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CQC reviewing practices' 'risk ratings' data as inaccuracies emerge

Exclusive The CQC is in talks with NHS England and the GPC around reviewing the data used by the regulator for its ‘risk ratings’ of GP practices, as GPs claim that the data used is inaccurate, Pulse can reveal.

Pulse has uncovered claims that practices were being marked down as being ‘risky’ because of problems with the interpretation of data, including a failure to acknowledge practices had stopped doing QOF work on NHS England advice, calculations being based on practice lists of zero patients and problems with the GP Patient Survey.

The CQC has said it is reviewing the indicators used alongside NHS England to see how they can be ‘refined’, while the GPC has said the ratings are ‘not fit for purpose’, and said it is working with the regulator to see whether they should continue in their current state.

The review by the three bodies comes after the inspection body has been under fire for its decision to publish GP risk ratings, which are used to prioritise practices for inspection, despite warnings from GP leaders that the data should be kept as an internal tool.

The regulator uses data from practices’ QOF performance, the GP Patient Survey, and other sources to highlight potential areas where there is a risk of poor care. Based on their scores in these 38 indicators, they are giving an overall rating of 1 - meaning very risky - to 6, the lowest risk rating.

But a spokesperson for the CQC has told Pulse that it had ‘concerns’ that they were being seen as ‘judgements’, and it was looking into how the indicators can be refined.

It comes as Pulse has heard multiple complaints about the validity of the CQC data, including:

  • One LMC writing to the chief inspector of general practice Professor Steve Field stating that saying the ratings are punishing their practices for ditching QOF indicators on NHS England advice;
  • The practice of a former LMC leader being labelled as a high priority for inspection because of their red ‘elevated risk’ rating for unplanned admissions, which was based on ‘statistically impossible’ data;
  • A practice having their patient survey scores were reduced by 34% because they had a high proportion of respondents who said the question ‘doesn’t apply’ to them.

It is the latest blow to the ratings system, launched by the CQC last week, which was immediately hit with a backlash from GPs astonished at how they could be given a risk rating without even being visited by the CQC, and the situation became ever more incendiary when the Government said it would use the risk scores on its new TripAdvisor-style NHS comparison website aimed at patients.

A CQC spokesperson said: ‘We have had many responses to the first publication of our intelligent monitoring data for general practice. A concern raised with us is that the bandings are being reported as judgements and ratings. We share this concern – the bandings help prioritise practices for inspection and are not a judgement about care quality. Judgement and ratings only come after inspection, drawing upon what we see and hear as well as the available data.

‘Intelligent monitoring clearly shows that the vast majority of practices are of low concern based on the available data. We are also pleased to announce we will be publishing a further batch of inspector reports early next week that show GP services delivering excellent care.

‘We are currently reviewing all feedback we have received and together with NHS England looking at how we can further refine indicators. Any changes we make will be reflected on our website and any practice whose banding changes such that they become a priority for inspection will be notified in advance.’

GPC deputy chair Dr Richard Vautrey told Pulse: ‘We [the GPC and CQC] have also agreed to set up a group together with the RCGP to review both the data being used and how it is used.

‘The intention is to have a fundamental look at what could be used by CQC rather than the current indicators and ranking which is not fit for purpose.’

The concerns about the inaccuracies were raised by practices after they realised they were being marked down for inaccurate data.

Dr Mark Sanford-Wood, medical secretary of Devon LMC – who wrote to Professor Field – said the CQC was ‘unfairly flagging many of those practices as being high risk, when they are nothing of the sort’.

He claims practices in Devon and Cornwall have found themselves marked down for their low QOF scores towards the end of the 2013-14 financial year, despite NHS England signing off a CCG-led initiative for them to stop reporting on QOF indicators that were scrapped under this year’s GP contract.

This is in in contrast to neighbouring Somerset, where practices were not given risk ratings having signed up to a local incentive scheme from January.

Dr Sanford-Wood wrote: ‘Sadly, your methodology is now unfairly flagging many of those practices as being high risk, when they are nothing of the sort. You are clearly not aware of the agreement reached in Devon otherwise I am sure you would have compensated for this, but it remains of great concern that a national programme such as this could be launched when so badly flawed by something so obvious.’

Former Sefton LMC chair Dr Andrew Mimnagh said that data for his practice showed a ‘statistically impossible’ level of accident and emergency admissions.

He said: ‘The partners are looking at how our 6,800 patients managed to rack up 150,000 AED attendances, given we have only 11 frequent flyers with more than 10 AED attendances per annum.

‘We’d have to have someone who’s basically living there, being readmitted every day… we’ve been monitoring the frequent fliers and attenders and it’s just statistically impossible to be racking up that level of attendances.’

Matthew Epton, a GP practice manager in Oxford claims his practice was marked down because of supposed poor scores from the GP Patient Survey, which marked ‘not applicable’ responses as negative responses.

