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Practices 'risk rated' by CQC based on QOF and patient survey data

GP practices have been given a pre-inspection ‘risk rating’ by the CQC based on data from the QOF and the GP Patient Survey, in a move that GP leaders say has created ‘more sticks to beat GPs with’.

The CQC announced details of its ‘intelligent monitoring’ scheme today designed to assign ‘risk ratings’ to practices, which are being used to prioritise when a practice should be inspected and will be published on the NHS Choices website.

It found that one in five practices had been determined to be ‘at risk’.

The CQC’s Intelligent Monitoring report, published today, set out the 38 indicators that have been used to assign practices their risk rating, which includes the proportion of dementia cases they diagnose relative to the national prevalence, and patients’ ability to see their preferred GP on their last visit.

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

Under intelligent monitoring, practices will just need to receive an ‘elevated’ risk score in three of the 38 indicators to be given the highest risk rating, which will mean they receive a red flag on the NHS Choices website.

The CQC says the indicators do not amount to a ‘judgement’ of practices, but the GPC told Pulse the information should never have been put in the public domain especially where indicators are outside practice control.

The Intelligent monitoring guidelines state: ‘We will use our analysis of these indicators to raise questions, not make judgements, about the quality of care. Our judgements will always follow inspections, which take into account the results of our intelligent monitoring and reports from other organisations.’

The 38 indicators span three of the CQC’s five inspection domains - whether practices are effective, caring and responsive - and more indicators likely to be added in future.

The first set of indicators include:

  • Dementia diagnosis rates, which will be based on QOF data. The CQC says practices should be aiming towards delivering the nationally expected threshold of 67% by 2015;
  • The number of emergency admissions for ‘ambulatory care sensitive conditions’ – ie, problems that could be managed outside hospitals;
  • Percentage of Cephalosporins and Quinolones as a proportion of antibiotics prescribed;
  • Flu vaccination percentage rates for patients between 6 months and 65, and those aged over 65;
  • Number of Ibuprofen and Naproxen Items prescribed as a percentage of all Non-Steroidal Anti-Inflammatory drugs Items prescribed
  • Number of AF patients being treated with anti-coagulation drug therapy or an anti-platelet therapy

There are a number of indicators derived from the GP Patient Survey, including:

  • The proportion of respondents to the GP patient survey who stated that in the reception area other patients can’t overhear;
  • The proportion of respondents to the GP patient survey who stated that they always or almost always see or speak to the GP they prefer;
  • The proportion of respondents to the GP patient survey who  described the overall experience of their GP surgery as fairly good or very good.

The CQC has already placed preliminary intelligent monitoring data for this year on a map, which shows 80% of practices are of low risk.

However, there are large swathes of blank data in Somerset where the CCG has dropped the QOF in favour of a local quality scheme - a scenario that is likely to become increasingly common under NHS England’s plans for CCGs to be able to drop the national QOF as part of its co-commissioning primary care proposals.

Dr Richard Vautrey, deputy chair of the GPC, said that these were ‘simplistic’ judgements.

He said: ‘The art of general practice isn’t reflected within these very simplistic and bald statements, but also to provide this level of detail and information without any context on the practice from which it came from. There’s no link about what type of patients a particular practice provides services too. What funding levels they receive compared to other practices, the challenges practices face from premises, or support from community team.

‘They’re becoming more and more sticks to beat general practices with, and more and more targets – when we’ve seen the dangers of a target culture in mid-Staffs, and the consequences of organisations simply focusing on performance management targets, and there’s a risk of this happening to practices as well.  

He added that GPs are ‘performance managed in an incredible way’.

Dr Vautrey said: ‘As soon as you start traffic lighting things, you’re making a judgement, and the intention of providing more information is not necessarily to make judgements on the basis of those indicators. The judgement comes when you’ve had your CQC assessment yourself - not these very simplistic summarising.’

Dr Peter Swinyard, chair of the Family Doctor Association, said that his practice was ‘at risk’ for factors they had little control over.

He said: ‘Apparently my practice is on Band 2 purely due to ACR tests missing, some people who won’t have their smears and because we don’t seem to have recorded multidisciplinary case meetings for palliative care - because we had no-one on the palliative care register in that period.’

