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Independents' Day

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)

  • 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.

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  • this country has gone bonkers

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  • 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

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  • 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 ....

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  • 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.

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  • This comment has been deleted by the moderator.

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  • 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.

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  • 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.

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  • Please do not feed the troll

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  • 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.

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