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CQC chief inspector: no 'concessions' will be made for GP capacity issues

Exclusive The CQC is 'not going to be making any concessions' for GP practices during inspections, despite acknowledging the pressures facing the sector, the watchdog’s new chief inspector of primary care has said.

Earlier this month, in its annual report on the state of health and adult social care in England, the CQC said that a 'large group of GP practices' have deteriorated to a lower rating due to 'ongoing capacity pressures'. 

But in an interview with Pulse, Dr Rosie Benneyworth, CQC chief inspector of primary medical services, revealed the regulator would not be loosening its approach to regulation.

Instead the CQC will be focussing more on how practices work with other services in their area because this could help to solve some of the pressures facing GPs, she said.

Dr Benneyworth said she wants GPs to see the CQC as a ‘critical friend’ that can ‘put a mirror up’ to practices to show where improvements are needed.

She said: 'We’re not going to be making concessions, ultimately our purpose is to ensure that patients get high quality and safe care.

'We know that practices are under huge demand and that’s making it very challenging. 

'But we are seeing different practices in different parts of the country really address those challenges by remodeling what they’re doing within their practice, working in conjunction with partner agencies across the local area, thinking about what their population needs are and how they can respond to those.'

She added: 'The thing that we’re already starting to test out, but we’re looking at how we can expand, is actually when we look at our inspection's key lines of enquiry, how much are people working in partnership with other organisations around them?'

Dr Benneyworth said in particular health services working with social care organisations was 'crucial'.

She added: ‘Where I’d like to get to is that we are seen as part of the solution to practices improving - that we’re able to be seen as a critical friend who goes in, who can actually put a mirror up to the practice and help them identify where their priorities for improvement should be.’

Meanwhile, she said the CQC’s new approach of phoning highly-rated practices every year instead of inspecting them as often had helped to ‘build relationships between inspector and practice’.

She said: ‘It started to enable our inspectors to have a much better understanding of the context and the changes that are happening within the local area and within the practice. And it’s hopefully going to breakdown some of those barriers between the CQC and practices going forward.’

 

Readers' comments (51)

  • I wonder if complex patients having a social care component to their problems is being conflated with social care being the sole issue by many thought leaders in the NHS.

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  • How much coal face clinical work has the chief inspector done in the last 5 years. If it's less than 6 sessions per week she has no right to comment on "pressures facing the sector". Get back to the front line and do what you were trained to do.

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  • Shame on her/them COC should suspend all assessments' until the workforce issue is properly addressed.It is actually the patients who are affected by CQC closing practices in a negative way. The Gps generally just retire early and leave primary care in a worse place. Armageddon is still to come when those of us in 50s retire in the next few years then CQC really will have a job on its hands

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  • Glad I work in Scotland, no Qof or cqc and the job is still shite! Just burgeoning demand and a tortured pension to contend with 💩

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  • Nhsfatcat

    Airline, capacity issue, no pilots, plane grounded. Airline goes bust. Everyone is safe but no service.

    Capacity issue is No1 safety issue. CQC is negligent is it doesn’t shut us down. No service, how safe is that!

    We cannot be judged by commercial safety standards or otherwise unless there is finance and well evidenced rules on optimal GP/or/consultation length and No. per GP. Staff/pt ratio and secondary care provision also needs assessment when deciding whether WE are poor or outstanding! Most GP services are outstanding in the context in which they find themselves operating.
    Shame we can’t compare the CQC against any other regulatory body...

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  • 'But we are seeing different practices in different parts of the country really address those challenges by remodeling what they’re doing within their practice, working in conjunction with partner agencies across the local area, thinking about what their population needs are and how they can respond to those.'

    It sounds like Dr Benneyworth is setting up the CQC to be more like management consultants - in which case she is going to have to come up with better ideas than this.

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  • "Mirror" I am not sure GP needs a mirror in this conversation. The problem is when resources are stretched priorities have to be made. No senior officials with whom the power lies are patently to politically weak or chicked to make these hard decisions so defer them to the coal face. Then snipe from the safe place away from the front line. Triage means occasionally leaving one potentially retreivable injury to deal with 10 more easily retreivable injuries. Based on available resources nd doing the most good. GP is at this point I feel. And as CQC don't see resourcing as an issue affecting quality they become another nail in the coffin rather than the resus room the system needs.

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  • CQC has become GMC .Till some tragedy happen they will not change their attitude. Reduce strength of CQC by 50% and their remuneration by 60% and make them feel work pressure and performance.

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  • Clearly the most important qualification to be the Chief Inspector for CQC is to remove any ability to think critically and be a non critical friend of an NHS destroying government. And of course don’t forget about the Thankyou gong at the end.......

