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At the heart of general practice since 1960

My CQC inspection was the most unpleasant exercise of my career so far

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We’ve had time for the dust to settle since our CQC inspection. It was no disaster; they haven’t closed us down, and the obligatory action points that followed won’t be too hard to implement – but it was without doubt the most unpleasant, unhelpful exercise I have had to undertake in my medical career.

Why does it have to be like this? Being inspected by the CQC is like having your least favourite great aunt come to visit and having to helplessly watch her run her finger along the mantelpiece, tut-tutting as the accumulating layer of dust exceeds her expectations by some margin.

It was like awaiting bed inspection by a Sergeant Major who believes his duty to his country is only properly fulfilled if he finds fault somewhere, somehow; or a Chief Examiner studying the fruits of your labour, clutching the mark scheme close to her chest while you get a sinking feeling that you have been studying the wrong curriculum.

The rules of engagement are far from self-explanatory. Take patient safety, for example. Naïve, foolish doctor that I am, I thought it might have something to do with staying up to date, giving my patients time to explain their problems, examining them carefully and seeing them promptly in an emergency.

But this isn’t so important after all. What really matters is that all our staff have a photo of themselves in their staff file. Silly me – how useful this will be when we have some stranger wandering around the back office trying to access patient notes. Now, instead of remembering what the 40 or so people I work with every day look like, knowing their names and regularly sharing a laugh with them around the kettle, I hurry to their files, double-check the stranger against each of the photos, and work out that they really are a stranger.

In its current form, there is nothing formative about a CQC inspection. It is infantilising and humiliating as two officious inspectors have free rein to poke around your beloved practice, ignorant of your unique ethos and values, careless of your history or the joys and challenges of serving your unique patient population. There is no attempt to celebrate what you do well, just a begrudging acknowledgment that may appear somewhere in the report, but will in no way compensate for your more obvious failings.

The rulebook followed by inspectors may be suitable for a large hospital, but many of the diktats that seem self-evident to the clipboard wielders are inherently ludicrous when applied to the small scale of a GP surgery.

Photographic identification in staff files makes perfect sense when you have a workforce of several hundred, but no-one can convince me they will ever be looked at in a small GP surgery.

Paper bedrolls standing on the floor may be an infection risk on an intensive care unit, where superbugs and open wounds in compromised patients abound, but show me the evidence that this daring contact of paper on carpet is a hazard to patient safety in your average consulting room.

Dare to suggest this to the inspectors, however, and you risk proving your guilt by appearing defensive, establishing your clear disregard for patient safety by questioning the authority of the inspectors. Better to bow your head, plead guilty and hope their report is lenient; there is no doubting where the power lies here.

And it could all be so different. The CQC could swap from inspections to support, scary headmaster to critical friend. No practice thinks they’ve got it all perfect and can’t be improved, we would welcome an external view point that seeks to help.

The CQC needs teeth, for sure, but it could save using them for those few practices that fail to respond to the supportive approach, rather than baring them menacingly at the outset of every visit. In its determination to hound out bad care, the inspection process threatens to bring nothing of value to the majority of well-run practices, leaving only a trail of crushed morale in its wake.

Professor Steve Field has been charged with bringing about an entirely new inspection process for general practice. But having just been inspected under the old regime, it feels like just when I got the hang of the rules someone declared a new game.

My plea to Prof Field is to put the emphasis on support and improvement, rather than scrutiny and punishment.

The political will, however, is in the other direction: hold on to your hats, it’s going to be a rough ride. 

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.

Readers' comments (13)

  • .....and what made you think it would be different? Please don't be surprised! These are the very same people that were the chief sneak prefect at school and in a different life would have been parking wardens! A few years ago I requested and was granted an audience with the main man at the PCT as I had noted that we had 'lost the love' - that helpful and joint working that was in the best interest for all. It became clear pretty quickly, and I appreciated the honesty, that indead the whole flavour of the relationship was changing - pretty much a dictact from on high. More top down governence than team working! What's the evidence that things were so bad before all this regulation and 'measuring the measurable' (how do you measure empathy, kindness, actions going the extra mile? - I don't know either - so let's not measure, photo in personel file, check. Couch rolls off the floor, check - sorted!)

