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GPs to be judged on how 'caring' they are for patients, says CQC

Exclusive Practices are set to be given an individual risk rating and be subject to inspectors making a judgement about how ‘caring’ they are to patients, under a package of changes to weed out bad GP care planned by the CQC in the wake of the Francis Inquiry.

The risk assessment is currently being developed for hospitals to determine the frequency of inspections, with those identified as ‘high risk’ inspected more often and more thoroughly than those at lower risk.

The CQC told Pulse that the risk ‘metric’ would extend to GP practices and that the regulator’s GP Advisory group had also decided at a meeting last week to begin work on introducing a ‘judgement element’ into GP inspections based on five domains - including how caring practices are to patients.

But the GPC said that there was a danger the measures would fail to capture the complexity of general practice and could be ‘misinterpreted’ by the public.

The move comes after NHS care came under increasing scrutiny following the publication of the Francis Inquiry into the failures of care at Mid Staffordshire NHS Foundation Trust.

In the wake of the report, health secretary Jeremy Hunt announced he was considering introducing a chief inspector of primary care who would oversee the regulation of GP practices and make the final call on poorly performing GPs.

Pulse reported in 2009 that the CQC wanted to develop risk profiles of practices in order to take action against those providing bad care more quickly, based on a raft of information, such as numbers of complaints, surveys of staff and patients and the commission’s inspections of practices.

The CQC told Pulse they were now developing this risk scoring metric and it would be based on the one developed in hospitals.

A CQC spokesperson said: ‘We are learning from the introduction of a risk assessment in hospitals and this will feed across the field. We expect this to evolve into a metric for primary care.’

The 20% of hospitals considered ‘excellent’ will be inspected once every five years, hospitals considered ‘good’ inspected once every three years and those performing less well inspected more frequently, depending on their stratification. Five national teams who will be sent to the most challenged hospitals to carry out ‘deep dive’ inspections.

But the CQC said it was not able to say whether low-risk GP practices would have a reduced frequency or depth of CQC inspections. GP practices are currently inspected once every two years, with ‘themed’ inspections at any point if there is a need across the NHS, and ‘responsive’ inspections if the CQC feel there is a problem that needs to be followed up on.

They also confirmed they are considering introducing a ‘judgement element’ in GP inspections - as first proposed by Mr Hunt, who said it would prevent mere ‘box-ticking’.

The element will be based on five domains - including how caring, well-led and responsive services are to patients - will form the basis for how practice performance will be made public on the CQC website, in an effort to make the process more accessible to the public.

They added: ‘The GP Advisory group is working with the CQC to match outcomes to the five domains. This will be a co-operative project with the profession, it won’t be forced on GPs.’

But Dr Richard Vautrey, GPC deputy chair, said the five domains over-simplified general practice, and the CQC should be cautious about how these questions are used in inspections.

He said: ‘There’s a danger if general practice is being boiled down to those five questions. General practice is very complex, having simple answers to those questions, the complexity won’t be captured. The detail of how GPs will be measured against those questions will be important.’

He voiced concern about a risk metric to categorise practices: ‘There would be a concern if practices were being judged in that way, causing consternation amongst patients.

‘It would be extremely important to explain to patients exactly what the judgement meant. GP practices are not hospitals, and shouldn’t be measured in the same way. GP practices are much more vulnerable to judgements that are misinterpreted by the public.’

The five domains inspectors will measure practices on as part of the ‘judgement element’ of inspections:

Are services safe?

Are services effective?

Are providers caring?

Are providers well-led?

How responsive are providers to feedback from users?

Source: CQC


Pulse Live: 30 April - 1 May, Birmingham

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Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

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Readers' comments (17)

  • We will be judged on how caring we are by a response from a tiny percentage of our patients these then will be published on the net without proper consideration of what this means....we are caring when we save lives,tend to our elderly and manage every other crises thrown at us....why do we allow this ...are CQC going to judge dentists on how caring they are...thought not

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  • Great! Where do I mark CQC on their "judgement element"?

    I score 0 for caring of course. And their effectiveness, and their well ledness. Can I give negative mark for response to feed back?

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  • Are CQC inspectors still taking bribes? If so, at what offer does one start?

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  • Doctors have learned 6 to 7 years to care patients. Their intention is to treat patients. Not to be abused by the polititians. Now politicians are abusing the Professions like medical doctors and consultants to steer the NHS patients into risks. Now they are telling Quality ( Care Quality ). No effeciant funding for treating patients would lead to poor qaulity which is not at fault of the GPs and the other clinicians. This is all about money. Money has been taken by the politicians to divert the clinicians into difficult position. Do you agree?

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  • A rather well infromed article followed by seriously ill informed comments. If this crude commentary is the output of GPs then we really do have a problem.

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  • I'm a newly qualified GP, and I think it's fair to say I am terrified about the future of my career choice. It was hard enough being constantly and rigorously appraised (which I totally am in favour of) as part of the MRCGP, but to think my career could be jeopardized because I'm trying to be a safe and good clinician! I agree with colleague comments further up, especially being very wary of CQC playing the numbers game, and not analysing the complaints / concerns patients present. I routinely have patients requesting MRI scans for 3 day history of foot pain - if I gave in to all with a view to please (rather than focus on clinical appropriateness), I would be spending thousands of pounds of NHS money in a matter of weeks. Then GPs would be bashed for overspending...again. Move to New Zealand / Australia, anyone?

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  • Also I don't think GPs are being "crude" - I think the flavour of these posts is testament to how worried we all are! Sorry...

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