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  • CQC needs to stand up and be clear that many problems are outside of the practice’s ability to remedy. Almost all problems in recruitment, capacity, retention, facilities and estates would disappear if only we were decently funded. We need to return to 11% of total NHS funding ASAP, and - given that 90% of all patient contacts with the NHS are in general practice - preferably more.
    CQC support would be invaluable in this, if only they had the courage to draw the right conclusions and state the obvious. Instead their published reports are damaging to the reputation and morale of each practice, and are essentially perpetuating the NHs habit of victim-blaming.

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  • Vinci Ho

    With all due respect, Dr Bennyworth , if you are reading these comments from our colleagues on this platform , you need to understand why there is such an amount of negativity towards what you said . I would even understand if you thought the title of this article was rather unfair and judgmental on CQC.
    But ( always a but) , deep frozen ice three feet below is never down to one day cold . Every story has its beginning and ending .
    The reality is that there is a deeply frozen relationship between CQC and our frontline GP colleagues and ,
    the government and your establishment need to do far better than this to repair the damages. The retention and recruitment crisis of GP and the recognition of the how important GPs are , simply reinforce my slogan , ‘ the government needs GPs more than we need it.’

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  • we have a new 2,700 house estate being built near our practice which is already bursting with 16,000 patients. this will add another 9000. How on earth are we supposed to cope with this and a tiny building designed to house 9000 patients originally. What other agencies are going to sort this out if we work with them.
    What utter nonsense from the CQC...

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  • Perhaps HSL will come to the rescue with her social prescribing academy! Or not. Again those in the rarified air seem to have lost their marbles.......if there is not enough resource i.e. units of workforce time - it doesnt matter how you reorganise your resources......you will still not be able to match demand..... and they wonder why GPs wont return from abroad? We down have any of this regulatory rubbish beyond the 3 year CPD cycle, and yet the system works BETTER than the UK. I think if we are look for cost efficiency and allocating resources appropriately, getting rid of CQC would be a good start. In terms of breaking down barriers, the CQC would need to get some up pretty quickly before the GP masses rise up with their pitchforks when they've had enough..... CQC, GMC, RCGP, PCNs..... whatever! I have said it for years.... mass resignations people.... mass resignations.... until you have the bravery to do so you'll just be ignored by those at the top who know the cardigans are too institutionalised and accepting of the abuse that is heaped upon them....they wont fight back....... GPs in the UK need a 'MeToo' movement... or plane tickets to Canada and New Zealand...... either way make a decision and leave the CQC talking to themselves in their mirror..... you know..... 7 years bad luck just might be worth it....

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  • I AM CALLING FOR A MASS RESIGNATION FROM THIS CRAPPY JOB.....
    LEAVE GENERAL PRACTICE TO THIS BUNCH OF "COCKY AND LAZY EXPERTS" TO MANAGE THE PATIENTS...AND GOOD LUCK TO THEM WHEN THE SYSTEM COLLAPSES.
    GENERAL PRACTICE NEEDS TO FAIL.

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  • This comment has been deleted

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  • The CQC need to pretend that they’re doing something worthwhile otherwise they’d be out of a job. They need to act in a punitive way as the government’s enforcer in order to validate their very existence. Very predictable

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  • Did you expect anything different from Dr Stoogio?

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  • So the CQC can blame practices with under recruitment - or blame the department of health who are the ones actually tasked with making sure there are enough GPs.

    They are choosing to blame individual practices rather than central government.

    This definitely is not related to the fact that central government appoint and pay the people in charge of the CQC.

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  • #HostileEnvironment. This cannot end well.

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  • Make your life easier do what the CQC want. Structure your sessions to reflect the time needed for "quality improvement" Our union lacks any teeth so fighting is pointless. Meet your contractual requirements and nothing else.

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  • resign - preferably en bloc in the same surgery. come to locumland where all is rosy. none of this shit. work flat out when you're in work - then go home. limit your hours to whatever you are comfortable with. i did this in 2006 and it saved my sanity !

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  • Actually I wonder if the same team (i.e HSL / RCGP) who brought us Chocolate coins and scribbling pads to cope with the stress induced by the incessant supply demand mismatch will try to advise GPs to 'self-refer' for social prescribing as the panacea to all our ills rather than actually doing anything practical about the whole situation?
    Anyone who pays RCGP subscriptions really needs to get their life in perspective.....

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  • Just awful. I don't want a critical friend thank you very much. I want an adequately funded environment in which to practice professionally.
    It took some time to slay the GMC and like the Hydra we are faced with another head to lop off. Anybody who works for this detestable organisation should be ashamed and resign forthwith.

