This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

GPs buried under trusts' workload dump

GPs to be interviewed to measure their compassion, says CQC lead

Exclusive: CQC inspectors will measure how caring and compassionate practices are by speaking to GPs, as well as staff and patients, to ‘get a sense of the practice’s values’ under plans being formulated by the regulator.

In an exclusive interview with Pulse, Professor Nigel Sparrow, national professional advisor for primary care for the CQC, revealed that the regulator was looking at ways of measuring practice values in an effort to make the inspection regime more ‘holistic’.

He also indicated that the frequency of the inspections would be risk-based, with practices where there has been safety concerns being inspected more frequently.

This follows health secretary Jeremy Hunt’s announcement last month, of a ‘rigorous’ new inspection regime of GP practices, which included a revamp of the way inspections were carried out and a new chief inspector of primary care.

The CQC began its inspections of practices just two months ago, with practices due to be inspected every two years by the regulator. But Professor Sparrow revealed that the regulator was already looking at how it can improve the inspection regime to take account of the ‘less easily measured aspects of general practice’.

Professor Sparrow said: ‘Currently we [the CQC] have lots of information sources, lots of metrics, but they don’t include the things to do with care, compassion and values. It goes back to the idea of holistic care.

‘We will look at this, but I think the only way to measure these things will be for inspectors to talk to people in the practice, that way they will get a sense of the practice’s values. We really want to find out: is the system well led, safe, caring, is it responsive to people’s needs?’

Professor Sparrow confirmed that this included speaking to GPs. He said: ‘When I used to visit practices for training practice accreditation, I used to spend a few minutes sitting in the waiting room and those few minutes were extraordinarily valuable.

‘They are not the things you can measure through numerics, but it gives you a general impression of the culture of that practice and how caring and compassionate those staff are, and I think it is important that we include that in our inspection regime.

‘When you discuss the way that the practice functions with a doctor, you get an idea of the culture and ethos of that practice and that builds into the dataset. So we look at data, we listen to patients and we talk to people.’

Pulse revealed last month that the CQC was planning to measure practices on five domains, including how caring they were for patients, and this is the first indication of how they may be applied.

Professor Sparrow also confirmed he anticipated a move towards practices deemed at high risk inspected more frequently than those deemed less risky to the public.

He said: ‘We haven’t decided on frequency, but I think it will be largely risk-based. Any practices that have declared non-compliance will be visited sooner rather than later, and those where safety concerns have been highlighted. So it will be about risk-based assessments. We don’t want to be visiting practices unnecessarily.’

He added he expected that each inspector would have a GP, practice nurse or practice manager present at all inspections to advise them. So far the CQC has appointed 65 GPs, practice nurses or practice managers to accompany inspectors, but it is looking to recruit ‘as many as possible’, he added.

A CQC spokesperson said that from July the CQC will begin a public consultation on the set of fundamental standards that all health and social care providers should meet and that next year there will also be a consultation specifically on how primary medical services should be inspected.

He confirmed it is likely that this will be led by the new chief inspector of primary care once they are in their role, but it will be informed by a stakeholder’s advisory group that includes GPC, RCGP and Family Doctors Association representatives. The CQC said they are still in the process of defining what the chief inspector of primary care’s role and remit will be.

Dr Mohammed Jiva, medical secretary at Rotherham and Bury LMC questioned how care and compassion would be measured, and said it would rely on individual inspectors’ perceptions.

He said: ‘The question I would ask; what tool will be used to measure compassion? Is it going to be patient feedback, carer feedback, professional feedback? It needs to be evidence-based and something that can be applied nationally.

‘Part of this relies on individual perception. The GP may be put in a difficult position because of local commissioning requirements. They GP can’t give the patients what they want due to commissioning restraints. The patient perceives they are not compassionate and understanding. The CQC will need to ensure that they understand that this is not the GP’s fault.’

Readers' comments (44)

  • We are patient health advocates, sometimes you have to be unkind and not compassionate to help patients change behaviour , and to encourage self management behaviour.

    Unsuitable or offensive? Report this comment

  • What a joke. You cant measure compassion, its an abstract quality, and trying to measure it just feels like another slap in the face for hard working general practitioners. Government needs to RACK OFF!!!

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    I recommend CQC to have a role play included in their training programme for these assessors or inspectors where the actor to be interviewed would play Harold Shipman 😳

    Unsuitable or offensive? Report this comment

  • May the best actor win.

