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Independents' Day

CQC to access patient records without their permission on new GP practice inspections

Exclusive The CQC will be able to access GP records without patient consent, Pulse has learnt, as the regulator launches its new handbook detailing how practices will be rated.

As part of the new inspection regime that was officially rolled out last week, CQC inspections teams - including the lay members - will have the power to review patient medical records ‘to assess the quality of care provided by the practice’.  

The regulator will not ask for patients’ consent before looking at the records, but it has said it will allow GPs to anonymise the records.

This comes as the CQC officially launches its handbook on how practices will be given ‘Ofsted-style’ ratings.

This explains that practices will ‘normally’ be given an overall rating of ‘needs improvement’ if they are found to be failing any of the five ‘domains’, which include how effective, caring, responsive, safe and well-led they are.

As part of the regime,Pulse has learnt that practices ‘should be prepared to provide discrete’ access to medical records, and that they could be asked to do so at any time during an inspection.

The CQC has powers to access patient medical records, which falls under Health and Social Care Act 2008, and Pulse reported in 2012 that CQC inspectors routinely accessed GP records without patient consent during a pilot of 40 practices to test the regulator’s model for inspecting practices.

But this is the first time the regulator has confirmed that accessing patient records will form part of the CQC’s new inspection regime of GP practices officially launched this week, which will rate practices as ‘outstanding’, ‘good’, ‘needs improvement’, or ‘inadequate’. 

How practices will be given their ratings

  • Practices will be given an Ofsted-style rating of either outstanding, good, needs improvement, inadequate for a total of 42 ratings which will have to be displayed in the practices and on the website alongside their final score.
  • Inspection teams will have to answer questions along ‘key lines of enquiry’ to answer five ‘fundamental questions’ of whether the practice is safe, well led, responsive, caring and effective.
  • Practices will also have to answer these questions in the care of six key patient groups including older people, people with long term conditions and people with poor mental health (including dementia).
  • The scores on the five questions and six population groups will then be aggregated, and practices will ‘normally’ receive an aggregate outstanding rating if they score outstanding on two or more categories.
  • But they will ‘normally’ be limited to ‘requires improvement’ where they have one rating of requires improvement or inadequate where they have been found inadequate in two categories.
  • These aggregate scores will then be combined to give the final rating.

In full: How GPs will be given their Ofsted-style ratings

In a statement on the CQC website, Professor Nigel Sparrow, senior national GP advisor at the CQC, said: ‘At any stage during the inspection we will let the practice know when and why we intend to look at medical records. Practices should be prepared to provide secure and discrete access to the required medical records during an inspection.’

Professor Sparrow told Pulse: ‘The main purpose of the review of medical records is to assess the quality of care provided by the practice. It is not to assess the individual clinician. In routine inspections, the GP or nurse specialist advisor will look at the medical records.

‘Although the 2008 Health and Social Care Act does not require this, our view is that in most cases it is appropriate for the clinicians on the team to lead this aspect of the inspection. This will usually be the case but where inspection teams have concerns about a practice it may be necessary for any of the inspectors to access medical records or to see a medical record.’

But Professor Clare Gerada, former chair of the RCGP, criticised the plans.

She said: ‘I think that given all the information governance safeguards that we have in place that can actually hinder not help patients - eg research, talking to worried relatives,sharing information across agencies to deliver integrated care - I am surprised as to the ease that CQC can access patient records for inspection purposes where there has not been any previous identified patient or clinical performance issues. Not even the GMC can I believe, enter a practice and for no reason demand to see patient records.’ 

Dr Chaand Nagpaul, chair of the GPC, said: ‘The confidentiality of private medical information is the basis of the trust that patients put in their family doctors and it is vital that this is not compromised. If CQC inspectors want to have access to the private medical records of patients they need to put in place systems that obtain the explicit consent of patients. I believe patients will be extremely concerned to learn that inspectors of GP surgeries are looking at their private details without their consent.’

Professor Field told Pulse that the inspection regime has evolved over the course of the pilots, with changes to the reporting and also a shake-up of training after Pulse revealed untrained GP inspectors were going on inspections.

He said: ‘One of the things we learnt means we’ve put far more training in, of both inspectors and the GPs, which is starting to run through now, and we’ve changed the training we had.

‘We’ve changed quite a bit of the structure of the report, and the biggest change was that I’ve introduced, at the start of the visit, a half hour can celebrate what’s good and outstanding in the practice, and highlight any challenges.’

Pulse recently revealed that the CQC also plans for inspectors to sit in on GP patient consultations as part of the new inspections regime, and the the regulator is planning to publish individual practices’ data on GP prescribing of antibiotics and benzodiazepines.

Last week the CQC’s chief inspector of general practice Professor Steve Field, claimed that 200 GP practices could be closed under the new CQC inspection regime. GP practices that are judged ‘inadequate’ in a number of areas by the new CQC inspections will have six months to improve. If they fail to improve they will be put into ‘special measures’ for a further six months, and if they are still found to inadequate, their registration will be removed. 

Readers' comments (18)

  • This is ILLEGAL and our "leaders" have to stand up to this and overturn this. wil they....will they Bo£$%^ks!

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  • Is it illegal? I believe CQC have been given "powers" means precisely that, that THEY are allowed to do this. But if leaves us, as guardian of the records very vulnerable. We took our oaths, we agree to uphold confidentiality, and we work very hard to do so.
    This is shameful and should be publicised more. The public gave a right to comment on such practices occurring with their records.

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  • No lay member or nurse will access medical records nor will they sit in on any consultation at my practice. I refuse to be judged by someone not qualified to do my job. If I face sanctions as a result I will take that on the chin and if necessary retire. CQC is a joke organisation which cannot keep its own house in order but seeks to police us in an increasingly intrusive way. If our "leaders" had any balls they would fight this tyranny.

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  • Quite apart from the question of consent, just how many records out of the several thousand held by most practices would have to be "accessed" to allow a meaningful assessment?

    In respect of being "allowed" to anonymise the records, how is this to be done with computer records (short of printing off the entire records and cutting off the top of every page)?

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  • We have a total anarchy.. Patients must be consulted at every step.
    If this was in the US, the decisions makers would have been castrated for flouting human rights.

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  • I think each patient whose records are viewed should be told, so they can rightfully complain to all and sundry.

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  • So basically any lay member on a CQC inspection team can sit in on any consultation they request and view any notes they see fit for any reason...... and this is legal, has been approved in terms of data protection and medical confidentiality by all bodies? And the CQC is already a well established organisation fit for purpose? With a clear set of lines telling them where their authority ends. The CQC is not an entity that is clawing its way into areas and creating its own kingdom with a seemingly ever changing portfolio?

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  • Outrageous - practices should just point blank refuse to allow this access and let the legal wranglings start. One or two test cases should do it. This is clearly unethical.

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  • Dr Chaand Nagpaul, chair of the GPC, said: ". If CQC inspectors want to have access to the private medical records of patients they need to put in place systems that obtain the explicit consent of patients."

    Not good enough Chaand. Either force the CQC to heel, or admit and tell all GPs that they have to comply with CQC. Meantime your bleating about how you wish things should be, helps no-one. Stand up and fight or resign and let someone else do the job.

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  • I wonder how many patients would be happy with this absence of consent? - IF they knew it was happening, of course.

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