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GPs go forth

CQC's 'risk ratings' are incredibly damaging - they must be withdrawn

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The CQC needs to take a long, hard look in the mirror and ask what it is for.

The publication of its ‘risk rating’ scores for GP practices has unleashed yet another media feeding frenzy – the very last thing GPs need as they struggle to keep their practices afloat.

Seemingly having learned nothing from the notorious ‘maggot-gate’ incident – in which a practice was hauled over the coals for a few harmless critters lurking in a distant corridor – the regulator’s press department has delivered yet another demoralising punch to the gut of general practice.

The CQC stresses the indicators do not amount to a ‘judgment’ of practices and that the ratings will help it prioritise inspections. Try telling the Daily Mail: ‘GP SURGERIES: 1 IN 6 IS FAILING’ read their front page.

Hard-working GPs and their practice staff come into work every day to do their best for patients, despite plummeting funding and a crippling workload. If the CQC is intent on fuelling the all-too familiar media vilification, it might as well light a bonfire under the whole of general practice.

The publication of a ratings scheme the CQC itself openly admits is not fit for determining bad practice is inexplicable. ‘We will use our analysis of these indicators to raise questions, not make judgments, about the quality of care,’ it insists. But, if so, why release them to the media? It defies belief that the CQC has consulted on, piloted and launched an inspection programme only to undermine it by publishing alternative ratings in which it has little faith itself.

GP practices lack control over many of the 38 indicators and, as our analysis shows, they can present a misleading picture of the quality of care. For instance, it is widely accepted that deprivation is one of the most important drivers of emergency admission rates, and practices cannot force patients to attend cervical cancer screening or have a flu jab. It is invidious to red-rate practices on ‘expected’ levels of dementia and COPD rates, when there may be good reasons why the levels are the way they are.

The use of the word ‘risk’ is utterly irresponsible when anyone could have predicted that national journalists would use it to scare patients. The CQC website has an astonishing lack of information to help patients make sense of the ratings, yet illustrates shortcomings with a big red circle and an exclamation mark. 

Pulse spoke to one practice that had no idea the local paper had picked up on its CQC risk rating and was asking patients to comment on their concerns. ‘But the CQC has not even been here,’ said the harassed practice manager. ‘How do they know?’

I have a message for the CQC. You say these ratings should ‘prompt GP practices to ask questions, reflect and take action in respect of their own performance’. I urge you to do the same.

If your mission is to improve patient care, you need to withdraw these ratings. You have demoralised an entire profession, and that is bad for patients, bad for practices and bad for the future of the NHS.

The chief inspector of general practice often says he is the biggest champion of general practice but actions speak louder than words. Apologise for publishing the ratings, admit they are misleading and take them down from your website.

Admitting mistakes, reflecting and learning are signs of a well-led organisation, are they not?

Nigel Praities is editor of Pulse

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Readers' comments (15)

  • A disgraceful betrayal of our profession by the CQC. A sham risk score process likely to impugne practices ahead of inspections which will no doubt show how 'effective' CQC inspections are when the false risk score is adjusted downward.
    Patients will take the scores assigned at face value and have long memories.
    The CQC must withdraw this misleading and inaccurate information with an public apology to ill affected GP's before irreparable damage is done to the reputation of good practices.

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  • Vinci Ho

    (1) Nobody must shy away from the truth work must be done to resolve a clear and present danger to our patients. Questions are :(a) is the risk a genuine one?(b) if so, how is CQC there to help?
    (2) Have to stress the word 'help' because for the practice or organisation to resolve the problem(s) , it easily requires more resources. So is CQC to have the authority to twist the arm of stakeholders to help the practice?(do not give me a politically correct answer on this!)
    (3) Using parameters to measure safety remains a contentious one. I wonder how open CQC has been in consulting the public and the profession before rubber-stamping these parameters . Or is this purely another political mission coming from the top?
    (4) We all know what this government is like on NHS and general practice , it is itself the 'ultimate risk'.
    So which side CQC is really on, professor?

    "If there is a hard, high wall and an egg that breaks against it, no matter how right the wall or how wrong the egg, I will stand on the side of the egg. Why? Because each of us is an egg, a unique soul enclosed in a fragile egg. Each of us is confronting a high wall. The high wall is the system which forces us to do the things we would not ordinarily see fit to do as individuals."
    Haruki Murakami

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  • Prof Steve Field used to be one of our leaders

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  • Siraj Shah

    On Monday 17 November 2014 the intelligent monitoring net nanny placed our practice in band 1 which flies in the face of the entire CQC inspection process! As only 11 days earlier (8th November 2014) they had published their inspection report showing we had met all essential standards and our practice was fully compliant with all regulations.

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  • It's 2119 hrs and I am sitting in front of an NHS computer to do some more work as I have finally put the children to bed (good dad). I have seen or spoken to a total of 64 patients today. I have done more the 50 scripts. I have 46 letters and 29 blood results to look at this evening. I still need to do my appraisal documents as it's due soon.

    I just had a look at the rating of my practice -BAND 1. This is even before the speak to any of my patients or seen any of my hardworking staff. Disgrace!! my only word. . Do any of my patient have a choice. They are lucky if they are accepted in any other practice as we are all struggling with the workload.

    Prof Field. Thanks for uplifting my morale today. I am sorry i cannot do anymore than I am doing.

    My last promise i will look at the bloods tonight in case, I have to call the OOHs for some hyperkalaemia that the labs didn't bothered to call about as they may be feeling like i am feeling now.

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  • @9:33pm and @9.11pm My sympathies to you both, I fully empathise with your frustrations as we too, having been inspected by CQC last winter and passing well on all levels, have been placed in Band 1 today also.
    The reasons we are at risk is appointment availability and access, based on data from last winter, when we passed (very well) our first CQC inspection.
    We have since recruited two new full-time GPs, after some years of chronic shortage and searching, and are the best-staffed we have been in many years. Our clinical indicators show all above expectations or meet expectations, and despite several applications to close our ever-enlarging list to NHSE, we have been refused as they do not feel there is a problem with access.
    I do wish the left hand would check what the right hand is doing sometimes...
    From what I can gather, this Band 1 rating may simply generate a sooner than expected re-inspection by the CQC (welcome!), although I understand there are many practices yet to gave their first inspections still. It may even deter one or two prospective patients from registering with us. Silver linings, eh?

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  • Prof Field & the CQC h ave brought the profession into publicdisrepute by publishing inaccurate & misleading data and should immediatly retract this. Should disciplinary or legal action follow?

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  • Although this does go against GMC guidance undermining the profession with data no one understands etc and they should referred to GMC, who really cares, its just the usual media bollox and wed do best to just ignore them all. and hope they go away. They are small minded beurocratic sivil servant losers and dont deseve the tim eof day. Lets just get on with our jobs and forget them. If some patients dont want to see us who cares they can go elsewhere they have choices now and thats fine.

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  • CQC are using data that, at least for us, is WRONG !!!! and therefore gives us an elevated risk when that is not the case and did someone forget to tell CQC that QOF is voluntary !!!!! What a complete shambles!!!

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  • Here's Humpty Dumpty. I, for one, am finding the workload intolerable. I want to close list for my safety and that of patients, but I am not allowed to!!! No doubt what my rating is going to be.

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