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Independents' Day

GP practices face a 'more light touch' regulation regime, CQC suggests

The CQC has indicated for the first time that it could move to a more ‘light touch’ regulation of GP practices.

It is expected that this new approach would be initiated by introducing ‘place based inspections’, which would see the regulator focusing on whole areas to see why practices are performing poorly, a report by the Health Service Journal has claimed.

He also said he was ‘not at all surprised’ at the opposition of the CQC’s new inspection regime from the GP profession, because it was a ‘sector that has never been regulated’.

Professor Field proposed the introduction of more focused, and less frequent inspections of GP practices – adding that if 80% of practices are rated as ‘good’ - then resources could be better spent ‘encouraging improvement’ in practices with known problems.

However, Professor Field also indicated that there would be no major change to GP inspections before all practices have been rated once. The CQC had been planning to inspect all practices by September 2016, but there have been suggestions this target would not be met.

The move to introduce ‘place based’ inspections form as part of the CQC’s new ‘quality of care in a place’ pilot to assess ‘whole health systems’ - as part of a step towards an area based approach to regulation.

As part of the pilot, the CQC will inspect whole health systems in Northern Lincolnshire and Greater Manchester - however, Professor Field insisted that the regulator will still look at individual providers and no extra inspections would be carried out as a result of the pilot. 

It will also specifically look at the experiences of the elderly and people needing mental health care to see whether analysis of different population groups is helpful in building a picture of the system as a whole.

The findings of the pilot will feed into the regulator’s strategy for the next five years, which CQC is currently developing.

Professor Field said: ‘If we’re looking at, say hospitals and GPs, if 80% of [GP practices] are “good” on our current ratings, are resources better spent looking at those which aren’t as good, and encouraging improvement, and having a more light touch [approach]?’

The CQC’s move to a ‘more light touch’ approach of regulating GP practices follows strong opposition of the new GP inspection programme from both the GPC and RCGP.

At the LMCs conference in May this year, a motion was passed calling for the abolition of the CQC, while the GPC chair Dr Chaand Nagpaul said that the regulator’s rating system of practices should be scrapped.

A CQC spokesperson told Pulse: ‘We have started work on our strategy for the next five years looking at how we regulate health and social care services in England. That work will look at a whole range of options for the future of regulation, including whether there is a role for CQC to report on the quality of care across local areas as well as how we prioritise our inspection activities.

‘We will carry out a full consultation on these options early next year.

‘Our focus remains on monitoring, inspecting and rating all general practices using our existing approach.’

Former RCGP chair and a GP in Lambeth, Professor Clare Gerada, said: I think what the CQC are picking up on is issues that are way beyond GPs’ control; like premises investment and staffing levels - they further beat us by telling us the barn door obvious that there is no money to improve premises and no staff to deliver care.

‘So, I think if they really are going to do a light touch, then that’s what the RCGP has for years been asking for - and they need to abolish this star rating system that they’ve got - it’s just nonsense and measures things outside our control and I think they should focusing on the bottom 5-10% of practices.

‘I’d like to give credit to the RCGP because I know they have been working very hard behind the scenes to achieve this.’

Readers' comments (12)

  • "We're an expensive gold plated sledge-hammer to crack a rather ordinary nut. In the past, regulation has proved largely pointless, ineffective and disproportionate, whilst still being cheaper than we are. So at some stage, the need to make our books balance will require that we stick within the cash we can charge practices for this nonsense. At that point, we'll probably do less work.

    We may also consider moving to focusing on the bad guys, rather than all and sundry, or looking at where 90% of the cost and risk is in the NHS - ie the rest of the system that is in meltdown."

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  • CQC realises that it is one of the problems that are leading to the collapse of general practice and when that happens it won't have practices to inspect and it will have done itself out of cushy jobs. So it makes claims that it will back off, though I have huge doubts that it will in reality. The CQC will continue to exist in order to serve itself.

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  • "CQC realises that it is one of the problems that are leading to the collapse of general practice"

    Disagree - I don't think they have that level of insight or foresight. They have just been criticised by the PSA - have a look at - and are pretending to listen.

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  • Great I foresee more use of 'intelligent monitoring' to chose the practices for further assessment / inquisition.

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  • I know from other practices they had to do a formal presentation on why they are here (really?? GP services have been around for much longer then CQC and I think the whole nation, bar the CQC inspectors knows why GP surgeries are here). Some of them had to stay till 7pm in evening (so they were forced to breach T&C of contract with thei employees and also work beyond their contracted time). Partners had to be taken off surgeries in order to accommodate the inspection etc etc.

    They really need to be scrapped. In any other industry, they'll be taken to court for breaches of regulation and contract.

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  • Peter Swinyard

    Light touch???
    ha ha ha ha ha ha ha ha ha ha ha ha scream!!!

    Remember the "high trust low bureaucracy" 2004 contract?
    ha ha ha ha ha ha ha ha ha ha

    [waiting to be carried away by the men in white coats....]

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  • The CQC don't make anything easy. I found the below link incredibly useful when preparing for the inspections. I was lost trying to find what I wanted on their own website.

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  • "However, Professor Field also indicated that there would be no major change to GP inspections before all practices have been rated once." There are 'certain words' or put another way 'no words' for divisive players like this. Maybe he's finally admitting there is a problem but with arrogance and disdain for an ailing profession.

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  • When I recently got out of GP a couple of years early. The CQC having undoubtedly helped swing my retirement-o-meter, I went to their web site to inform them. It took a long time to navigate their confusing descriptions and links. However I did my best and completed various forms. 6 months later the practice received an email acknowledgement and a message from a human saying that the form used was incorrect. After much searching I ended up at the same form but I couldn't access it because I no longer had the correct privileges. I therefore asked if they were sure that they were not correctly informed of my retirement from clinical work. Three weeks later an apology came saying that all was in order after all and they were sorry to have bothered me. Standards! What standards?

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  • In 5 years time when the NHS is privatised, will one of these multi-national health companies with politicians in its pockets be bothered by CQC?
    I doubt it.
    CQC will quietly disappear and their inspectors will be looking for other jobs.

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  • I am a GP ( and past LMC Vice President in my locality, so: GP-friendly);I also assist CQC inspections as a GP Advisor. I have been privileged to witness good and indeed outstanding Practices whose expertise deserves praise and to be shared (expect more on how this could be done).I have also visited Practices at the opposite end of the spectrum that contributors to this forum probably believed no longer existed. In these circumstances it is our duty (and legal requirement) to be assured that patients can receive safe and effective treatment, and to take action on their behalf if it cannot be.

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  • Better get your sox on then steven..they will all have problems soon enough

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