    Unsuitable or offensive? Report this comment

  • I tend to find that people with small feet are very compassionate. CQC should check shoes sizes.

    Unsuitable or offensive? Report this comment

  • @Anonymous | 12 June 2013 7:48am

    We're all government's lackey's now..stopped being patient's advocates a long time ago but sounds good when taking your MRCGP

    Unsuitable or offensive? Report this comment

  • The cynicism in the comments above just go to show that there is a huge rot at the heart of general practice.Good on you Prof Sparrow; we need to weed out the bad apples.Medicine should be for those with a vocation not money grabbers

    Unsuitable or offensive? Report this comment

  • Tom Caldwell

    Really Prof
    "‘They are not the things you can measure through numerics, but it gives you a general impression of the culture of that practice and how caring and compassionate those staff are, and I think it is important that we include that in our inspection regime."

    You wish to include things that cannot be measured in your inspection regime......

    This from the CQC which is still deciding what it's standards are and a Chief inspector of GP's who's remit is still to be decided.

    Unsuitable or offensive? Report this comment

  • Ther is cynicism in the profession when it has been treated in a cynical way by the political class.How will they sort out the compassion fatigue which is rampant throughout the NHS.

    Unsuitable or offensive? Report this comment

  • If I decide not to play 'ball' with the inspectors, does this prove my practice is not compassionate? On the other hand, if I can 'ham it up', does this prove my compassion?

    Unsuitable or offensive? Report this comment

  • Anon 8:38

    I can only assume you are not a GP, or if you are very inexperienced.

    Perhaps you would like to engage your brain a little. Compassion cannot be measured. It is not even defined. You cannot enforce a one fits all idea of compassion to a diverse society - which is why GP with local and individual knowledge of the patients are valuable.

    We are also providers of health care, not just clinicians. As NHS have limited resources, part of our duty is effective use of this - it means we will have to manage the conflict of interest between patient's desire and the cost effective medicine. You may appear to lack compassion if you decline to do a home visit for a patient who is capable of going out but thinks having to use a bus is too much of a hassle and taxi is too expensive (believe me, I gets few of this), yet if I started to be "compassionate" I'll only manage to see 10 patients in a day, rather than 40.

    I'm afraid it is people like you with such shallow thoughts who is fueling the politician to bend the NHS to suit their political needs, when it should be designed to improve the nation's health.

    Unsuitable or offensive? Report this comment

  • You can measure compassion.Remember that scene from Clockwork Orange:you pin someone down forcing their eyelids open and paralyse their eye muscles.Then you make the subject watch violent images and see if they show delight or not.The great thing about this method is that coupled with aversive conditioning (ie:electric shocks) you can train compassion into the subject.So if the CQC adopts this method not only can it potentially detect but also cure us GPs of hypo-compassionism

    Unsuitable or offensive? Report this comment

  • 12 hour days without meal or tea breaks, are not particularly conducive to compassion. What does the CQC recommend I do about that?

    Unsuitable or offensive? Report this comment

  • Anon 08:38
    You really show your understanding of human nature-get in there Prof Sparrow, beat some compassion into the professionals who are measured assessed, validated and inspected to within an inch of their lives.
    In fact, we all signed up to care for people with compassion and dignity, but this is being extracted from the profession (like so many others) by insulting levels of scrutiny!
    "The beatings will continue until morale improves" as someone once said!
    And I have size 5 feet!!!

    Unsuitable or offensive? Report this comment

  • So if we as a group are so beaten up and demoralised why are we encouraging more youngsters to go into general practice?

    Unsuitable or offensive? Report this comment

  • Isn't this what corrupt governments in developing countries already do?

    "We will inspect you based on MY opinion. You'd better look after ME if you know what's good for you" seems to be the order of the government officials in such country.

    I suppose Prof Sparrow wish us to take a backward approach does he?

    Unsuitable or offensive? Report this comment

  • This comment has been moderated.

  • AS a former clinical psychologist and currently practising gp I can assure you there is no psychometric test currently inuse to measure compassion that hashigh reliability and validity

    Unsuitable or offensive? Report this comment

  • I want to know whether we're really short of money or not because it seems there is alot to throw about.We already have patient feedback questionnaires and now the state wishes to introduce this.How is this going to "improve" upon what already exists?

    Unsuitable or offensive? Report this comment

  • Could BMJ learning quickly organize an online module in how to appear compassionate please.or could the CQC front man point us towards a role model.perhaps dr sparrow himself could be one.

