Posted by: beyondtheheadlines27 May 2014
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.