments made by the inspector.

What will happen after an inspection?

The inspection outcome will be in the form of a very brief report highlighting their findings. Where the CQC believe that there is a compliance gap, they will follow their enforcement policy in any decision around serving an enforcement notice.  

Once this series of inspections have been completed, the CQC will report their findings as part of a thematic review and share them with the GCC.