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Independents' Day

Practices forced to spend scores of hours preparing for CQC inspections

Exclusive Nearly half of GPs say their practices are being forced to spend more than 20 staff hours preparing for a CQC inspection, with many spending hundreds of hours, Pulse can reveal.

A Pulse investigation into the true costs of the inspection regime for general practice also reveals that it cost £13.3m from 2014/15, while it is also expected that GPs’ regulator fees could double as the Government seeks to phase of its central funding of the CQC.

The survey of 206 GPs who have gone through an inspection found that practices are using scores of staff hours to make sure they are fully prepared for an inspection by the regulator, with one practice stating that it had spent almost half a million pounds in opportunity costs.

It also shows that practices are on average cancelling 15 patient consultations on the day of inspection.

GP leaders have warned that Pulse’s findings highlight that practices are ‘losing precious time for patient care’ to instead prepare and engage with the CQC’s ‘bureaucratic inspection process’.

This comes as calls from the BMA and the RCGP to scale back the role of the CQC has begun to intensify more than ever before – with the College earlier in the week calling for an ‘emergency pause’ in CQC inspections to relieve pressure on ‘crisis-hit’ practices and avoid a risk to patient safety.

But the CQC’s chief inspector for general practice, Professor Steve Field, instantly rejected the RCGP’s plea, adding that an inspection by the regulator ‘should not be a burden for a well-managed practice’.

The survey found that 48% of GPs spent more than 20 staff hours preparing for an inspection, while 36% spent between 15-20 hours, and 11% spent up to 12 hours on preparation.

However, Dr Thomas Marland is a GP in Poulton-le-Fylde, Lancashire told Pulse that the CQC’s inspection also had a big financial impact on his practice, adding that it would inevitably affect the ‘productivity’ of the practice.

Dr Marland said: ‘We worked out that the whole exercise cost us £430,000, mainly in staff time, but including £15,000 on decorating and cleaning.

‘Staff agreed to take time off in lieu instead of charging overtime, which would have been payable at the weekend rate. But the process has left us with a staggering amount of time owing, so productivity decreases.’

Another GP in Essex said that his practice had paid upwards of £8,000 in fees and preparation to get ready for a recent inspection, while a GP from Woking says his practice spent close to £10,000 to change floors and carpets across three different sites to prepare for inspection.

Dr Chantal Simon, a GP in Oxford, said: ‘Preparation runs into thousands of pounds in practice manager and administrative staff time, not to mention the hours of GP time doing pointless courses to tick boxes – and that is even before we have been inspected.’

GPC deputy chair Dr Richard Vautrey told Pulse that the Government could make savings and improve the quality of care by ‘taking a serious look at what it tasks the CQC to do, and halt GP inspections’.

He said: ‘Whatever the standard of practice, all practices are spending huge amounts of time preparing for and then engaging in this bureaucratic process and therefore losing precious time which is desperately needed for patient care. LMCs, the BMA and the RCGP have made it very clear that this time is not being well spent nor are the millions of pounds spent on this process good value for money.

‘In its quest to make efficiency savings and at the same time improve quality of care, the government should take a serious look at what it tasks CQC to do and put in place an inspection pause whilst we work with them to radically review this system,’ he added.

Survey results

How long did you practice spend preparing for the inspection?

0-12 staff hours 11%

12-15 staff hours 5%

15-20 staff hours 36%

More than 20 48%

How many appointments did your practice have to cut on the day of the inspection?

No appointments 28%

0-10 appointments 14%

11-20 appointments 23%

21-30 appointments 19%

31-40 appointments 10%

41-50 appointments 4%

More than 50 appointments 2%

The survey launched on 9 June 2015, collating responses using the Survey Monkey tool. The survey was advertised to Pulse readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. Some 206 GPs answered these questions.

Readers' comments (20)

  • But Prof Field, speaking from his office at Ivory Towers, I'm Alright Jack Avenue, We can put up our fees however we like but you can't Shire, said there is no burden. So it's all ok then.

    It's no wonder that those in positions of power are despised nowadays, they ignore evidence and spout their propaganda and they believe their own propaganda too.

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  • "practice spent close to £10,000 to change floors and carpets across three different sites to prepare for inspection."

    It seems to me that either
    1. The flooring was inadequate and should have been changed without the need for inspection.
    2. The flooring was OK but the practice were so scared of criticism that they over-reacted.
    3. The requirements are not clear.

    If 1. Then I have little sympathy. 2 and 3 need some clarity.

    In other words, are practices doing more than is required, have they done too little in the past or are the requirements unreasonable? This needs a full and independent analysis.
    My guess s that practices are so scare of being criticised or shut down that they are doing too much and trying for perfection.

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  • Unfortunately that is the modern political disease.

    Release propaganda and then cause havoc.

    I do think the RCGP should expel steve field from the college asap.

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  • Dear All,
    So their gongs will be for "services to carpets".

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  • How a CQC inspection can cost £430,000 is beyond belief. That sort of figure is simply ridiculous. We have been inspected and we did spend a lot of time and I came in, whilst on holiday and on my silver wedding anniversary to be there as I acted as lead GP, but the costs were not in the same ballpark. We changed to disposable curtains and have changed our chairs, both of which probably needed doing anyway.

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  • Not at all sure about this. The social care sector has been doing this for years, care homes and the like. If cleaning, redecorating, etc. needs to be done, then it needs to be done, regardless. Policies and procedures should be kept up to date also regardless of a CQC inspection. Because care homes are visited unannounced they must keep everything to a given standard all of the time with the assumption that "the CQC will visit tomorrow" surely this is the attitude which practices should adopt. It is all about adopting and maintaining standards. Any business will tell you that if your premises, systems and procedures are not up to the highest standard you cannot rely on the service being delivered.

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  • Gosh, I wish I could adopt the same attitude as care homes.

    Charge patients, refuse when I think e are to full, I can refer to someone else to pass on responsibility with no consequences, not have to be involved in commissioning, no changing policies or guidelines year on year etc.

    Or may be you should consider general practice isn't like the 3rd sector yeah?

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  • We deliver care in patients' homes . Logically they should be inspected too. Perhaps we could ask patients if they would be willing to pay to have their homes inspected so they can have home visits .

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  • The government wants general practice gone . They have done everything to make this happen . LRE .

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  • Wikipedia
    General Practitioner
    Chief Inspector of General Practice at England's Care Quality Commission.
    Chair, Department of Health's National Inclusion Health Board
    Honorary Professor of Medical Education at the University of Warwick
    Honorary Professor in the School of Medicine at the University of Birmingham

    General Practitioner in Droitwich, Worcestershire from 1987 to 1997.
    1997 to date, Bellevue Medical Centre 1997, one day a week
    He has been part of the invited faculty of the Harvard University’s Harvard Macy Institute programme "Leading Innovation in Healthcare & Education", in Boston, USA.
    He was Regional Postgraduate Dean for the NHS West Midlands Workforce Deanery.
    He was a judge for the 2011 Hippocrates Prize for Poetry and Medicine.

    2007-2010 Chair of the Royal College of General Practitioners (RCGP).
    In 2011 he was appointed to lead the NHS Future Forum, an advisory group that David Cameron convened when Andrew Lansley's NHS shakeup
    Deputy Medical Director for NHS England from 2012-2013.[

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