Is the CQC’s inspection regime fit for purpose?
Peter Higgins says the regime guarantees high standards in practices but Dr Peter Swinyard argues that the inspections completely miss the point
The CQC has given us clearly defined measures by which practices can be reviewed.
The actions of inspectors are consistent, proportionate and fair in most circumstances; we are rarely surprised by the conclusions they reach.
Even though our profession has labelled inspections as another drain on precious time, the vast majority of practices sail through with little trouble. And while practices risk being branded ‘not safe’ in the local newspaper, they equally have the chance to be publicly praised.
The system should be commended for providing an invaluable system to flag up practices that are compromising patient safety. Practices identified as ‘requiring improvement’ shouldn’t have survived so long without basic governance systems – this breaches the requirements of their contract.
For instance, none of us would want to be treated in a practice where staff aren’t aware of a nurse’s career history, or whether she has been CRB checked. The same would go for a surgery where staff have no training or professional development, or where there is no feedback to improve services.
In many of these cases, GPs might be up to date with their clinical skills, but let down by a lack of organisation. The CQC gives these few practices a wake-up call, which previous systems failed to do.
The CQC is an essential component of the reform that has seen commissioners drive down contract prices and providers cut costs to stay in business. It was created to safeguard quality and give an independent, consistent and uniform view on quality of care, and it is succeeding in doing so, even though it still faces a significant challenge to prove this.
The CQC’s regime is far more effective than that run by PCTs, and I’ve witnessed this first hand working with the new regional managers on behalf of my LMC. We formed an early alliance to get an insight into how they would tackle inspections so we could advise practices on how to prepare. We also invested heavily in workshops and reference material. CQC managers and inspectors in turn have been sensitive in introducing this regime and sympathetic to practices as they adapt to the new requirements.
We don’t need to fear an organisation that is committed to quality and high standards. Instead, we should turn this to our advantage by lobbying for resources to improve our practices.
Peter Higgins is chief executive of Lancashire and Cumbria LMC.
The CQC’s method of prioritising box-ticking over improving quality of care will never make for a robust inspection process. Much of its inspection regime is built around looking at statistics that are seldom put in context. Take the scurrilous ‘risk ratings’, which should have been an internal management tool and yet were published with little explanation, damaging practice reputations. Some of the criteria are bizarre – it’s still not clear why ratings are reliant on QOF results for retired indicators when the framework is voluntary.
The damage of a poor CQC report is immense. Although practices put in ‘special measures’ are given support, no amount of extra help will make up for the negative consequences of being publicly named and shamed. Recruitment is already difficult and it’s hard to imagine good staff wanting to work in a practice tainted by a negative report.
Moreover, you only have to look at the plethora of expensive software solutions designed to help practices pass inspections to realise there is real paranoia among GPs about preparing for a review. Does the CQC think the time spent drawing up a stack of protocols filed in the back office has done anything but take resources away from the job of looking after patients?
We also must not forget that the cost of inspections is detrimental at a time of severely falling GP incomes. GPs are the only NHS doctors who have to pay for inspection. We get no reimbursement.
What the CQC is failing to measure is the one factor that really matters – the quality of the consultation. Various proxies for consultation standards – QOF scores, patient feedback ratings, NHS Choices feedback, and the Friends and Family Test – are all likely to misleadingly suggest low quality because they take place without moderation, checks or balances. CQC inspections check whether you’ve got the right drugs in the cabinet, but can do little to ensure that a GP is prescribing these properly. They check how many internal meetings a practice has recorded, without any idea of what has been discussed. I accept that the CQC is trying to move away from this to talking to staff and patients, but the protocols are still required.
CQC inspections would work much better if inspectors dispensed with the tick boxes and sat in consulting rooms, congratulating their colleagues on the areas where they performed well, and advising on urgent improvements.
Dr Peter Swinyard is a GP in Swindon and chair of the Family Doctor Association.