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Hunt to announce new 'rigorous' inspection regime for GP practices to improve patient care

Health secretary Jeremy Hunt will announce a new ‘rigorous’ inspection regime of GP practices this week, with the appointment of a new chief inspector of primary care to raise standards the Department of Health has revealed.

According to a briefing ahead of the speech, the DH said that Mr Hunt would announce a move away from the ‘box-ticking culture’ in the NHS and a return to the idea of the ‘family doctor’ so that patients know who is untimately responsible for their care.

He will say that one of the reasons for the recent pressure on A&E departments is because patients are going to A&E because there is no ‘credible alternative’. 

He will add that a new ‘rigorous’ system of inspection will be introduced to see the focus put firmly back on whether GP practices are providing effective and responsive care for all. A new chief inspector of general practice will be appointed to make sure this happens.

He will add that he wants a similar situation as in hospitals where a named doctor is responsible for the care provided at all times, and that they are clear the ‘buck’ stops with them.

Mr Hunt will say: ‘As a member of the public, I want to know my GP. And I want my GP to be someone that knows me and my family.

‘Yet we’ve turned GP practices into places where it’s a daily challenge for receptionists to cope with huge call volumes and GPs to get through to all the people they need to see.’

The Daily Mail also quotes the health secretary saying: ‘Everyone agrees that hospitals should only be a last resort for the frail elderly and that – for someone perhaps with dementia and other complex conditions – A&E departments can be extremely confusing places.

‘But what alternatives do we offer? GP surgeries where it is often impossible to get an appointment the next day; same day appointments but only if you call at 8 o’clock in the morning sharp and are lucky getting through; long waits on the phone to get through, sometimes at premium rates; difficulty in registering with another practice if you move home, or aren’t happy with the service you are receiving; out-of-hours services where you speak to a doctor who doesn’t know you from Adam and has no access to your medical record.’

It comes after Mr Hunt gave his clearest indication yet that he expects GPs to take back responsibility for running out-of-hours services.

Speaking on the BBC’s Politics Show yesterday, Mr Hunt said: ‘I think we need to go back to GPs having responsibility for making sure that for the people on their list there is a good service available.’

Deputy GPC chair Dr Richard Vautrey said he was waiting to hear details of how the new inspection regime would work.

He told Pulse: ‘It is essential that they will take a reasonable, pragmatic and proportionate approach to general practice inspections and regulation, understanding that we are not working in a sterilised operating theatre but a consultation room that mother’s regularly wheel prams in to.

‘In addition any attempt to introduce simplistic summary scores for general practice will not help inform patients about the quality of care we offer. We provide a complex service and this cannot be boiled down in to a simplistic and superficial judgement.’ Click here to read Dr Vautrey’s full comments.

RCGP chair Professor Clare Gerada said that the college supported any plans to promote better quality in general practice.

She said: ‘[We] are open to working with the Government and the CQC to devise a system that is going to create the right incentives to improve standards, including whether there is a case for introducing a chief inspector of primary care. But this must be done without adding to bureaucracy or creating a crude system of overall ratings for GP practices.’

‘Rumours of Ofsted-style inspections and tougher regulation are unhelpful and extremely demoralising, especially at a time when GPs are already heaving under the pressure of a bureaucratic and stifling tick box culture.’

 

Readers' comments (35)

  • this is the tory agenda and always has been make working conditions intolerable and slash income,they think doctors have nowhere else to go but they do,the only effective response is mass resignation from the NHS at a date set in the future election day for example

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  • "Yet we’ve turned GP practices into places where it’s a daily challenge for receptionists to cope with huge call volumes and GPs to get through to all the people they need to see." - In that statement my Hunt he must acknowledge it is their fault and not ours!!!

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  • Let common sense prevail

    I quite agree. Mr Hunt is taking responsibility (on behalf of successive governments) for taking general practice to the brink of collapse through increases in workload and squeezing of resources, but announces that the solution is to employ an inspector with a rigorous inspection regime. This rather conjures up images of the enormous man with a large whip who drove on the slaves as they rowed the Roman galleys into battle.

    My analysis...
    Problem: too much demand, poor resources
    Solution: more GP's, staff and improved premises

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  • Let common sense prevail

    P.S.
    I have no difficulty with GP's being responsible for providing a first class primary care service. After all we have the track record of achieving every target that has ever been laid at our door, and we are by far the most cost effective sector of the NHS. But if you want a world class service this will require investment. There is no other way.

