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Independents' Day

GPs must find an alternative to CQC inspections - or watch their colleagues walk

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There has been an understandable amount of disquiet over the re-hashing of old data from QOF, the GP Patient Survey, prescribing patterns and hospital admission statistics by CQC - now presented as the banding of surgeries from one to six. But the argument of how one measures good health care seems to have been side-stepped.

No-one really knows what makes a good doctor. Each medical school has a slightly different syllabus and teaching style because there is no true way to measure the effectiveness of each one, or what a good doctor is (apart from not being struck off).

Furthermore, I’m not sure there is evidence that patients’ opinions of doctors is an accurate correlate with good clinical practice. For example I am led to believe that Harold Shipman’s patients thought that he was a good doctor and perhaps he would even have passed the Family and Friends Test, his CQC inspection, and his revalidation, the lot. I don’t know of any proof that patient satisfaction means that one is a good doctor.

The trickiest issue for those GPs like me who complain about arbitrary measures of ‘clinical effectiveness’, be they the QOF, CQC inspections or any one of the enhanced schemes, is whether we need to provide a viable alternative to CQC inspections, data extractions and public floggings.

I agree that there needs to be a robust and alternative way of identifying practices that are not providing a good clinical service, but I accept it’s not clear at the moment what that might be.

Appraisal and revalidation have been set up to scrutinise individual doctors and identify those who pose a risk to their patients (and whether it is appropriate or works is another debate for another time).

Similarly, inspection of practices by CQC seeks to ensure that they meet requisite standards of high quality care. But I don’t think either of these systems are the right mechanism for measuring GPs’ success. 

For a start, I don’t believe we have nailed down what quality care actually is, let alone whether there is evidence that it can be effectively and accurately measured, or how harmful using a tick-box, data-extraction methodology to measure quality is to doctors. This very process is often cited as part of the reason GPs are leaving the profession in droves. 

A friend told me that the local LMC is well aware of practices in the area that are struggling or who are not performing as well as comparable nearby surgeries. He argues that a measuring scale for identifying such practices is not required - and I agree that there should be an alternative way for struggling practices be identified, investigated and helped to turn things around.

Currently the CQC threatens failure to meet their ‘standards’ by taking away a practice’s CQC registration or its contracts with NHS England.

But we’re struggling for GPs as it is. We must come up with a better alternative. 

Dr Samir Dawlatly is a GP in Birmingham. 

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Readers' comments (11)

  • Lol. Samir, its all a joke really. Its been decided by the higher ups that Primary Care as it is now in the NHS is to privatised. Period. Turkeys praying for Christmas comes to mind. Soon , there wont be enough GPs to walk. We are clawing our way to the bottom and soon will be totally irrelevant. The whole gaming is to show that we are not needed and someone with a 6 weeks course can do the work we do. Apologies for bursting your bubble. Thats the undeniable fact.

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  • Nair 7:15pm
    Indeed but it's self evidently nonsense that you can do primary care without Drs. The numties in government however have such total contempt for GPs that they actually believe it. When their job has been done and they grow old and infirm they will come to realise the damage they did...but I bet you they'll still be blaming their 'absent' GPs for the mess they created when they were fit and well and 'running the country'

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  • I wonder what they are genuinely hoping to get out of this nonsense. Is it because someone *really* thinks that this is a useful way to compare doctors and thinks that the general population has the mathematical and scientific literacy to understand random sets of information in which case they aren't exact fit for their job; or, because they actually do want to undermine confidence in GPs and belittle the profession, in which case they are not fit for their job because this is utterly unprofessional behaviour. Either way this ranking thing is just headline and sound bite making...but what's new

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  • we need to replace this whole misguided bureaucratic structure with peer clinical governance..our leaders are so spinelessly incompetent they have allowed this noble profession to be dictated to by pen pushers who have no true understanding of quality care,waste money and time,will not achieve the stated aims ..but will succeed in encouraging early retirement and poor recruitment.

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  • 7.15
    weird comment indeed.

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  • Anonymous 1:13am
    The only weird thing about Nair 7:15pm is that he speaks the truth. Time for us all to wake up, or in your case get some sleep :)

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  • Patient satisfaction is a measure of something that is valuable to patients. Perhaps patients have different values to the medical profession - but why seek to impose your own values on others?

    Living a shorter life but with high levels of satisfaction and good quality of life may be more important to patients than living a longer life with poor quality of life and low levels of satisfaction.

    PS. Harold Shipman fooled everyone - including his fellow doctors - for years.

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  • I completely agree that "patient satisfaction" may be completely unreliable when it comes to rating a health care professional's efficacy. What of the patients who trot in wanting antibiotics for a viral infection, and leave feeling annoyed for not getting them?

    Often a good health care professional will make decisions that are directly at odds with the patient's intentions (probably helped along by Dr Google and the Daily Mail). Patients can have a quite skewed idea of risk, and merrily demand things that would be unsafe for them, then proceed to be annoyed.

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  • "Patients can have a quite skewed idea of risk, and merrily demand things that would be unsafe for them, then proceed to be annoyed."

    And doctors may make decisions based on simplistic guidelines that may have little relevance to an individual patient's situation. Whose "idea of risk" counts? Whose body is it anyway?

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  • 1.24 the guidelines are not simplistic and are often quite large and complex documents. Risks are generally assessed following taking a history and examining the patient and informed by relevant investigations as required. Risk assessment is not always easy but GPs try to take patients feelings about risk into account.

    When we give antibiotics, we are affecting the resistance levels in the whole community so it's a decision that affects more than one body.

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