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GPs to be judged on how 'caring' they are for patients, says CQC

Exclusive Practices are set to be given an individual risk rating and be subject to inspectors making a judgement about how ‘caring’ they are to patients, under a package of changes to weed out bad GP care planned by the CQC in the wake of the Francis Inquiry.

The risk assessment is currently being developed for hospitals to determine the frequency of inspections, with those identified as ‘high risk’ inspected more often and more thoroughly than those at lower risk.

The CQC told Pulse that the risk ‘metric’ would extend to GP practices and that the regulator’s GP Advisory group had also decided at a meeting last week to begin work on introducing a ‘judgement element’ into GP inspections based on five domains - including how caring practices are to patients.

But the GPC said that there was a danger the measures would fail to capture the complexity of general practice and could be ‘misinterpreted’ by the public.

The move comes after NHS care came under increasing scrutiny following the publication of the Francis Inquiry into the failures of care at Mid Staffordshire NHS Foundation Trust.

In the wake of the report, health secretary Jeremy Hunt announced he was considering introducing a chief inspector of primary care who would oversee the regulation of GP practices and make the final call on poorly performing GPs.

Pulse reported in 2009 that the CQC wanted to develop risk profiles of practices in order to take action against those providing bad care more quickly, based on a raft of information, such as numbers of complaints, surveys of staff and patients and the commission’s inspections of practices.

The CQC told Pulse they were now developing this risk scoring metric and it would be based on the one developed in hospitals.

A CQC spokesperson said: ‘We are learning from the introduction of a risk assessment in hospitals and this will feed across the field. We expect this to evolve into a metric for primary care.’

The 20% of hospitals considered ‘excellent’ will be inspected once every five years, hospitals considered ‘good’ inspected once every three years and those performing less well inspected more frequently, depending on their stratification. Five national teams who will be sent to the most challenged hospitals to carry out ‘deep dive’ inspections.

But the CQC said it was not able to say whether low-risk GP practices would have a reduced frequency or depth of CQC inspections. GP practices are currently inspected once every two years, with ‘themed’ inspections at any point if there is a need across the NHS, and ‘responsive’ inspections if the CQC feel there is a problem that needs to be followed up on.

They also confirmed they are considering introducing a ‘judgement element’ in GP inspections - as first proposed by Mr Hunt, who said it would prevent mere ‘box-ticking’.

The element will be based on five domains - including how caring, well-led and responsive services are to patients - will form the basis for how practice performance will be made public on the CQC website, in an effort to make the process more accessible to the public.

They added: ‘The GP Advisory group is working with the CQC to match outcomes to the five domains. This will be a co-operative project with the profession, it won’t be forced on GPs.’

But Dr Richard Vautrey, GPC deputy chair, said the five domains over-simplified general practice, and the CQC should be cautious about how these questions are used in inspections.

He said: ‘There’s a danger if general practice is being boiled down to those five questions. General practice is very complex, having simple answers to those questions, the complexity won’t be captured. The detail of how GPs will be measured against those questions will be important.’

He voiced concern about a risk metric to categorise practices: ‘There would be a concern if practices were being judged in that way, causing consternation amongst patients.

‘It would be extremely important to explain to patients exactly what the judgement meant. GP practices are not hospitals, and shouldn’t be measured in the same way. GP practices are much more vulnerable to judgements that are misinterpreted by the public.’

The five domains inspectors will measure practices on as part of the ‘judgement element’ of inspections:

Are services safe?

Are services effective?

Are providers caring?

Are providers well-led?

How responsive are providers to feedback from users?

Source: CQC


Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

Put your questions on how to avoid a career-ending complaint to our panel of experts at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

Readers' comments (17)

  • Trouble is that some patients, if they do not get their own way, eg are not prescribed antibiotics when it is not clinically appropriate or are declined to be referred to secondary care for excema/dermatitis care (which can be well managed in general practice) will be able to say how uncaring we are. Yet another reason to retire early and get out in one piece whilst we can!

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  • Do we have any information on the CQCs "GP Advisory Panel" - how recruited, remit, TOR, accountability - and what the spokesperson meant by "This will be a co-operative project with the profession, it won’t be forced on GPs."?
    The problem with this type of approach is that the details will almost certainly end with a lot more boxes to tick - and be almost impossible to evaluate!
    What happens when the Inspectors have had a personal bad day?

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  • Hello micro management.

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  • Don't see that these requirements are particularly unreasonable. The problem is one of perception - to outsiders, everything that is suggested to improve Primary Care is opposed by a vociferous minority. I think we should just get on with it.

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  • Another 'bucket of stuff' that Harold Shipman would have probably sailed through.

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  • Thank Goodness I work in Scotland and will be spared this utter nonsense! Like many other knee-jerk initiatives, this will not weed out dangerous or "uncaring" practice. The response to Harold Shipman is way OTT and would not find him out. Busy GPs who don't spend precious time chatting could be labelled as uncaring, when in fact they are carefully assessing investigating diagnosing and treating. This over-regulation and micro-management has to stop. Just let us get on with our work instead of interfering and every possible chance

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  • "such as numbers of complaints"today we had a complaints meeting of our gp' in all.three of them were half truths mixed in with some lies,the other four were so frivolous that it was shocking to read of them went like this."no one told me i had to put in a request for my repeat prescriptions"!!cqc please be carefull of the numbers game.they mean nothing without analysis.

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  • I'm a duty doctor on every monday, arguably the busiest day of the week. Even my regulars find me astute on mondays (infact most of them have learnt not to see me on monday for non urgent problems). But what do you expect when I'm making close to 70 clinical contacts (about 50 face to face and 20 phone calls) in a day!

    I doubt it has anything to do with improving the quality of primary care - more GP bashing to satisfy politician's agenda.

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  • Neither quality nor care, its simply another tool to sap the spirits of the profession. Funds spent on this would be far better used to pay for something useful like cognitive behaviour therapy so patients don't have to wait 6 months but that really would be care.

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  • " some day a real rain will come and wash all the scum off the streets"

    Travis Bickle in Taxi Driver

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