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The waiting game

Professor Nigel Sparrow: ‘What matters to patients is care and compassion’

The CQC’s newly appointed GP lead tells Madlen Davies how the commission’s new army of inspectors will rate the ‘ethos’ of practices

‘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.


  • 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

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  • Nigel Sparrow

Readers' comments (4)

  • As a retired Inspector for Further Higher & Adult Education with experience of inspection & reporting. I have seen a dramatic change in some GP practices in recent months. A more compassionate attitude is developing. Dr Sparrow is absolutely right you only have to sit in a waiting room look, listen and observe the body language of the patients & staff waiting to see their GP.
    I would strongly recommend that you include a Carer in your inspection team they know only to well what to look for in compassionate care.
    I strongly recommend that PPG groups include Carers & Patients and that they meet the inspection team.
    Carer Ambassador

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  • Dear "care ambassador"

    Umm, you do realize this hasn't even been consulted yet, so it has not had any impact on GP practices. The changes you've mentioned is either imaginary or happened entirely without CQC inspection.

    And how do you propose to quantify "compassion". As a father I sometimes tell my daughter off - not because I lack the compassion but because I feel it is my duty to prepare her for adulthood. It's a different manner of compassion but I'm sure if you ask my daughter she'd rather not be told off and be able to do whatever she wants. Same for general practice.

    And how do you propose the views that's put forward by the carers and patients are justified representitive view of whole of my practice population? If my practice is shut down on word of (lets say) 100 patients but 8400 others were happy, would you say that's reasonable?

    All of what you say is fantastical wish list without any evidence to show it will not only improve care, but is achievable and cost effectice. I'm afraid you'll have to realize latter is still importent to the NHS as the nation simply do not have unlimited resources to provide health care.

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  • Record the data for patient satisfaction with how their doctor cares for them now.
    Repeat this in 5 years after all the systems have been brought in to regulate general practice including CQC.
    When patient satisfaction levels have been shown to have markedly fallen then we can conclude that the whole process has demoralised the profession and led to the loss of many experienced doctors by early retirement.
    It will however be too late by then.

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  • You will never satisfy a population that's hooked on freebies.GIVE ME MORE!!!

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