The CQC is considering ‘OFSTED-style letters’ to patients of practices where it has found unacceptable failings or inadequate care, as the chief inspector for primary care unveiled the findings from its first 1,000 inspections and his plans for the regime from April 2014.
Professor Steve Field revealed that inspectors found problems with a third of the first 1,000 practices the CQC has inspected, and detailed a catalogue of failings, including maggots found in treatment rooms, out-of-date vaccines kept in fridges with no temperature monitoring and a case where two GP partners reported each other to the GMC for incompetence.
However, GP leaders warned that the sample of practices inspected did not necessarily represent the true picture of general practice as there had already been concerns raised about the vast majority of them. GPs also said this was a wake-up call for the Government to increase resources for practices.
This came as the CQC revealed that all future inspections will include a GP and a nurse, and it will ask how ‘caring’ practices are as part of the regime beginning in April.
The vast majority of the first wave of inspections were targeted, with some random inspections, and it found 34% of practices had failed one of the inspection standards, with 10 having very serious failings.
Professor Field said: ‘We’ve asked [inspectors in the first 1000 cases] to look at things which are really important from a safety point of view, and around about a third have problems. The really serious ones, at the moment, are less than 2%. But [that’s] because we’ve done some targeted ones, and some random ones… I think the message is “we can all do better”, but some practices are brilliant and we haven’t looked at the brilliant ones, systematically.’
Practices who flagged up potential concerns have been targeted in this first wave of checks and Pulse has reported previously how this is likely to skew the number of practices who have failed to achieve inspection standards.
CQC inspections at a glance
- The CQC found that one-third of GP practices were in need of improvement
- The inspection teams found maggots in a treatment room and out-of date vaccines in fridges with no temperature monitoring
- Professor Steve Field said he is considering ‘OFSTED-style’ letters to every patient of poorly performing practices
- The inspectors will ask whether the practices are ‘caring’ and show compassion for patients
- Every team will include a GP and a nurse, who will be trained from January 2014 onwards
- Inspectors will visit 25% of the practices in every CCG within six months from April 2014
- Practices will have to publish results of their inspections in their waiting rooms
- The CQC will focus on out-of-hours providers from January
Professor Field said he was searching for ways to ensure patients ‘really know’ when their practice is inadequate, and he said the OFSTED system of writing to pupils in a language they understand was ‘a great one’.
The results of practice inspections will have to be displayed in waiting rooms and the CQC will publish them on their website, with the first ratings due to be published in October.
He said: ‘As part of the new contract changes they have to be published by the practice and put into the waiting room, I will write an open letter to practices, to the patients in each practice – hopefully using the press – that will be published on their website.’
He added: ‘There is a question, about whether I should personally write to all the patients in the really, really bad practices, in the inadequate practices, and we’re looking at whether that’s feasible.’
‘Because in OFSTED they write a letter to, to the junior school pupils and the senior school pupils in a language they understand.’
‘I think the principle is a great one, so it will be an open-letter to patients. If there’s a practice which is really, really inadequate, the question which I’m toying with in my mind is how you make sure patients really, really know. ‘
Professor Field was setting out the CQC’s new approach for inspecting general practice at the release of its report, ‘A fresh start for the regulation and inspection of GP practices and GP out-of-hours services’.
The document confirmed that the inspection teams will be testing whether practices are ‘caring’, as first revealed by Pulse this year, as well as questions around whether they are safe, effective, responsive and well-led.
Professor Field had previously identified that conducting inspections without a GP present was ‘flawed’, and the new system is being brought into address this.
The report makes a commitment that teams of inspectors will include GPs, a nurse and sometimes patients.
It states: ‘Our inspections will be led by expert inspectors, with clinical input led by GPs. The teams will include an inspector, a GP, a nurse and/or a practice manager and a GP registrar. Teams may also include an expert by experience – someone who uses a GP practice or has a particular experience of care that we want to look at.’
Professor Field said: ‘We’re going to set up an academy inside CQC and spend a lot of resource. Just like when I was a college examiner, or a trainer inspector. We’re going to train the GPs, the patients and the nurses, and the inspectors – together and separately – to gain skills.’
The new inspection regime will begin with a total investigation of GP out-of-hours services, which the report says ‘face particular challenges in providing safe, compassionate care’.
GP practices will begin being inspected through the new approach from April 2014, with inspectors visiting 25% of the practices in every CCG within six months. The CQC hopes to have inspected and rated every surgery in England by April 2016.
GPC chair Dr Chaand Nagpaul said he was encouraged by the high standards of care the first wave of inspections had found. He added: ‘While most patients receive high quality care from their GP, we need to understand where and why shortcomings in a small number of practices exist, and the BMA is committed to working with the chief inspector to improve standards. It’s important, however, that anecdotes of poor practice are not be used to distort the reality which is that the overwhelming majority of hard-working GPs provide high quality care which is appreciated by patients.’
‘The ultimate aim of this process must be to provide necessary support for improvement and empower all GP practices to reach the highest possible standard of care. As part of this, we need to seriously look at the infrastructure and resource constraints many practices face, as these are often the main roadblocks to improving standards in general practice.’
Dr Andrew Mimnagh, a GP in Merseyside and chair of Sefton LMC said a general practice’s financial circumstances must taken into account before the CQC act on the findings of an inspection. /he said: ‘It sort of begs the question, as they’re inspecting things like premises which have been traditionally underfunded. It does become a bit of a self-fulfilling prophecy, of “we didn’t invest in primary care and we’re closing your doctor down”… it seems a bit like give a doctor a bad name then hang him.’
Health secretary Jeremy Hunt said that that the first wave of inspections showed the majority of patients ‘received good quality care’ from their GP, but stressed there were ‘areas of concern’.
He said: ‘[The first inspections] have shown that many people receive good quality care from their GP, however they also highlighted areas of concern and some examples of very poor care, with 34% failing at least one of the required standards, and in 10 practices there were very serious failings that could potentially affect thousands of people.’
‘The findings from these inspections are helping the chief inspector develop his plans for changing the way the CQC inspects general practice, particularly focusing inspections on the things that matter to patients.’
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