CQC inspections uncover minority of GPs providing ‘shocking’ care

Exclusive Most GP practices are passing their CQC inspections, but as many as a third are failing inspections based on one standard and a small number are providing ‘shocking’ care, according to the latest data from the regulator.

The figures, obtained by Pulse, show that although the majority of practices are compliant against the CQC’s essential standards, there are a handful of areas where a signficant proportion have failed inspections.

It comes as one LMC reported that ‘aggressive’ CQC inspectors and ‘stressful’ inspections have led to it setting up a liaison service for practices

So far there have been a total of 586 GP practice inspections across 580 locations since April, with the CQC selecting a number of outcomes to measure practices against during each inspection.

To date a third of the 104 practices inspected on the CQC’s standard for requirements relating to workers have been found to be non-compliant, while a fifth of the 139 practices inspected for cleanliness and infection control were non-compliant.

Some 15% of the 108 practices inspected against the outcome on management of medicines were non-compliant, and on safety and suitability of premises 13 out of 76 practices inspected were deemed to be below par.

One in 10 of the 270 practices checked for their processes for assessing and monitoring the quality of service provision were not up to scratch.

CQC leaders insisted that overall GP practices were providing ‘excellent’ care and pointed out that some of the first practices to be inspected where those where concerns had been raised by NHS England, while others had declared non-compliance and failed to produce action plans to rectify the situation.

But Professor Steve Field, who was appointed as chief inspector to oversee the regulation of GP practices last month, also warned that CQC inspections that had taken place since April had thrown up examples of poor care that he would ‘not tolerate’.

In an interview with the BBC earlier this week, Professor Field said: ‘Most general practice in England is very good but we’ve conducted 586 inspections so far and unfortunately a very small number of practices are providing shocking care. We want to make sure wherever you live in England you have the best GP care possible.’

‘We found practices not monitoring fridge temperatures for vaccines. If you’ve got vaccines for children in a fridge, it might be only a few practices but that’s hundreds of patients. This is a really obvious one because if you don’t monitor fridge temperature then the vaccine won’t work, the children won’t be immune.’

‘There are some surgeries we’ve found that aren’t supporting the people who work in the surgery, they’re not checking their references when they join, they’re not providing them with professional development. We’ve found also some out-of-date drugs. I must stress this is a minority. But a minority, because GPs have 1,800 patients on each list, can affect a lot of people. And I’m not going to tolerate it.’

He added: ‘Already we’ve found some practices and we’ve given seven warning letters in one practice. We have powers to close them down straight away. We’re talking about a tiny number, but it is quite amazing.’

Recently the CQC named and shamed its first practice. Pulse has already reported that two practices have launched legal proceedings to fight closure notices from the CQC, and another practice was closed by its local area team having failed to meet the regulator’s premises standards.

But Professor Nigel Sparrow, professional advisor for primary care for the CQC, said the inspections carried out so far were ‘really encouraging’ as the most risky practices had been inspected first.

He said: ‘We have seen some excellent practice. The figures of compliance are as expected in that the first practices that we inspected included 140 practices where concerns had been raised by NHS England Area Teams and also practices that had declared non-compliance but did not produce action plans to achieve compliance.

He added: ‘We have visited practices on the basis of data relating to QOF and patient surveys. We have also visited practices that have been selected randomly. We want to celebrate the good practice that we see as well as highlighting where improvements are needed. A large proportion of the visits have included a GP, practice nurse or practice manager and we are actively recruiting clinicians to accompany inspectors on visits.’

However the figures for the total number of GP practice inspections in the first six months of the financial year suggest the regulator is behind in its inspection schedule. A spokesperson for the CQC said it hoped to inspect approximately 20% of GP providers by April 2014; 1,513 of the 7,563 primary medical service providers registered in April, though new providers could have registered since then. The 580 locations inspected so far represent just 7.7% of the total.

In August, the CQC admitted it was drafting in additional inspectors and authorising staff to work overtime to clear the backlog.

Meanwhile Norfolk and Waveney LMC has begun to offer an LMC liaison service to every practice being inspected, following reports in the LMC’s September newsletter of reports of ‘aggressive CQC inspectors’.

Dr Tim Morton, chair of Norfolk and Waveney LMC, told Pulse: ‘There have been occasions where an inspector has been over-zealous. We’ve offered all practices LMC observers if they wish. It’s still at the early stage of inspections where inspectors are finding their feet as well as practices.’

‘Some of the reports of what inspectors have been asking were not understood and the inspectors didn’t take kindly to being asked for clarification. The wording of what they were requesting and their attitude was not what practices were expecting.’

‘We’ve done a lot of work with the CQC and they said “it won’t be aggressive - it’ll be about pointing out ways of improving” but it wasn’t quite like the friendly inspection they made out. It was a stressful and traumatic day.’

‘Saying that, they’ve all passed - so no difficulties there. And we do have an excellent relationship with CQC management team.’

Responding to this complaint, a CQC spokesperson said: ‘CQC is committed to driving improvement in services and as part of this, our inspectors may have to ask questions of providers to ensure the national standards are being met.’

He added: ‘CQC has a robust internal complaints procedure. We welcome feedback and will respond to concerns.’