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CQC to access patient records without their permission on new GP practice inspections

Exclusive The CQC will be able to access GP records without patient consent, Pulse has learnt, as the regulator launches its new handbook detailing how practices will be rated.

As part of the new inspection regime that was officially rolled out last week, CQC inspections teams – including the lay members – will have the power to review patient medical records ‘to assess the quality of care provided by the practice’.  

The regulator will not ask for patients’ consent before looking at the records, but it has said it will allow GPs to anonymise the records.

This comes as the CQC officially launches its handbook on how practices will be given ‘Ofsted-style’ ratings.

This explains that practices will ‘normally’ be given an overall rating of ‘needs improvement’ if they are found to be failing any of the five ‘domains’, which include how effective, caring, responsive, safe and well-led they are.

As part of the regime,Pulse has learnt that practices ‘should be prepared to provide discrete’ access to medical records, and that they could be asked to do so at any time during an inspection.

The CQC has powers to access patient medical records, which falls under Health and Social Care Act 2008, and Pulse reported in 2012 that CQC inspectors routinely accessed GP records without patient consent during a pilot of 40 practices to test the regulator’s model for inspecting practices.

But this is the first time the regulator has confirmed that accessing patient records will form part of the CQC’s new inspection regime of GP practices officially launched this week, which will rate practices as ‘outstanding’, ‘good’, ‘needs improvement’, or ‘inadequate’. 

How practices will be given their ratings

  • Practices will be given an Ofsted-style rating of either outstanding, good, needs improvement, inadequate for a total of 42 ratings which will have to be displayed in the practices and on the website alongside their final score.
  • Inspection teams will have to answer questions along ‘key lines of enquiry’ to answer five ‘fundamental questions’ of whether the practice is safe, well led, responsive, caring and effective.
  • Practices will also have to answer these questions in the care of six key patient groups including older people, people with long term conditions and people with poor mental health (including dementia).
  • The scores on the five questions and six population groups will then be aggregated, and practices will ‘normally’ receive an aggregate outstanding rating if they score outstanding on two or more categories.
  • But they will ‘normally’ be limited to ‘requires improvement’ where they have one rating of requires improvement or inadequate where they have been found inadequate in two categories.
  • These aggregate scores will then be combined to give the final rating.

In full: How GPs will be given their Ofsted-style ratings

In a statement on the CQC website, Professor Nigel Sparrow, senior national GP advisor at the CQC, said: ‘At any stage during the inspection we will let the practice know when and why we intend to look at medical records. Practices should be prepared to provide secure and discrete access to the required medical records during an inspection.’

Professor Sparrow told Pulse: ‘The main purpose of the review of medical records is to assess the quality of care provided by the practice. It is not to assess the individual clinician. In routine inspections, the GP or nurse specialist advisor will look at the medical records.

‘Although the 2008 Health and Social Care Act does not require this, our view is that in most cases it is appropriate for the clinicians on the team to lead this aspect of the inspection. This will usually be the case but where inspection teams have concerns about a practice it may be necessary for any of the inspectors to access medical records or to see a medical record.’

But Professor Clare Gerada, former chair of the RCGP, criticised the plans.

She said: ‘I think that given all the information governance safeguards that we have in place that can actually hinder not help patients – eg research, talking to worried relatives,sharing information across agencies to deliver integrated care – I am surprised as to the ease that CQC can access patient records for inspection purposes where there has not been any previous identified patient or clinical performance issues. Not even the GMC can I believe, enter a practice and for no reason demand to see patient records.’ 

Dr Chaand Nagpaul, chair of the GPC, said: ‘The confidentiality of private medical information is the basis of the trust that patients put in their family doctors and it is vital that this is not compromised. If CQC inspectors want to have access to the private medical records of patients they need to put in place systems that obtain the explicit consent of patients. I believe patients will be extremely concerned to learn that inspectors of GP surgeries are looking at their private details without their consent.’

Professor Field told Pulse that the inspection regime has evolved over the course of the pilots, with changes to the reporting and also a shake-up of training after Pulse revealed untrained GP inspectors were going on inspections.

He said: ‘One of the things we learnt means we’ve put far more training in, of both inspectors and the GPs, which is starting to run through now, and we’ve changed the training we had.

‘We’ve changed quite a bit of the structure of the report, and the biggest change was that I’ve introduced, at the start of the visit, a half hour can celebrate what’s good and outstanding in the practice, and highlight any challenges.’

Pulse recently revealed that the CQC also plans for inspectors to sit in on GP patient consultations as part of the new inspections regime, and the the regulator is planning to publish individual practices’ data on GP prescribing of antibiotics and benzodiazepines.

Last week the CQC’s chief inspector of general practice Professor Steve Field, claimed that 200 GP practices could be closed under the new CQC inspection regime. GP practices that are judged ‘inadequate’ in a number of areas by the new CQC inspections will have six months to improve. If they fail to improve they will be put into ‘special measures’ for a further six months, and if they are still found to inadequate, their registration will be removed.