    Unsuitable or offensive? Report this comment

  • As women are deemed to be more compassionate than men and general practice is now predominantly female this is effectively a non issue.Keeps the likes of Prof Sparrow in his ivory tower but otherwise a complete waste of taxpayer's money

    Unsuitable or offensive? Report this comment

  • Anon @ 11:27

    I think it'll be us funding CQC so that they can criticize our lack of adherence to their perception of compassion. In which sense they are not eating NHs money, just our incomes.

    I understand S&M is the only other industry where you pay to be flogged.

    Unsuitable or offensive? Report this comment

  • this country has gone bonkers

    Unsuitable or offensive? Report this comment

  • The CQCs ringmasters have shown superb compassion to the profession by giving us 6 effective paycuts, increasing costs to practice and to receive a pension; being in cahoots with the press to pedal incorrect figures blaming us for the A+E crisis, inspecting us more, causing our CCG collegues to micromanage everything we do, being so restrictive on tendering that GPs will be blamed for more NHS failures as commissioners without the being able to wield real change. Let's see how compassionate I am when my contract terms are made worse or i get out and become a patient counting, clock watching employed person.
    Burning over and out

    Unsuitable or offensive? Report this comment

  • Wednesday pm double appointment very compassionate, late friday pm duty surgery not so! Have these people got nothing better to do. Are there any other countries in the world that bother with all this ....

    Unsuitable or offensive? Report this comment

  • The childishness of these comments is just laughable. I know GPs are in a rut and feel demoralised at the moment, for some valid reasons too, but still.

    Surely you agree that a) good care often involves compassion as well as many other things b) as a public service, its right that GPs are held to account for the care they provide and c) it'll be difficult to do this in a perfect way but its right that an attempt is made to uncover examples of poor care or callous treatment in primary care.

    If you agree with all that then the best thing to do is engage with the issue, get on board with the consultations, be constructive
    and try to shape things in your interest, not throw your toys out of the pram based on a headline.

    Unsuitable or offensive? Report this comment

  • This comment has been deleted by the moderator.

    Unsuitable or offensive? Report this comment

  • Anon. 12.43 - what an offensive and patronising comment! We are done to death with the tick-box, "if it moves measure it" culture. There are things that can't intelligently be measured - and if anything falls into that category, then "compassion" does. As someone else has already pointed out, Harold Shipman would have sailed through any such test with flying colours - judging by the adoration that we're told his patients felt for him. How much more dangerous it would be to have a GP like that formally certified as "compassionate".

    And no, I am not a doctor. I just believe in intelligence and fair-mindedness - and despise the mindless application of "measure and rubber-stamp" when applied to things that the assessors probably wouldn't have the intelligence to know if they saw it.

    Unsuitable or offensive? Report this comment

  • Anon @12:43

    I think you might be a little confused. As an individual clinician, none of us are opposed to compassion. However, as an organization funded by the tax payer, we are obliged to look beyond what happens on individual basis.

    Tell me if you know of ANY organization which gets compassion inspected. There are plenty of public funded organization out there - police, social service, education, transport, MPs to name a few.

    As for GPs being held accountable, have you actually considered the fact GPs, even as a collective, do not have full control of the health care system? DoH decided on budget (believe it or not, health care costs!), health targets, structure of health care system. Secondary cares are independent organization from primary care where they have their own agenda. Advisory organization such as NICE and SIGN publishes guidance and regulatory body such as GMC and CQC decides on acceptable limit of practice. And of course, CCG exerts it's own layer of restrictions and limitations to comply with governmental pressures. Before you ask, GPs do not have the control of CCG (if you don't even know this, you really should refrain from making statements like the one you made).

    So, how do you propose to separate out the bits GPs are responsible and bits which we have no control over? But I guess you have no interest in doing that as you are merely interest in bushing the easiest person to bush.