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  • I agree with both of the above. He is accepting that "they" have caused changes in general practice which are bad for patients and GPs. I for one would be delighted if he would steer the ship back to better waters.
    However, who are " they"?
    They are civil servants in the DOH and a certain gentleman called Nicholson. They are also the people who only last month forced a unilateral contract change which is the worst example of tick box culture we have ever seen.
    If he said " lets sit down together and discuss how we can improve things" perhaps we would get somewhere.
    After the contract imposition I am not hopeful.
    Add to this the requirement for " competition" and general practice is doomed. Competition for all services that private providers find profitable, imposition on the mugs for those that they don't.
    Patient choice for everyone except if it does not fit the imposed protocol, in which case blame your GP.
    There has to be accountability for the people who caused this mess, and it starts at the DOH. Where is their vigorous Inspection?

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  • "It comes after Mr Hunt gave his clearest indication yet that he expects GPs to take back responsibility for running out-of-hours services."
    Great, the final nail in the coffin. I give notice of my resignation on 31/3/15 (when the old pension ends, and removes any remaining incentive for working extremely stressful 12 hour days).
    Vote with your feet guys.

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  • "It comes after Mr Hunt gave his clearest indication yet that he expects GPs to take back responsibility for running out-of-hours services."
    Great, the final nail in the coffin. I give notice of my resignation on 31/3/15 (when the old pension ends, and removes any remaining incentive for working extremely stressful 12 hour days).
    Vote with your feet guys.

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  • Over the last 4 years resources going into primary care have decreased as a percentage of the NHS budget and the GP share has plummeted.
    If this goverment wants our co-operation they will have to do better than beat us with a stick.
    Has Jeremy Hunt forgotten that we need some carrots as well?
    I look forward to just over 12 months time when I start drawing my pension - what a sad state of affairs.

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  • Dear Mr Hunt

    This week and on a regular basis I have told patients that the intervention they want will not be offered because there is no clinical evidence that it will make people live longer or healthier lives. I justify this be telling them that the NHS has a duty to only fund interventions that prove a beneficial outcome.

    Sometimes I tell a patient that the intervention is beneficial but will not be funded because the benefit is marginal in relation to the costs involved

    I have yet to see a clinical trial demonstrating the benefit and cost effectiveness of this intervention in terms of people living longer or healthier lives. In such a circumstance I put it to you that this is a waste of money and perhaps bordering on the completely unethical practice of using public (NHS) money for political gain.

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  • What's the saying about constantly weighing the pig doesn't produce the best bacon?
    My partner was told that he was harder to see than the Queen! I'm not certain that this is true but Mr Hunt needs to tackle demand. The buck stopping with the GP is fine if the service or need required is of a GP and their skills. Such as a patient that refused flatly to see a nurse for ear wax and got a GP appointment! This is part of the problem Giving people what they want wins votes and is popular, giving them what they need is right and proper. The public expect too much from too little but no one will stand up and tell them that. I'm 45 and will take my vastly reduced pension at 50 and find other work, as it wont be worth proping up the ponzi scheme that the pension is and I can go and work where I'm valued properly as I've had enough of 12-14 hour days and being accused of being rich and lazy.

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  • Problem: Not enough appointments and not enough doctors wanting to be GPs

    Solution: Invest in more GPs and better working conditions / contracts / premises.
    This is not rocket science!

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  • Mass resignation would focus the government's mind wonderfully.
    Unfortunately the younger and middle aged GPs with mortgages and school fees to pay will never find the guts to do it.
    They will suffer any humiliation the Government dishes out in order to keep their careers and family finances in place.
    As an older GP close to retirement, I would do it without hesitation.
    We as a profession have been abused and bullied long enough to make me ready to resign.
    But I'll bet I'll be doing it individually.
    The profession doesn't have what it takes.

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  • Easy solution is move towards contract based on activity not a block contract

    Every one will be happy patients will get value for money (Longer appts) GP's will be happy as can decide how much work they want to do and Govt probably will never be happy

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  • Aren't we just going around in circles?What has been said has already been said.They know that the majority of GPs have no choice but to grin and bear it.Unlike the lucky some we cannot all mass retire or resign right now:mortgages to pay and all that.We have no alternative employer to go and work for so basically we're buggered.

