‘This is not about the good and the excellent. To start with, it is about “Is the practice good enough to function?” And almost all practices are,’ says Professor Nigel Sparrow, who has been handed the difficult task of being the GP-friendly face of the Care Quality Commission as inspectors begin spot-checking practices.
He is clearly settling into this role, as he bats away scare stories about practices being closed by the CQC under infection control rules for keeping soft toys in the waiting room or failing to remove reception area carpets.
‘[Inspection] is not going to be a high-stakes problem for practices. The vast majority of practices will have no problems whatsoever,’ he says breezily, but beneath his amiable exterior it is clear that the regulator is gearing up for major changes to its inspection regime.
Inspections of practices began to be rolled out in April and each practice is meant to be spot-checked once every two years, but Professor Sparrow confirms that quality and risk profiles for each practice are also being developed to identify those that require more frequent inspections.
Mid-Staffs pressure
The Francis Inquiry into the failings at Mid Staffordshire NHS Foundation Trust has piled the pressure on ministers to crack down on bad quality care in the NHS. And – despite it not being mentioned in the inquiry report – health secretary Jeremy Hunt has used the aftermath to raise the idea of a chief inspector of primary care, based in the CQC, to raise standards and to call for more ‘holistic’ inspections of GP practices.
Professor Sparrow says the new chief inspector will be appointed later in the year and the regulator is looking at how to implement a new inspection regime: ‘We’re not short of data in the NHS. But what matters to patients is care and compassion. So we have to make sure our inspection regime recognises that.’
He says care and compassion will be measured by inspectors talking to patients, staff and doctors. ‘When I used to visit practices for training practice accreditation I used to sit in the waiting room and those few minutes were extraordinarily valuable.
‘They’re not the things you can measure through numerics but they give you an impression of the culture of that practice, how caring and compassionate the staff are.
‘When you discuss the way the practice functions with a doctor you get a sense of the culture of that practice, the ethos of that practice.’
Uphill battle
The GPC has voiced concerns that simple metrics will not capture the complexity of general practice, and a bad CQC rating could lead to panic among patients and loss of confidence in their GP. But the ever-optimistic Professor Sparrow says that this is a ‘challenge’ to which the regulator will have to rise.
He says: ‘General practice is not an easy thing to measure, so we have got the challenge ahead over the next few years to ensure the things that we measure are useful and meaningful and actually recognise the true quality of general practice.’
He faces an uphill battle convincing GPs of this, with representatives at the LMCs conference in May backing a statement that the CQC is ‘not fit for purpose’ and saying they had ‘no confidence in its ability to regulate health services’.
Closure notices
Confidence in the regulator was shaken by closure notices issued by the CQC to five GP practices earlier this year. Official figures also showed hundreds of practices were forced to declare themselves non-compliant with at least one CQC essential standard when they registered in April.
Pulse revealed in March that practices had spent millions on preparing themselves for CQC registration, with the average practice spending £2,500 in the first year. But Professor Sparrow has past form when it comes to persuading GPs to swallow more regulation – he is also currently medical director of revalidation at the RCGP. He says the CQC has learnt the lessons of the practice inspection pilots that took place late last year and the regulator has hired 65 GPs, nurses and practice managers so that each inspector has a professional with a background in primary care to accompany them on practice visits.
He stresses that practices should not have to spend large amounts of money to become compliant and GPs have a year in which to implement action plans submitted to the CQC. ‘That’s the way most development plans work,’ he adds.
Setting standards
A public consultation will begin in July over the fundamental standards all health and social care providers must meet, and will define what good quality practice is, and the new chief inspector will be able to look at the integration of other services with primary care.
‘When [patients] transfer from one sector to another, problems often arise. The idea of looking at the integration of care and that patient’s journey is an area the CQC needs to be addressing in the near future,’ he adds.
Will he be putting himself forward for the chief inspector of primary care job? ‘The job description’s not been defined,’ he deflects, and quickly moves the conversation on, continuing to slather praise on his profession.
‘General practice is a wonderful institution. We need to start recognising the things we do well. The continuity of care, the fact we have a registered list of patients. It gets one of the highest ratings of organisations in the country.’
Public relations job done, he smiles and leaves the room.
CV
- A GP for 29 years, currently practising in Newthorpe, Nottingham
- National Professional Adviser at CQC since April 2013
- Medical Director of Professional Development and Revalidation at RCGP
- Member of the Standing Commission on Carers at the DH
