CQC should be able to issue GP ratings remotely, says LMC

The CQC should be able to issue GP practice ratings without an on-site inspection, an LMC has suggested.

Londonwide LMCs made the request as part of their response to a Government consultation launched last month, asking whether CQC regulation is ‘appropriate and proportionate’.

Currently, a GP practice must be inspected in person to receive a change in rating, which the LMC argued is ‘limiting for CQC and demoralising for practices’, as it said improvements by the practice are not sufficiently recognised in remote inspections.

Londonwide LMCs said: ‘As CQC is moving away from the traditional style of inspections and into more remote monitoring post-pandemic, we would like to request that law makers make the necessary changes to the regulations to enable CQC to issue ratings without having to cross the practice’s threshold.’

The LMCs receive ‘regular feedback from practices that physical inspections can be not only disruptive and stressful,’ it said, ‘but most importantly, any improvements made by the practice will not be taken into account and will not affect their rating until there is another on-site inspection’.

Londonwide LMCs added: ‘We believe this is limiting for CQC and demoralising for practices, particularly when they want to move away from a Requires Improvement rating or move out of Special Measures (Inadequate rating) but cannot see their hard work being recognised sometimes for years, as the CQC is currently unable to update a practice’s rating without crossing the threshold.’

The processes of the factual accuracy report and ability to appeal ratings should remain the same for ratings awarded remotely, the LMCs said.

It added that practices should be able to request an on-site inspection ‘if they have reason to believe that the assessment and rating they received through a remote inspection was unfair or not sufficiently evidence-based’.

On the 2014 Regulations, the entire premise of which is risk-based, Londonwide LMCs said: ‘While this is appropriate, we have seen many examples of excessive criticisms in practice inspection reports and also poor ratings on the basis of perceived, but not necessarily proven risk.’

Londonwide LMCs added that its experience of supporting practices shows a ‘lack of proper understanding of the realities of running a GP practice; and lack of understanding of cultural differences’.

It added: ‘Depending on the lead inspector involved, there may be standards expected that are not required in the practice’s contract or the regulations themselves. Practices are expected to continuously improve regardless of the challenges they are facing in terms of capacity, workforce and an ever-increasing workload. Good practice or “nice to dos” are often translated into “musts” and the bar keeps getting higher, which is simply not sustainable.’

Londonwide LMCs’ consultation response highlighted examples where they believe the CQC did not act proportionately: ‘A practice was criticised because the pull cords in their toilets were not clean and were advised to install plastic covers. 

‘The practice did as advised, but on re-inspection they were criticised again because despite the plastic covers, the pull cords were still not clean underneath.’

Another example said: ‘We had a prospective partner who applied to join a practice’s registration and their application was returned as they had not explained an employment gap of two months in their CV. 

‘While we appreciate that Regulation five expects applicants to explain gaps in employment history, we considered that a two-month gap was not significant enough to warrant further explanation.’

During the pandemic, the CQC switched to a system of ‘remote’ monitoring for GP practices.

In May 2022, the CQC said it would use ‘inspection activity that is more targeted and focused on where we have concerns, without returning to a routine programme of planned inspections’.

Last month the CQC said it was ‘considering what is the best model’ for primary care regulation.