    If your'e youngster thinking of entering general practice then you better get lubed up and develop an enjoyment for being sodomised!Thats the must have quality for GPs of the future

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  • Nhsfatcat

    Dear Mr Hunt
    Should you insist on further additional inspection (remember CQC are coming soon) please hire me to do them for you; or at least GPs who mostly still work on the front line most of the time. Our leaders and other ex-jobbing drs have no idea what it is like to run a full time busy practice, they think they do as they attend surgery occasionally but have the relief and variety to not have that pressure.
    Do not hire civil servants to do it who have never worked in health, actually, have you?
    Give us proper back fill monies to be covered and you'll get a decent assessment by someone who knows what they're doing, should you insist on wasting this money instead of putting it into the health system.
    Best Wishes for your job prospects in 2015,
    Simon

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  • @Anonymous | 21 May 2013 11:38am

    "Mass resignation would focus the government's mind wonderfully.
    Unfortunately the younger and middle aged GPs with mortgages and school fees to pay will never find the guts to do it."
    ------------------------
    I have more than 20 years service to go, and have mortgage and children but I am prepared for mass resignation.

    The simple fact is (if we all did it) the government would still have to provide an immediate health service. The likes of Virgin, Boots or any other large private provider simply wouldn't have the workforce to come in and take over in one swoop.

    In all probability it would be the end of the Health Secretary at the time and possibly the whole Government.

    There would have to be an emergency mechanism to pay GPs to look after the current population as A&E isn't a viable option for the DOH.

    In the short-term CCGs or NHS England would end up having to pay GPs as locums to look after their own patients whilst a solution or wholesale shift to the private sector is sought.

    That would certainly take time and in during that period the Government might realise that there aren't enough GPs to fill the current 12-14 hours days required.

    Market forces would predominate and at locum rates the DOH would be crippled. We might all end up salaried or in locum chambers but the result must be better than what we have now.

    Independent contractor status is mere fantasy as we have contracts imposed or changed at will and our clinical workload dictated to us on every political whim rather than genuine patient need!!

    So let's talk again about how the younger generation aren't in the mood for mass resignation..

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  • Jeremy Hunt is a stupid clown but ....
    He is going to hand major OOH responsibility to GP by November this year.He would impose a 10 percent pay cut and then doctors have to earn it back by working on Saturdays :-)
    Best wishes .BMA and RCGP and Pulse will make some noises and then every one will be back to work according to his plan.We are fighting a lost battle unless we rip this contract enmass .

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  • Every individual doctor has to weigh up their own personal circumstances, work life balance and preferences. We don't all have to do the same thing. If 10% of all GPs actually retire and a further 20% (like me) choose to resign from partnership to do locums or other things the government will get the message.
    Some people will be happy to continue with the current situation, and good luck to them.
    As for me, resignation already tendered!

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  • Vinci Ho

    Agent Hunt is no M. Gove , much cleverer.
    Fact is OOH is going back to us and he will be promoted on the next cabinet shuffle (or even a challenger to replace Darth Vader) if he successfully conquered this already defeated profession on this 24/7 project .
    GPC?RCGP? Would you want look up to these teachers' unions????

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  • BMA and RCGP and doctors .net and Pulse will make some noises and then every one will be back to work according to his plan.We are fighting a lost battle unless we rip this contract and resign from NHS.

    NHS England is looking at QOF and they will ask NICE to make is less "onerous" for GPs .QOF will then make about 10 percent of income and not 15-20 percent and then this "additional" money will be have to earned back by GP surgeries by opening full service on Saturdays and may be Sunday Mornings as well.

    Groundwork is already under way as a concentrated media attack by Mail,Telegraph abd BBC health teams in guise of AE melt down stories to soften up the GPs so public is on side of Jeremy once he takes on Lazy GPs.

    Pensions ,Pay Freeze,falling income ,scrapped Child Benefits and now weekend unpaid slave labour


    And you guys will keep posting here as anonymous whingers LOL(no offence intended)

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  • If it happens - I'll loose 10-15% of my income, but balance it up by reducing the expenditure by letting go of my staff, including salaried doctor. The result will be less appointments for my patients.

    I'm afraid I'm not prepared to work even longer (50+hrs is enough for me) for less pay. If that makes me a lazy over paid GP, then so be it.

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  • NICHOLSON RESIGNS!,,,,,,,

    Maybe all is not lost?