For example, the CQC said that only 60% of 234 patients said that the last nurse they saw or spoke to was good at giving them enough time, he said.

However, only one of these patients had marked the practice down as poor, eight as ‘neither good nor poor’, while 84 had said the question was not applicable.

Mr Epton explained: ‘The 84 patients that have clicked doesn’t apply probably did so because they didn’t see a nurse on that visit or have never seen a nurse. The correct result should have been 94%. This is a massive difference and makes our practice look relatively poor and damages our reputation.’

The GPC, who met with the CQC after seeking legal advice on the damage caused to practices’ reputations, have also insisted the regulator must work with the media, and particularly local press, to counter erroneous reports that practices are putting patients at risk.

Readers' comments (26)

  • Can we have a front page headline in The Daily Mail retracting the misleading and incendiary statements?

    erh No.

    CQC apology and removal of the data from their website NOW?

    Damage is done.
    NHS = N.o H.ope S.oon

    erh NO

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  • in any other type of environment - they would be sued for damage caused. We were "fortunate" to be labled low risk but it was not in our gift in any event to have any impact on what we were to be judged on
    No one would object to their ratings being published if the practices had been inspected and found wanting, albeit upsetting but to have practices brandished as a failing practice on such spurious data is absolutely appalling and the whole thing should be retracted. And a statement from Jeremy Hunt apologising to those adversely affected by such ill thought through idea

    GPs are trying to do an excellent job with escalating demand driven by some of the national press. The government is demanding new housing development especially in the south east without any infrastructure to support the people that occupy the houses. Instead of supporting those struggling - it is constant knock - Shame on you HMG

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  • If I ran my Practice like they run their organisation.....! Absolutely shambolic...

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  • Its too late,the damage is done.

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  • Could this be taken to judicial review?

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  • I think it's important to keep in mind that the 1-6 scale applied by CQC is merely their prioritisation for inspection and, therefore, should not be given undue significance (notwithstanding our great leader JH and the DM). There's no reason why a practice identified for early inspection shouldn't be graded outstanding at the inspection itself.

    I think the bigger issue is the flawed data, including the patient survey. As with all these things, the interpretation by the reader will not always match the intention of the author; for example, in our Friends and Family responses we got 2 patients who answered that they wouldn't recommend us and in the explanatory remarks were the following reasons:

    "I haven't got any friends" and

    "My family all live up north"

    Sad, but true.

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  • GPC, it is high time to ditch the current Contract, to move to a 15 minute at least , 25 appointments a day system, for our safety and for patients.
    The current system of list size puts impossible demands on us with no time for patients and all sorts of criticism for poor care and patients waiting for weeks for appointments, which is wrong and not their fault; in spite of us seeing 40 + patients a day.
    We have to define safety in numbers seen. At the moment, we cannot close list size in spite of impossible workloads and then we are judged as being poor providers.
    GPC, the whole edifice is crumbling on your watch. It appears to us that you are hand in league with the Govt. Otherwise, you would have done something by now.

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  • We immediately responded within minutes of the publication as it showed us at an ELEVATED RISK but there were zero figures in there and were totally contrary to the results. You cannot have an elevated risk on something that has not been measured or observed by you. 0 is 0. The NHS England survey report shows something quite different if fact an EXCELLENT result…….so CQC wrong again !

    We asked for an immediate review and the current response is “ This email is an acknowledgement that we have received your enquiry and that we will respond as soon as possible.

    Kind Regards,

    Primary Care Intelligent Monitoring Team, Care Quality Commission,Citygate,Gallowgate
    Newcastle Upon Tyne,NE1 4PA
    Tel: 03000 616161

    I am not holding holding out much hope here as CQC seems to be a law unto itself...

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  • We immediately responded within minutes of the publication as it showed us at an ELEVATED RISK but there were zero figures in there and were totally contrary to the results. You cannot have an elevated risk on something that has not been measured or observed by you. 0 is 0. The NHS England survey report shows something quite different if fact an EXCELLENT result…….so CQC wrong again !

    We asked for an immediate review and the current response is “ This email is an acknowledgement that we have received your enquiry and that we will respond as soon as possible.

    Kind Regards,

    Primary Care Intelligent Monitoring Team, Care Quality Commission,Citygate,Gallowgate
    Newcastle Upon Tyne,NE1 4PA
    Tel: 03000 616161

    I am not holding holding out much hope here as CQC seems to be a law unto itself...

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  • Vinci Ho

    You see.
    This mess is not just irritating people like me who are labelled as the regular 'moaners' , it infuriates all the other colleagues who normally would not speak out about politics. That is the Achilles' tendon of CQC on this matter.
    What does that reveal about CQC? One word , incompetence. And who should be responsible? We all know the answer......

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