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  • Time to leave the NHS and take market value - for better for worse - and like dentists - add the cost of everything [ including CQC inspections] to the bill. Hang around long enough and you will work to the bone and go bankrupt.

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  • Who inspects the inspectors?
    Anyone can apply to be an inspector without any clinical background. The inspectors are the same folk that graded NHS services as excellent whilst patients died in their care!

    If you have never worked in a hospital or GP practice you are not qualified to judge the services provided. some hospitals graded as excellent are filthy, but this lot only see what they want to see, they visit the best parts of a service and turn a blind eye to what they don't want to see.
    GP's spend so much time ticking boxes when they could be seeing patients and one can only believe that GP's are not trusted to do what they trained to do ... to care for the sick. No other service has to have proof of every task carried out yet the GP bashing continues ... it is a disgrace the way GP's are being treated!

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  • Leaving the NHS to market value is what they are driving towards.
    They have divided society so that everyone is at each others throats.
    Rich and poor, poor and poverty stricken, race, culture, religion, professional status.
    Unity of purpose and empathy has been driven out because people have been driven by short term selfishness.
    GP's accepted short term gains not so long ago. They are now reaping the reward.

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  • The legal mandate CQC have as the independent regulator of health and adult social care providers in England doesn’t support them to act as a critical friend and champion improvement. They must ensure that providers meet the ‘essential standards of quality and safety’. There is no mandate to act as a “critical friend” or a responsibility for CQC to drive up improvements – a ludicrous oversight on the part of political policy makers and one that must frustrate CQC themselves. In contrast the Scottish, Northern Ireland and Welsh systems have an objective to improve the quality of the health of the population through the quality of health care provided. The challenge for Prof Field is to work within these constraints until he is supported by a change in regulation that gives a clearer mandate more in line with the rest of the United Kingdom. It would be good to see CQC proactively sharing useful intelligence about what works well and building a culture that seeks to motivate providers to continuously improve. So lots to do!

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  • We can be our own masters. Dentists, lawyers, accountants et al have no masters other than statutory legislation. In any case, a Heath Robinson type of payment wherein, for historical reasons, one can go bankrupt in spite of seeing 40+ patients and working 12 - 13 hours, absolutely needs changed.
    Otherwise, there will be few new recruits to this profession, as no one, certainly I for one, would care to join today with the possibility of going bust tomorrow according to Govt. whims. We have to be strong minded. There is a worldwide shortage of medical personnel and people will always need doctors. For sure.
    £ 3 - 4 take home per consult is hardly a King's ransom as it stands. I am certain we can do better. The only sadness is, I like the NHS and what it stands for, but it is an unrequited love, which makes me no choice but to leave.

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  • This eloquent article will sound very familiar to many decent, hardworking schoolteachers who have been hounded by an arbitrary, poorly focused regime of Ofsted inspections for years. The effect on morale has been devastating and the effect upon "standards", negative. I was an Ofsted inspector, but resigned when I saw the negative effect of inspections for the majority of decent schools.

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  • Very shortly there will be far fewer practices to inspect. As the prey dies off so will the predators .

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  • Bob Hodges

    CQC closing down one practice for spurious reasons could be the first domino in the chain of collapse of General Practice.

    I know of of not one area where local GPs have sufficent capacity to absorb an influx of new patients from a closing down practice in the same area.

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  • John Glasspool

    Someone said "traffic wardens"- I think in a previous life they would have been the Stasi, and quite happy with it. I so empathise with the former Ofsted Inspector above. I cannot see any massive improvement in education as a result of Ofsted; in my view, most state education wasn't at all bad before, in any case.

    Remember though- government wants low morale in public services- you are easier to control that way, and few of us have the guts to leave, or get out early and risk the pension hit. (Except me and Missus that is- still in my first week of post-NHS euphoria.)

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