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  • The said part is the she can write such ill advised bilge.

    Concession isn’t the exact wording just an understanding and empathy and practical nouse around the current work place.

    With that in mind lack of CPR equipment is likely more important than a tap running protocol? From a true example locally and my “nouse” tells me which ranks higher?

    Perhaps she needs to look and reflect on “responsive” and “respect”

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  • Dear policenthieves..... unfortunately the GMC has not yet been slayed..... it merely retreated for a while.....

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  • Can’t hire another GP because the job is so crap? Keep getting patients allocated and workload dumped? Your fault- you should be working more in collaboration.....blah blah

    We should resign. On mass. And sell our services back... just like lots of consultants are doing

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  • Well. What would you expect from a bunch of cowardly arselickers who can't do the day job and whose sole purpose is to look after number 1.
    Mirror? If you put a mirror up in front of Dr Bennyworth do you think she might see a reflection? If she thinks that actively destroying the NHS in the way the CQC is going about it, is going to help patient care then she clearly is no longer a Dr in any real sense of the word.
    If your ultimate aim is to get patients high quality and safe care then take the lack of resource upstairs, CQC. But of course you won't will you?
    Rant over.
    Let the beatings continue until morale improves...


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  • deluded. replacing GPs with noctors is NOT the answer as she may suggest, it may be cheaper short term but in the long term it will cost more as every research paper shows. having trained ANPS, they may be fantastic but they don't have our level of training. it is a false premise to subject such staff to our workload pressures - you will burn them out too and far quicker. any suicide - nurses suicide rates are increasing as well - will be on their heads. i though the NHS was trying to change to be non bullying and more supportive - guess CQC missed that bulletin. shameful

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  • I did want to continue the job I used to enjoy but CQC just keep bringing my early retirement ever closer by their unrealistic expectations.

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  • ‘- it is a simple, although appalling, truth that the Health and Social Care Act 2012 marked the end of the NHS.
    Perhaps the most atrocious betrayal of all came from an unexpected quarter – the medical profession. The British Medical Association pursued a policy of appeasement, which rendered it guilty of a crime of quite astonishing proportions: the death of a health system...etc
    Prof Raymond Tallis

    One might add that devaluing scientific medical knowledge to below that of opinionated humanities concepts and foreign commercial interests, was never going to end well.

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  • Just pretend to up standards without considering the workforce issues.
    Fellow GPs, you've seen it now. Do not work in staff shortage areas as you will be hung out to dry for helping.
    I wonder how many face to face sessions Dr Benneyworth has done to come up with this. A critical friend my foot.
    How would a GP who needs to see 40 patients a day be able to help another GP who need to see 40 patients too if they have to waste time on the CQC and useless meetings? I have already dropped sessions and I cannot wait to retire. Or wait....perhaps I might just stop seeing patients and join the CQC and come up with rubbish like this but no, I have too much self respect to do this to my colleagues.

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  • AL "4 TRIES IN ONE GAME" BUNDY

    I am actually glad the CQC exists
    Some places the service is stretched too thin
    single nurse practitioner most of the week
    visits waiting days
    This makes a locum at these places even more high risk
    e consults and telephone triage
    pretends to address the demand
    but without good notes
    compounds the lack of continuity
    and the eventual risk of an adverse outcome

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  • CQC has a place but not without being realistic of the working environment and resources.
    Mass privatization will solve the funding issues and control demand and workload. We will not need to do QoF, can refer and use what ever drugs we want and get our professional freedom back and actually do a proper job without all the constraints and blame. No more bad parenting consultations, no more attention seeking personality disorder problems, social problems, fibromyalgia, child protection (not sure what you can really do in 10min when social services fail having days) etc. Even if they present, you have more time. Breath of fresh air. People will actually appreciate a GP.

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  • Just ludicrous comments.

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  • AL "4 TRIES IN ONE GAME" BUNDY

    I am actually glad the CQC exists
    Some places the service is stretched too thin
    single nurse practitioner most of the week
    visits waiting days
    This makes a locum at these places even more high risk
    e consults and telephone triage
    pretends to address the demand
    but without good notes
    compounds the lack of continuity
    and the eventual risk of an adverse outcome

    And in some places there is a
    mysterious notional corporate gp only
    who like the scarlet pimpernel
    is never actually seen
    (you know who you are... )

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  • AL "4 TRIES IN ONE GAME" BUNDY

    Bawa Garba
    did not have any defence with poor staffing funding etc
    when an adverse outcome occurs it
    the scapegoating will begin..
    and its usually the last person involved

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  • First of all I still don't understand why we have to pay CQC fees if their job is to protect patients . Government and patients can pay for CQC fees .
    Secondly if CQC does not want to make concessions for lack of Gp then let GP surgeries close their list so that those surgeries can look after their current patients properly . Those patients who cannot register with Gp can visit their MP and ask for more new practices to be opened .
    Enough of CQC and politicians treating like doormat.

