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Independents' Day

Five popular myths about the CQC, debunked

Andrea James tackles some commons misconceptions about how CQC inspections work

Many GPs were alarmed by the recent Care Quality Commission (‘CQC’) statistics published in Pulse confirming that, when applying for CQC registration, 20% of all GP practices declared non-compliance with one of the 16 essential standards of quality and safety.

It’s important to remember that almost every GP practice which applied for CQC registration prior to 1 April was successfully registered despite declared areas of non-compliance. Non-compliance does not automatically result in a CQC ‘failure’ or the closure of your practice.  

In fact, legislation governing CQC registration specifically allows providers to self-declare non-compliance along with an action plan setting out how they will become compliant within a reasonable timescale.

I set out below some simple answers to the questions most commonly raised by my GP clients.

If you add a new service to your practice or extend the premises you must re-apply to the CQC.

False. You would not need to re-apply to CQC for registration in these circumstances.  

However, the Care Quality Commission (Registration) Regulations 2009 require all registered services to notify CQC about certain changes, events and incidents affecting their services or the people who use them.  This is done by completing a form, not through a fresh application for CQC registration. Events about which you must notify CQC include changes to the kind of services you provide, abuse or allegations of abuse carried out during the provision of care or any change in the membership of your partnership.

The CQC will ask you to remove carpets, soft furnishings and skirting boards, regardless of how easy it is to disinfect them.

False. The CQC uses a judgement framework to assess whether a service complies with the 16 essential standards of quality and safety, one of which is cleanliness and infection control. There is no blanket ban on carpets or skirting boards (although some PCTs did mistakenly direct GPs that they needed to remove these items to be CQC compliant). The issue which CQC will assess is whether the GP practice complies with the cleanliness and infection control standard, with or without carpets in situ.

One of the new standards will measure how ‘caring’ GPs are towards patients.

False - this year. The Care Quality Commission (‘CQC’) assesses whether services meet 16 essential standards of quality and safety.  Caring is not one of the specific essential standards.

However, CQC has recently announced its strategy for 2013 – 2016.  This includes changing what they look at when they inspect services.  The new aim is to tackle five simple questions about any service, which are:

- Are they safe?

- Are they effective?

- Are they caring?

- Are they well-led?

- Are they responsive to people’s needs?

These changes will come into effect in NHS hospitals and mental health trusts first, but will be extended and adapted to other sectors, including GPs, during 2014 and 2015.  

The CQC also inspect GPs’ fitness to practise during inspections.

False. Doctors’ fitness to practise is regulated by the General Medical Council (‘The GMC’), not CQC.  CQC exists to regulate health care and adult social care services in England, as well as protecting the interests of people whose rights are restricted under the Mental Health Act.

However, whilst CQC’s purpose is not to inspect GPs’ fitness to practise, CQC will look at whether any service’s staff, including its GPs, are safe and effective. CQC makes clear that, where it identifies serious concerns about a healthcare professional’s fitness to practise, its ‘Chief Inspectors will make sure that concerns…are brought to the attention of other regulators and partners in the system’.  Earlier this year, The GMC and CQC entered into a Memorandum of Understanding which provides that CQC will inform The GMC of three things:

- any concerns and relevant information about a doctor which may call into question his or her fitness to practise;

- any concerns and relevant information about a healthcare organisation or a part of that organisation which may call into question its suitability as a GMC Approved Practice Setting or learning environment for medical students or doctors in training;

- any concerns and relevant information about a healthcare organisation which may call into question the robustness of its systems of medical appraisal and clinical governance.

You can be reported to the GMC if you fail to meet CQC standards.

True. As I said before, incidences of non-compliance with CQC’s essential standards can be minor, moderate or serious.

However, it is only intended that CQC will share information with the GMC where, as part of its inspection of an overall service, CQC identifies concerns about an individual doctor which are serious enough to indicate the doctor’s fitness to practise may be impaired.  

Andrea James is head of healthcare regulatory at George Davies Solicitors LLP, a former in-house solicitor to the General Medical Council and specialises in advising doctors.

Readers' comments (4)

  • Funny how when you point out the actual truth about CQC's inspections to the GPs busy ranting about it, they go very quiet. Not a single comment....

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  • - Are they caring?
    - Are they safe?
    - Are they effective?
    (They will be assessing these from next year)
    Is this really the CQC's job? Surely being caring/effective etc is an assessment of an individual GP which should be part of the GMC's responsibility, not the CQCs? What happens if everyone is caring and one GP is not caring? - Will the registration be revoked? what happens if one nurse at a hospital is not caring - will the hospital be closed?

    The ultimate test is market forces, if GPs are not caring, patients will (should) just leave for a different surgery.

    Currently GPs have to register with CQC, GMC + register for appraisal/revalidation and The performers list.

    If they are a trainer they also have to be assessed by the deanery.
    If they teach medical students they have to be assessed by the university.

    All of this costs money and essentially tests which surgeries are the most proactive and managed best. It certainly will not pick up or penalise terrible GPs.

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  • Some very useful information here. There are however a few slight inaccuracies:

    i) If anew service is being provided, GPs DO need to apply (in advance) for approval from the CQC if this involves provision of an additional “registerable activity”. For example, unless a practice is already registered for providing Minor Surgery or Specialist Family Planning, then advance authorisation from the CQC will be required.

    ii) Similarly, if the new service is to involve additional premises being used, then authorisation for this will also normally be required – in advance – from the CQC.

    iii) Any new service being provided will necessitate the Practice’s CQC Statement of Purpose being updated, and a new version of the Statement published within 28 days of the new service commencing.

    iv) Formal notifications to the CQC need to be made in the event of no fewer than 13 different circumstances – and a different form needs to be used for each one of these. (Copies are available on the CQC website). One of these notifications does involve any change in Partnership – but don’t forget that, in addition, formal applications will be needed to the CQC in this case, both to remove an existing Partner AND to add to new Partner. Partnership Agreements should not be signed until these CQC approvals have been granted.

    v) During Inspections, the CQC may also wish to examine all the relevant paperwork about a GP’s authorisation to practice – including up-to-date copies of GMC registration, professional indemnity cover, qualifications, right-to-work, CRB/Disclosure and Barring Service clearance, mandatory training certificates, etc. This applies not only to GPs but ANY staff who have direct patient contact (including Practice Nurses, Health Care Assistants, etc).

    The CQC regulations tend to be quite complex. Seek advice if there is any doubt.

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  • Hello Richard, thanks for your comment.

    I think you may have misunderstood some of the Q&A when you say there are "a few slight inaccuracies" because GPs DO need to notify CQC of changes such as additional services being added. I quite agree with what you say about notifications and think this is clear from the Q & A, where I stated "The Care Quality Commission (Registration) Regulations 2009 require all registered services to notify CQC about certain changes, events and incidents affecting their services or the people who use them....". The point I was making is that such changes would not, however, require a fresh application for CQC registration. This is a query which had been raised by some GPs, who had found the original application process arduous and were concerned that they would need to make an entire new application for registration each time a change arose.

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