CQC inspections ‘flawed’ admits new chief inspector of primary care

The CQC inspection process used since April is ‘flawed’ because of a lack of GP inspectors, the new chief inspector of primary care Professor Steve Field has admitted.

Professor Field said the new-look CQC had ‘learned a big lesson’ from the feedback on inspections to date and reaffirmed his commitment to getting GPs in charge of and involved with every inspection.

GPs welcomed the inclusion of more GP inspectors, but questioned how far GPs with appropriate experience would be able to devote the necessary time and resources to carry out visits.

Some practices have already been closed down following CQC inspections, which have so far targeted a small number of practices that were considered problematic following the initial registration process, along with a random group of practices without concerns.

Speaking at the NHS Alliance conference on Thursday, Professor Field said results would be reported early in December on the first 1,000 practices to undergo the inspection regime.

But he said: ‘It is slightly flawed, because there aren’t GPs on all of those visits, so we’ve learned a big lesson and that will change.’

Professor Field said based on his experience as a postgraduate dean doing training visits, he wants to have a GP on every inspection – as well as a nurse, practice manager and GP trainee in addition to a trained non-GP inspector and lay person – when the CQC launches the new inspection process next April, and encouraged GPs to get involved.

Speaking to Pulse, Professor Field said: ‘We’re learning from the criticisms we’ve had and part of that is putting GPs on the visits.’

‘I’d like as many GPs as we can take to be involved in visits. I think [each GP] would have to do 10 or so inspections at least so you can moderate it. And as we get going if GPs want to come as observers we’ll probably allow that. And we’re going to have a GP trainee on every visit, that’s about them learning from other practices.’

Professor Field said the majority of practices were delivering a high standard of care and that struggling practices would be given time and support from NHS England area teams and other groups such as the RCGP to help bring them up to standard.

But Dr Robert Morley, executive secretary at Birmingham LMC, told Pulse recent inspections had caused enormous stress to GPs in his area.

He told Pulse he had received feedback from ‘very traumatised GPs’ from one practice in the past two weeks, who were very shocked and stressed at the attitudes of the inspectors, who included a GP among their number.

He said: ‘They were left feeling the practice was going to be closed down. When asked if they would [be able to resolve the issues] the inspector said, “well, you might not get the chance”.’

However, Dr Morley added that having GPs involved could improve things, but questioned how it would work.

He said: ‘I welcome the fact on the one hand [the CQC] says more GPs will be involved in these inspections – but on the other hand, where are they going to find them from – are they going to be the sort of GPs with the right grounding in bread and butter general practice, or are they going to be those from the ivory towers of the RCGP?’

Dr John Canning, chair of Cleveland LMC, who has been involved in discussions with the CQC on behalf of the GPC, said he supported GPs being involved but that he had ‘major concerns’ about how primary care could afford it.

He told Pulse: ‘Where are they going to get the GPs from? Even if it’s ten days every two years, for 8,000 practices that is 4,000 days out of GPs’ time – and patient care – every year.’

‘Under the current regime, the primary care sector has to pay the costs of inspection, which could add up to £500 a day per GP. Also the GP will have to travel to each visit and will be required to at least another half day writing it up and reading through reports.’

He added: ‘I would be very concerned that GPs who end up doing this will be those who work in rarefied situations and do not do the work of a normal GP and where they have a relatively easy workload compared with the rest of us.’