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  • YOUR PROFESSION NEEDS YOU! DO YOU KNOW ANYBODY WHO WORKS FOR THE CQC? STOP THEM! ARMAGIDEON TIME.

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  • This is all part of the establishment plan unfortunately - defund and demoralise a public service until the public finally accept "privatisation" as a remedy; and the establishment fat cats make a killing.
    Mass resignation would certainly bring things to a head quickly, and government is weak at the moment; however, the profession would need a list accepted by the profession, of firm and united ideas on what it wants in order to subvert a mass resignation demand.
    The government has always used divide and conquer tactics very successfully.
    Are we sufficiently united and determined? I don't think so; I think still too many are tied into punitive mortgage and leased premises and are scared in losing their "job security" regards the future.
    However, they say that drastic times call for drastic measures.

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  • @ KeepThe RedFlagFlying | Locum GP26 Oct 2019 11:59am

    ‘’divide and conquer tactics’ have indeed traditionally been used to overcome one’s adversaries and it would seem that recent governments have repeatedly employed this tactic against the medical profession. The government however have made a bad tactical mistake. There never was a politically unified medical profession in the UK (and likely never will be), to divide and conquer, so individual doctors just made their own personal decisions and RLEed. Not necessarily the ‘planned’ result and is likely to turn out very expensive for the pursuers.

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  • Hello Bennyworth - and who excatly puts a mirror upto the CQC?
    Typical arms-length bodies trying to shirk from the reality and vainly attempting to prove thier exsistence(sorry 6 figure salary.

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  • Dear All,
    It is absolutely staggering that she can utter these words within days of her own organisations report recognising the realities and extent of the GP capacity problems.
    Clearly someone who believes in the beatings continuing until morale improves. On a score of "How to connect with those you regulate?", are negatives allowed?
    Regards
    Paul C

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  • Then we shall make no concessions to them?

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  • I wonder if the BMA could take the CQC to court for breaching the human rights act in their dealing with doctors ?

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  • If somebody tells you they are a critical friend....run for the hills. I would consider myself a critical foe of the CQC.

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  • Took Early Retirement

    CQC, like the GMC: lower than vermin. Shut some more practices and see how that helps? Why not start in Ramsgate?

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  • I may be bucking the trend here, but I think the CQC is in some way correct.

    If something is brown and smelly, no matter what you dress it up as, it will remain brown and smelly. Calling it good or outstanding will not make it any less brown or any less smelly.

    I believe we are all trying to do our best for patients with inadequate resources and growing demand, but if we are calling a 3 to 4 week wait for an appointment, 10 minutes per consultation when we need 15, probably 20 minutes, and 40 to 60 patient contacts daily, a good or excellent service, then we are deluded and complicit.

    This is not what I want to offer, but this is the level we have been funded to. Sorry.

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  • So Matthew, you think you should be given a poor grade because you're snowed under and can't keep up with demand even though you could be doing lots of excellent work? Well thats morale building... and another good reason for medical students not to choose general practice....... you can't keep flogging yourselves to be reprimanded call the CQC a useful service...... ask yourself what is the point of the CQC? What has it really achieved? Does anyone think standards have increased under CQC? absolutely not.... the data proves it... to improve the service you need a well resourced system with motivated team members..... oh look what we haven't got..... hence I moved to Australia.... the future was completely obvious, the GP leaders clearly impotent..... it will take a proper crisis for anything to change.... are you happy taking the blame for when the overstretched system fails? Because thats where many GPs are headed..... not because of their fault.... but because of deflection of blame to avoid the government taking responsibility for the real issues.... they could institute a statute of limitations.... but they dont..... the CQC is simply another smokescreen to shift the focus and blame.......

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  • Big bucks Benneyworth.

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  • CQC should be there to help, not shut down practices. CQC has a large funding and manpower resource- let have some of this on the frontline.

    Their resource needs to be put into practices in areas such as Plymouth to prevent GP services collapsing. GPs don't need to be taken "out of class" for long periods of time to be "told to do better".

    We need an input of additional hands on the pumps. CQC staff could actually be useful - rather than filling in reports and tying up frontline staff in meetings.

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