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A faulty production line

CQC's risk assessment of GP practices will 'demoralise an already shattered profession', says Burnham

Exclusive The CQC’s publication of GP practices’ pre-inspection risk assessments risks ‘demoralising an already shattered profession’, shadow health secretary Andy Burnham has told Pulse.

Mr Burnham said he supported the principle of more transparency, but said that the CQC should have consulted with the profession before publishing the data yesterday, which categorised one in six practices as being at risk of providing poor care, based on data from QOF scores and the patient survey.

However, the CQC has defended its publication of practices’ risk assessment, saying that people ‘shouldn’t jump to conclusions based on indicators’.

GP leaders have denounced the decision to measure on ‘simplistic’ indicators and said placing them in the public domain creates more ‘sticks to beat GPs with’ before they’ve even been through an inspection.

The assessments are being used to prioritise when practices are inspected, but they have also been published on the CQC website and practices considered risky will have a red flag against them on NHS Choices.

Speaking to Pulse at the Commissioning Live conference in Manchester, Mr Burnham strongly criticised the regulator’s decision to put these in the public domain as it did.

He said: ‘It should have been done with more support from the profession. I’m not opposing the principle of what has been done, it is the way it has been done.’

He added: ‘To put information out about services without alarming the public, I think you have to have real solid evidence which is worked through with the profession. And I think because parts of the profession have felt unable to support this it ends up confusing the public. It was meant to help the public, and they’ve gone about it in the wrong way.

‘I can understand why this has caused alarm amongst GPs and members of the public. I think that’s why I say it needed to be done after an agreed set of criteria, then a process of inspection that people had signed up to. It’s not going to help bring stability to the system if we’ve got patients leaving practices and going to other practices.

‘I’m not against the transparency, and I doubt the profession is either – but it important to get it right and the Government has gone off too early on this. The worry is that it could demoralise further an already shattered profession.’

Sue McMillan, deputy chief inspector of primary care, told delegates at the conference that the risk assessments are indicators, and the CQC ‘never said we will use it in any other way’.

But Ms McMillan said the information was not being used the way it should be.

She said: ‘I feel sometimes it is used wrongly. I don’t like people jumping to conclusions based on indicators – they are indicators, nothing more, and we have never said we will use it in any other way.’

However, Ms McMillan said that publishing data was part of the ‘culture’ of being open.

She said: ‘I also think it is in keeping with that culture of being open about the information we are using and how we are using it and personally I think that is the more important thing.

‘It is our duty as a regulator to be very open about the information we use. We have used the words intelligent monitoring for quite a long time, and we have been saying to practices and the public that we use nationally available data to do our intelligent monitoring.

‘There are risks in publishing it because people will use it wrongly, but I think it is important to be open.’

Readers' comments (29)

  • The logical extension is for CQC to inspect patient homes before we visit as we deliver care in these environments . If CQC states it is not required then why is it necessary to inspect surgeries which at one time were often the Doctor's home. Any patient not wearing clothes that have boil washed should be excluded . All pram wheels should go through a "sheep dip " .

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  • Could you please let me know how much Prof Fields is being paid for his position as CQC Chief; also his income from being a Partner at his Practice; for his work around the NHS Constitution and of course, what is the weighted global sum per patient allocated to his Practice. I guess, one will find that he is being paid for working 48 hours per day and his salary from all sources is running into 500k per year. Transparency is the key word, sl let's start with the Boss

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  • Re Annon 8.48am. There is nothing to stop any doctor, but preferrably a GPC member referring Prof Field to the GMC.

    Grounds:

    You must work collaboratively with colleagues, respecting their skills and contributions.

    You must treat colleagues fairly and with respect.

    You must be aware of how your behaviour may influence others within and outside the team.

    Be honest and open and act with integrity.
    Never discriminate unfairly against patients or colleagues.

    Never abuse your patients' trust in you or the public's trust in the profession.

