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CQC plans for inspectors to sit in on GP patient consultations

Exclusive CQC inspection teams may sit in on GP consultations as part of the new inspection regime being rolled out this year, Pulse can reveal.

The CQC told Pulse that this would form part of new methods of gathering evidence when inspecting GP practices and will feature as part of the pilot inspections that will run up until the formal launch in October. Although inspectors will not sit in on consultations as part of every practice inspection, the CQC said it ‘reserved the right’ to do so.

Reacting to plans, most GP leaders said the move was ‘a step too far’ and also not the role of the CQC.

GPC negotiator Dr Beth McCarron-Nash said: ‘It’s wrong, I don’t agree with it at all. It’s the role of the GMC, not the CQC, and they’re overstepping the mark.’

Dr Robert Morley, head of the GPC contracts and regulation subcommittee and executive secretary at Birmingham LMC, said: ‘I personally feel it’s wholly inappropriate, regardless of patient consent. There is a world of difference between, for example, Ofsted sitting in on a teaching lesson and an inspector sitting in on that most confidential and intimate encounters, the consultation between a patient and their doctor.’

‘There are all sorts of issues. A patient might feel pressurised to consent, either to support their GP or to support the inspection process. The entire nature of the consultation would alter, making it highly unlikely that CQC could gather any truly meaningful information from the process and it is hard to envisage any situation in which CQC should do this in a routine inspection.’

Dr Morley added: ‘It really would be a step to far and, in all honesty, if this does start to happen I do hope the profession as a whole would rise up and refuse to accept it.’

A CQC spokesperson told Pulse: ‘Observing care is one of the ways that we can gather evidence, in addition to reviewing records, policies and other documents, listening to staff, and pathway tracking patients through their care.’

‘This means that members of our inspection team reserve the right to sit in on consultations as part of their visits – this would be on rare occasions and if we felt it necessary and of course, we would obtain the necessary consent from patients beforehand.’

But Dr Andrew Mimnagh, a GP in Sefton and the former chair of Sefton LMC, said one upside of CQC sitting in on consultations would be to GP development, similar to Ofsted inspections.

He said: ‘That is what teachers get with Ofsted, they get the observation of their lessons, they get the feedback on it and they do get developmental and improvement feedback.’

The CQC published a 100-page handbook on the new GP inspection regime last month, setting out requirements for achieving the new Ofsted-style ratings that will see practices marked as ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’.

These four ratings are based on 42 separate performance standards, which practices will be contractually required to publish alongside their overall rating in the waiting room.

Speaking at the Pulse Live conference in London earlier this week, Dr Morley warned of the extra stress and workload that the inspections would cause.

Readers' comments (46)

  • What about mental state examination of GPs? When would CQC recommend walk through gates at GP surgeries. GPs are also vulnerable for stabbing like recent isolated incident at Leeds school

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  • for this to work one assumes that the CQC inspector has to be a trained clinician - most likely an experienced GP. At a time of austerity with a recognized shortage of GPs can we afford to do this? wouldn't it be better to have those clinicians (the inspectors) actually seeing patients? Me thinks, another poorly thought out idea.

    why not save money and scrap CQC - the savings can go into primary care to fund more GPs and some of the CQC members can get out from behind their desks and help out on the frontline!

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  • NHS needs to be liberated from mindless and ignorant planners; why a GP should have appraisal and revalidation if someone has to supervise his or her consultation causing disrespect to patients and flouting any form of confidentiality
    May God bless the NHS and all those advocating such unnecessary changes.

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  • Anon 6/5/2014 1:48pm,
    Did anyone notice your gentle observation?
    You have hit the nail on the head. This is not about anything but 'slowly slowly catchee monkey'
    GPs are too disparate a bunch to act as one and sign resignations which need to be signed with a sang froid attitude.
    The government [public] may respond however they like but everyone needs doctors and under our law the government must pay.
    If all the doctors have resigned then they no longer need to abide by any contract other than that with the patient.
    Thank God I am out of it.

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  • Took Early Retirement

    Anonymous | GP registrar | 04 May 2014 2:51pm

    Actually, probably not true. I am now 57, I took "old" MRCGP exactly ten years ago, in order to become a trainer. I got a "pass with merit" and if I had been more selective in my videos would have got a distinction. As it was I submitted 7 of the first 10 consultations I had taped.

    ("Taped"- showing my age!)

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  • Another layer of time consuming red tape in an already overwhelmingly beurocratic society. As mentioned this is a time where luxuries such as CQC cannot be afforded due to higher priorities for the funding and the time it takes practices to prepare could be spent seeing patients. I dont personally mind someone sitting in but it just seems a little sinister and not the role of CQC. Big brother perhaps

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