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.’