    You must work in partnership with patients, sharing with them the information they will need to make decisions about their care

    You must give patients the information they want or need to know in a way they can understand

    You must support colleagues who have problems with their performance or health. But you must put patient safety first at all times. [think underming confidence in GP practices, scaremongering, scapgoating, bring the profession into disrupte counts]

    You must be considerate to those close to the patient and be sensitive and responsive in giving them information and support

    Anyone brave enough to take the shot?

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  • Burnham's an opportunistic little liar - it was his Labour Government that created the CQC and it was his Labour Government that inflicted the CQC on to General Practice. This whole mess is a Labour created hell-hole.

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  • Why oh why don't NHS managers understand basic Management Tools.

    This is "TQM"
    Total Quality Management, as developed most famously by Edward Deering and adopted by the Japanese car industry.

    The NHS adopted it in the 1990s, yet DH still don't apparently understand how to use it.

    Yes you go and measure what you feel is important

    BUT if it falls outside parameters then you go and
    LOOK... And see if there really is a problem and what the answer is.

    Not just spew it out all over the Internet.

    We are a 6. But with partner just retired and no replacement after 4months of trying we could soon be a 1
    ... And whose fault will that be???

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  • Surely this is a breach of the data protection act as this infiirmation is being used for a different purpose than the reason it was collected. I am no lawyer but I would be interested in the advice of someone who is. BMA ?

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  • "One CQC official insisted on Twitter that assigning practices a number on a scale of one to six based on perceived risk level was 'not ranking', suggesting the media had failed to report the information"
    CQC knew the consequences of what they press released. Blaming it on the media is disengenious. Did anyone at the CQC ring and brief the media and if so what spin did they give? This is not transparency, but the perversion of transparency and evidence based science.

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  • Prof Field has apparently written to The Daily Mail and BBC demanding corrections to their stories etc. We should be insisting his "private Oh S**t want have a done" correspondence be openly and transparently available to read.

    As above I really do think GMC should take a view. This damages public confidence in the profession, in specific ways to some practices, to the point of defamation, possible business financial and reputational losses; incorrect, misleading data, worries patients based on mostly irrelevant evidence and this is PRIOR to inspections.

    It would take less than this for a burnout, depressed overworked over-regulated GP to get referred to the GMC for a few ill-considered "slip ups" or completely understandble mistakes under pressure.

    As per Anon 9.46pm - if you missed a high Potassium, "no quarter will be given" by the GMC especially if incidentally you were getting counselling for stress and might be at future risks to patients....

    CQC GP Chief needs ro resign. Period.

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  • Managers do not need any qualifications, most of them have none and are incredibly thick. Do you know any body who is half clever wanting to be a HS manager ? No wonder the NHS is in the shape it is, mostly run by dopes.

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  • Evaluation of the risks posed by General Practice is a great idea. I’m all for it, and have come up with a few more ‘risks’ of my own:

    Risk: The percentage of working days when I don’t feel completely drained by the end of it. (01/07/2013 to 31/03/2014)

    Risk: The number times I suffer from one of 20 stress-related symptoms per 100 working days. (01/04/13 to 31/03/14)

    Elevated Risk: The percentage of times when I finish work in time to eat with my family. (01/07/2013 to 31/03/2014)

    Risk: The percentage of working days when I have any sort of break. (01/07/2013 to 31/03/2014)

    Elevated risk: Number of tasks dumped by secondary care as a percentage of all clinical tasks. (01/04/13 to 31/03/14)

    Risk: The ratio of income versus redundancy liabilities when the practice folds (01/07/2013 to 31/03/2014)

    Risk: The percentage of income paid into pension, in a scheme is 30%, or less, of drawings received (01/04/13 to 31/03/14)

    Elevated risk: The percentage of articles in the Daily Mail, read in the preceding 9 months, which
    don’t maliciously criticise and undermine GPs. (01/07/2013 to 31/03/2014)

    These risks are simply unacceptable, and demand an urgent inspection. They will have to be quick though, as I’m quitting in four months!

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