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Delay CQC inspections for at least a year to protect GP mental health, say top GPs

Exclusive Professor Clare Gerada has written directly to the CQC's primary care inspector to request that it does not reinstate GP inspections as planned this autumn, but instead defer inspections for at least another 12 months.

Professor Gerada, who is the medical director for the state-funded GP mental health programme NHS Practitioner Health, warned the alternative could lead to widespread burnout and early retirement among GPs.

The former RCGP chair urged the CQC to allow GPs healing time following the pandemic, including time to mourn lost colleagues and relatives.

Writing for Pulse today, former deputy BMA chair Dr Kailash Chand has backed the professor's calls - going even further by asking for a two-year inspection hiatus.

Their pleas come after the CQC announced plans earlier this week to restart routine inspections of lower-risk GP practices from this autumn, with inspections for higher-risk practices being scheduled for this summer.

It also comes as the BMA and RCGP have both urged the CQC to overhaul the process of GP practice inspection rather than restart it during the pandemic.

In her letter, sent today, Professor Gerada urged CQC chief inspector for primary care Dr Rosie Benneyworth 'for the sake of the mental health of the GP workforce' to reconsider the decision to restart inspections 'and to delay by at least 12 more months'.

Professor Gerada - who herself overcame coronavirus early on - said this comes as GP mental health was already 'very poor' even before the pandemic

She said: 'Going into the pandemic GPs were exhausted, burnt out, demoralised and depressed. The impact of Covid will only exacerbate these problems as is already evident by referrals to our service.'

Professor Gerada argued that the CQC's decision to restart inspections comes as 'we are at the beginning of the first recovery phase' from Covid-19 and as the whole NHS is 'faced with re-prioritising and rescheduling work and practices are now having to adjust to working in new ways'.

'As you can appreciate this is very challenging and even now systems are not fully embedded and to inspect now seems unreasonable,' she said.

She also pointed out that practices will be dealing with 'an enormous unmet need', with a diminished workforce, which will be 'compounded by a backlog of reports, referrals, and work, suspended due to the pandemic', while 'preparing for an inevitable second spike'.

'[P]utting GPs through the additional pressures of having to prepare for an inspection might tip some of them over the edge of despair, leading to resignations and early retirement as well as a surge in mental illness amongst them', while also distracting from 'the task in hand' of 'patient care and returning services to some sort of normality', the letter said.

Professor Gerada concluded: 'GPs and their teams now need to re-group, to mourn the loss of friends, family and colleagues and to have a period of reflection to help them digest what they have been through and in so doing be in a position to support their staff and patients.

'They do not need the added work, distraction and psychological burden of preparing for an inspection, no matter how limited.'

Meanwhile, writing for Pulse, Dr Chand said: 'In this global crisis, general practice is busier than ever, and sitting on the timebomb of an avalanche of non-Covid diseases that will be hitting in the not-so distant future. Announcing of reintroduction of dysfunctional bureaucracy in general practice is another ill-thought continuation of shambolic management during the pandemic.'

He added: 'I would urge NHS England to seriously consider the request from the BMA and Professor Clare Gerada’s letter to the chief inspector of the CQC, and abandon the idea for CQC inspections for at least two years.'

The CQC paused routine inspections in Marchdespite initially planning to carry on inspections despite the Covid-19 emergency.

It has since been focusing on remote monitoring of risk; and the new emergency support framework, under which it has engaged with GP practices on the phone to sound them out on issues they may need support with during the pandemic.

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Readers' comments (43)

  • Well done Clare at least someone on our side, I suspect however they wont listen to you or others, of course what we should all do is refuse and have the backing of our unions but this wont happen just like everyone signed up to PCNs even knowing they would create more work for less payment.

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  • As it is accepted that it affects GPs mental health negatively, is there a good argument for re-starting it?

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  • thankyou from all GPs and practice staff that I speak to.

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  • Scrap CQC inspections altogether except for those with practices reported concerns. The regulations they impose are covered by GMC standards, contractual, health and safety and TORT. GPs do not need to be fussed about these standards which they have to comply with anyway, but just adds a time wasting process. Then of course CQC is tempted to invent rules and interpretations of it own to impose, to prove it needs to exist. It does not.

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  • Appreciated. I do not know how this institution sleeps well and pats itself on the back. It is abhorrent and itself a dangerous, unsafe and ineffective entity that does not care, for those that care.

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  • One thing I had hoped for out of this "crisis" was that "government" per se, may have taken some serious overall review of the real need for Gold plated bureaucracy that the NHS has been burdened with and demoralised by. What a breath of fresh air that when the chips are down, usual processes can be put on hold and the teams rally together and out perform expectations in all areas. Some clinicians even commented that they were allowed to their clinical judgement rather that follow protocols!! Bureaucracy has not only been imposed by successive governments, it has also taken on life and promulgation of its own. The message is simple; the regulators can stay away until any of their worth has been missed.

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  • Since when are CQC giving a flying fart about GPs or their mental health or anything else ?
    They are a law to themselves, not reporting to anybody, just causing havoc

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  • Finally some sense. They wont do it as CQC will then have nothing to do for a year and will have to sack themselves

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  • Thank you Clare and Kailash.
    There has been constant updates on covid, complete change in working patterns, trying to keep staff and patient's safe etc. Family members had to self isolate. GP stuck abroad and over last 3 months, few of my colleagues have been off sick. Thankfully, physically I am ok. But mentally exhausted.
    long list of phone calls as covering other colleagues. Trying to keep up with RCA (CSA substitute) requirements for MRCGP, dealing with patient and family concerns etc. Done home visits on EoL patients were Palliative team had declined. Help a stranger who had fainted in a street. After admitting him, I had to ring A&E to check if he had any COVID signs on investigations/not and only then decided to go back home (paranoia!) Despite all the above, I am happy to do my work.
    CQC-if they decide to come for inspection, the above commitment will not count. CQC haven't managed to get the right partners names for my practice for last 2 years. Tried to delete partners who have left but at the same time, they removed other partners!
    I haven't made any comments on pulse for long time. This is a serious issue.
    MH of not only GPs but the managers, nurses, admin staff , reception team etc needs to be taken into account as all of them are vital part of the team.

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