CQC sets out plans for unannounced GP access inspections

Exclusive The CQC has outlined its framework for unannounced inspections into patient access at GP practices, with the first inspection taking place last week.

Pulse has also learned that the focused inspections will not result in any change in ratings for practices.

The news comes as the CQC’s chief inspector of general practice has said that ‘all’ concerns raised about GP access will be followed up – although not all will result in unannounced practice inspections.

It also comes the CQC confirmed last week that ‘routine inspections of practices will continue to be paused’ and ‘only risk-based assessments undertaken’ where ‘deemed critical to safety and quality’, as part of a bid to free up GPs to participate in the expanded Covid booster programme.

The unannounced access inspections – which were announced as part of NHS England plans for improving access to GP practices this winter – are focused around a series of statements.

A CQC spokesperson explained these would help CQC inspectors to ‘structure conversations during the inspections’ and to ‘understand how the practice is handling pressures around access, any challenges they may be facing, and any action that the practice has taken manage and improve access’.

The statements are:

• Patients had timely access to appointments/treatment and action was taken to minimize the length of time people waited for care, treatment or advice.

• The practice offered a range of appointment types to suit different needs (e.g. face to face, telephone, online).

• Patients were able to make appointments in a way which met their needs.

• There were systems in place to support patients who face communication barriers to access treatment.

• Patients with most urgent needs had their care and treatment prioritised.

• There was information available for patients to support them to understand how to access services (including on websites and telephone messages).

• There were enough staff to provide appointments and prevent staff from working excessive hours.

• There were systems in place to monitor the quality of access and make improvements.

The CQC has previously stated that the inspections on access will be ‘supportive’ to practices and the spokesperson stressed that they are not ‘a departure’ from what the CQC already does ‘in terms of responding to risk and concerns we might receive, including around access’.

‘We are continuing to respond to risk as we have during the pandemic but we will now use these focused questions to better understand and report the challenges a practice might be facing around access. As a focused inspection, it will not lead to any changes in rating,’ the spokesperson said.

The news comes as a recent CQC board meeting heard that feedback received regarding primary medical services has significantly increased since the start of the year – by 161%.

CQC chief inspector of primary medical services Rosie Benneyworth told a CQC board meeting on 17 November that the lion share ‘relates to concerns that we are seeing about access to care in general practice’.

‘The vast majority of that increase, unfortunately, has been negative sentiment rather than positive sentiment, but we are monitoring that very closely.’

She added: ‘We are working at the moment to look at how we follow up. We are following up all of those concerns that are raised with us and inspectors have that information which they are looking at as part of their review of providers.’

The CQC spokesperson explained that CQC inspectors ‘review’ all the information that is provided via patient feedback.

‘This is part of our normal ongoing monitoring so could inform the regular reviews that we undertake of all providers, lead to an inspector reaching out to a practice or help inform future inspection activity – for example helping to guide what we may need to look at on an inspection’, they said.

Adding: ‘As ever, we respond proportionately to risk and the information that we have about a service – we would only inspect if it was necessary due to the nature of the concerns.’

It comes as NHS England’s GP Access Plan, released in October, said the CQC was ‘rapidly developing an inspection methodology with a particular focus on access to GP services’. 

It added that the CQC would make unannounced inspections ‘wherever appropriate’.

The GP Access Plan included proposals for the CQC to work with NHS England to ‘make the required improvements across those practices which are not meeting people’s reasonable needs’.

ICSs were told to identify the 20% of practices that were performing worst on a range of metrics, including percentage of GP appointments that were face-to-face, CQC complaints data and the rates of 111 calls from their patients during GP hours and of A&E attendances ‘compared to what would be expected’.

But Pulse revealed that the data NHS England has given ICSs to help them identify the 20% of local GP practices to face action on access was based on a one-month ‘snapshot’.

Meanwhile, NHS England is yet to publish regional plans to improve access to GP practices which it said would be agreed by 19 November.