    Unsuitable or offensive? Report this comment

  • Please do not feed the troll

    Unsuitable or offensive? Report this comment

  • Anon 8.38 / 12.43 .... sad really. The message here is loud and clear if you were compassionate and empathetic enough to read it ( through the lines!)
    My gut instinct is many of the people who are angry and frustrated and furious about this nonsense and are saying so .. with some vigour ... i am glad to say are often in my experience the most empathetic of GPs. They just don't go about reflecting on it ... they just do it! For many it is this relationship that is fundamental and core to what we do. Beig told more and more how we should do everything. Being measured in many areas where there is little value ... but you have to spend time keeping the auditors happy means that many of us are spending less and less time doing things that WE used to do and some of us value. Let me give an example. For years I did combined antenatal clinics with Jill the midwife I worked with. We would take turns with the patients. For 14 years I did intrapartum care ... (for which I was paid the same amount as for removing a coil). We were on call for our patients whether we were on call or not for the practice ... which might mean being around a whole weenend when we were off. After deliveries I always saw mothers at home. Now we dont do intraprtum care, it seems to me that the mothers get very little ante natal care and I now phone them at home and then see them as need in the surgery afterwards.
    I am not saying that my view is "right" but I recently reverted to seeing mothers antenatally again as they seemed to get so little support. The get all the tests and scans but little hands on support. It seems to me that in every area .... we used to decide what we valued as professionals. Now we spend our time as others see fit. What is more they will soon want us not only to be compassionate but smile and look happy while we are doing it.
    GPs will only truly relax and be compassionate when allowed to do a professional job in a professional manner. When they are allowed to feel that it they and their patient that matters and not either the government or a distant professor.
    It is interresting for me that for 15-18 years working long hours, doing our own intrapartum care, running two hospitals and a minot injury unit 24/7/365 I adored this job. Now recently reired I am happy to other things but miss my ptients every day. Miss the new NHS ... not likely!!
    Lastly took my son recently to look at medical schools .... he is keen! If he asked me I would strongly recommend medicine. However I would recommend he works in the third world where he can do good or in another country where professional values are still valued as opposed to derided.

    Unsuitable or offensive? Report this comment

  • What happens if we fail the compassion criteria? Are we to be re- educated or simply removed from the register ? There is no point in doing an investigation unless it alters the management of the subject. I think it should be made clear what happens if one is deemed to be sub- compassionate

    Unsuitable or offensive? Report this comment

  • What a joke! I suppose CQC has to justfy their existence! This is now getting beyond ridiculous

    Unsuitable or offensive? Report this comment

  • And there was I thinking the regulatory system was sensible and the GMC regulated the person and the CQC the premises and organisation...............................

    Unsuitable or offensive? Report this comment

  • I think people with blue eyes long hair and eye lashes are more compassionate.

    Unsuitable or offensive? Report this comment

  • CQC haven't got a clue how to conduct a real audit, and are inventing drivel to cover up their shortcomings. Other professions don't have to go through the wringer like this and yet they perform perfectly well

    Unsuitable or offensive? Report this comment

  • I fail to see how a GP can be expected to dollop up a good degree of compassion while this 10 minute time slot continues. There's hardly time to achieve anything other than a cursory 'hello, here's a prescription and goodbye' ...
    Maybe a stop watch should ding at 5 minute intervals reminding the GP to shed a tear or look sympathetic while he rushes through the on-screen data

    Unsuitable or offensive? Report this comment

  • Spuds

    What a load of utter garbage. Is the venerable Prof really paid to come up with this stuff?

    Any they wonder why morale is low and people are desperate to find a way out of General Practice. What a waste of time and what an unnecessary increase in stress to prepare for yet more scrutiny, this time regarding something which is completely unprovable one way or the other.

    It's all so so depressing.

    Unsuitable or offensive? Report this comment

  • I forgive Prof Sparrow and his ilk for they do not know that they do.They're just following orders.Hired guns for the kill that's all.

    Unsuitable or offensive? Report this comment

  • Can see there will be CPD workshops in acting soon

    Unsuitable or offensive? Report this comment

  • wat a f**** joke...since when u can measure compassion....so we need to become nice to patient no matter how unreasinable they are so we can score high on compassion...God!! i dont know what these inspector thinking off!!!

    Unsuitable or offensive? Report this comment

  • Actually you don't need to measure anything.Just keep tightening the tumbscrews and the moneygrubbers (sarcasm intended) will leave until you're finally left with a residue of "the compassionate ones" to be at your constant beck and call

    Unsuitable or offensive? Report this comment

  • now here is word compassion fatigue never thought of it but can feel it, its horrrible to be compassionate all the time, when you know the person is a lzy git

    Unsuitable or offensive? Report this comment

  • What a load of crap

    Unsuitable or offensive? Report this comment

  • I'm not at all caring or compassionate after a Monday on call ..........should I leave now ?

    Unsuitable or offensive? Report this comment

Have your say