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  • Nicholson has nothing to do with it.He is not the one unilaterally imposing contracts upon us:a mere puppet and a scapegoat

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  • Does anyone really know the real value of having "own notes"versus emergency care summary. Suspect it's not nearly as useful in preventing admission as has been stated.People get ill at nights and weekends when there is no other support for them around. Are the real problems not long term lack for support for A&E-you heard it understaffed, underfunded not appreciated-an ageing population and unfettered demand for free services? No wonder the system is failing. GPs working all night and weekends won't solve these problems. Look elsewhere.

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  • @Anonymous | 21 May 2013 5:59pm

    Its all rearranging the chairs on the Titanic

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  • @Hasan Habib 21 May 2013 2:35pm

    So you suggest laying off a salaried doctor to maintain your profit margin.I guess you must be sitting on your arse all day doing nothing.For those GP partners who have a full week that's not an option.How are we going to acommodate the extra clinical workload?

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  • Our organisations need to get tougher and mass resignation needs to be a serious option if things are worse and we are forced to do more for less!!!

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  • Returning 24h care to partnerships is a legal minefield that is probably too complex for the government to pull off. I doubt the government can simply shut down OOH companies without a prolonged and expensive fight through the courts. General practice is already pretty onerous so few GPs will be seeking to increase their hours and in this era they can't be forced to with modern EWD law and UK health and safety law banning driving without sleep. Remember you don't need to see much drop in GP numbers to cause primary care to collapse and there is already a looming recruitment crisis.

    Returning to co-ops will reduce salaried/partner GP availability in office hours and might make the whole situation worse as appointments in the productive time of day are reduced if locums are not available. Not only that, there are limited support services at 3am so shifting care to the early hours will reduce efficiency. Ultimately the government will wake up and realize they actually have a doctor shortage and they are unable to beat market forces forever. Salaries can only go one way from here...

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  • "Mr Hunt will say: ‘As a member of the public, I want to know my GP. And I want my GP to be someone that knows me and my family."
    I think that Mr Hunt has slipped into some kind of time warp, or possibly he wishes to undo the last 50 odd years of GP history, if he seriously thinks that it is realistic to have a GP who knows him and his family, who is available both during the day and at night. Even when I started in partnership over 19 years ago, about a year before the formation of the GP co-op in our area, there was no way I knew most of the patients who called OOH as the practice had about 18,000 patients. Also the notes were locked in the surgery (well, 3 different surgeries, actually). Consulting without the notes was a regular and frequent occurrence both in and out of hours.
    I resigned from partnership last year, worn down by 12 hour days and constant box ticking. I shed some tears when I found some old maternity form folders and realised that I could put faces to those names from about 15 years ago more easily than I could remember the patients I had seen the previous week, but I shed no tears for the loss of the old way of delivering OOH. In many respects it was dangerous for both patients and doctors.

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  • How will the Chief Inspector of GP Practices evaluate a surgery without a great deal of box-ticking?

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  • Can anybody explain why any young doctor should choose General Practice as a career in the UK?

    It seems to me to be dead in the water and the carves about to be stripped clean of any 'tasty bits' by being put out to tender to the private sector.

    I would strongly advise them to use the NHS in the UK to get fully trained then head off to better climes both weather wise and career wise overseas.

    For older GPs do what I did. Take VER and free yourself of all the crap being sprayed on you from successive politicians. I can foresee GP collapsing in the next few years so get out whilst you can.

    I'm off to the beach. Good luck.

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  • Why RCGP says it will "support any new initiatives to improve health provided if right incentives are available" - when it is clear that the govt will not give any more incentives. How these people can't understand the motives of govt after being in such responsible positions.

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  • "Anonymous | 21 May 2013 7:07pm

    @Hasan Habib 21 May 2013 2:35pm

    So you suggest laying off a salaried doctor to maintain your profit margin.I guess you must be sitting on your arse all day doing nothing.For those GP partners who have a full week that's not an option.How are we going to acommodate the extra clinical workload?"

    Dear Mr Anonymous

    Have you read my posts at all with your glasses on

    1.) where have I suggested laying off salaried GP?
    2.) Where have I suggested that I sit on my arse doing nothing all day ??????????

    No matter you are the best example of a clueless and defeated profession that DH is beating with a stick every day LOL

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  • Sudheer Surapaneni

    Inspections are necessary but they should not become a tick box exercise, but rather a comprehensive assessment of the systems in place, procedures being followed and areas for more Improvement and the help the Government should provide in achieving them. No point in scapegoating individuals or demonising the practices.

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  • Why do our colleagues in general practice shun out of hours work but welcome lucrative contract ?

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