Professor Steve Field, chief inspector of general practice, said: ‘There is a lot of good and outstanding care taking place across the country as our data and recent reports show.

‘While it is positive that 78% of general practices are currently a low concern based on the available data, there is no reason for complacency and standards must continue to improve.

‘It is important to remember that the data is not a judgement as it is only when we inspect we can determine if a practice provides safe, high-quality and compassionate care. The data is a further tool that will help us to decide where to inspect and when.’

Pulse first revealed that the CQC was drawing up plans to draw up a risk profile for every practice to allow it to spot poor or potentially dangerous GPs back in 2009.

The CQC risk ratings

  • 20% of practices have been categorised as band 1 or 2, considered high-risk, and the CQC has said it will prioritise the top 10% of practices for inspection within the next three months.
  • Practices who have been given a rating can access their intelligent monitoring report now, this gives a summary of the number of risks and elevated risks that have been identified in the practice.
  • It also includes the full table of achievement against each of the 38 indicators, listing whether it is identified as a; red, elevated risk; orange, risk; blue, no evidence of risk (ok); or green, no evidence of risk (good).
  • The intelligent monitoring scorecard will be available to patients through the MyNHS section of NHS choices.

Related images

  • CQC -online

Readers' comments (33)

  • Publishing this could make some sense. However it is only relevant if there is a breakdown of the age demographics of the practice and the full practice income. This needs to be £ per patient per year, regardless of the contract (GMS, PMS, APMS) and including extras like payment from nursing homes, number / hrs of GP Registrars etc. Without this there is no comparison

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  • QoF is voluntary

    So how can it be misused this way?

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  • We all know A&E attendences, life expectancy and disease outcomes are mostly dependent of deprivation.
    All this means is practices serving deprived populations will be negatively affected.

    Also why would QOF be included if the NHSE has allowed CCG`s to cancel present QOF for other parameters in several parts of the country. QOF was voluntary anyway!!

    Insome areas there are >10 fold variation in deprivation between local practices.
    Aren`t individuals and the politicians more responsible for deprivation than GP`s!

    GPC please mount a legal challenge to same!

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  • Vinci Ho

    If you read the appendix(as recommended by Richard Banyard) on the definitions of outstanding ,good, requires improvement and inadequate. Everything is circumventing the word Safety.
    So some parameters are necessary to measure how 'safe' a practice is . Otherwise , CQC will be falling into the trap of the infamous 'unconscious bias' from the inspectors.
    All comments are welcome.

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  • Level 2 - failed on 3 one of which was

    GPPS004: The proportion of respondents to the GP patient survey who stated that they always or almost always see or speak to the GP they prefer. (01/07/13 to 31/03/14)

    - I'm single-handed!

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  • local practice passed a CQC visit without any recommendations in January 2014 and is now level 1

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  • Peter Swinyard

    ref anon 3.29pm - brilliant. I refer you all to
    Incidentally this is the CQC which has not yet decided whether to give permission for a partner of mine to leave the practice on 1st September (2+ months ago having given us 1 months notice)., I think he may have left the country (or to have moved to Welwyn garden City which is much the same thing) - I would love them to say no and tell him to come back to us!!!

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  • Vinci Ho

    Vinci Ho | 17 November 2014 3:38pm
    So the questions are :
    What is the real meaning of safety in general practice ? Why are certain parameters chosen but not others being used to 'measure' safety?
    To QUANTIFY how safe a practice is the politically correct way to run these inspections?

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  • ‘It is important to remember that the data is not a judgement as it is only when we inspect we can determine if a practice provides safe, high-quality and compassionate care. The data is a further tool that will help us to decide where to inspect and when.’
    It is begger belief why CQC wants publicise the data if it was only meant to be for their use to prioritise their visits.
    If is time to have a vote o no confidence in the self styled czarist , Prof Fields

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  • I didn't realise CQC were responsible for contracting GP's.Far too much noise, very sinister.

    This will be the future unless it is nipped in the bud, practices will run to these targets and nothing else

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