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CQC to step up unannounced inspections as it unveils new-look regime

The CQC intends to ramp up unannounced inspections of general practice in the next few years and will target practices that have received a number of reports of poor care.

In its ‘Shaping the future: CQC’s strategy of 2016 to 2021’ report, the regulator highlights how having access to continuously updated information on practice quality will allow it to target on-the-spot inspections more effectively.

The report states the CQC will use information collected outside inspections – including self-reporting by practices themselves – to increase the frequency of inspection in poorly performing practices, even where care is improving.

The strategy document also outlines how it will carry out the shift to inspections once every five years for the best practices, as announced in the General Practice Forward View.

But the GPC has said ‘major concerns’ persist and that moves to reduce the frequency and detail of inspections should be reflected in a cut to the fees that have been ‘unreasonably imposed’ on practices.

The major change outlined for GP practices in the CQC strategy is the unannounced inspections.

The report states: ‘We will inspect a service earlier than planned if our insight identifies a level of concern that warrants it, or if we think quality has improved. With more effective monitoring information, more of our inspection activity will be unannounced.’

All inspections, whether unannounced or five-yearly, will be determined by practices participating in more extensive self-reporting of quality, and the regulator says it is looking to make this information public.

The report states that in addition to GP data from CCGs and the public, ‘[CQC will] enable GP practices to share up-to-date information with CQC and other regulators and expect them to describe their view of the quality of care they are providing against our five key questions, as part of annual reporting processes, including what has changed over the year, their plans for improvement and examples of good practice’.

The watchdog has already been forced to apologise for publishing unverified quality information, after giving every practice a risk rating in 2014 as part of its intelligent monitoring scheme.

Other commitments highlighted in the report include:

  • Practices rated ‘needs improvement’ and ‘inadequate’ will be inspected every year and every six months respectively.
  • New methods for inspecting practice federations and other new care models, which could include inspecting a sample of practices in the organisation, and inspecting leadership.
  • A commitment to ‘save time and reduce bureaucracy’ by producing shorter, more consistent inspection reports more quickly’.
  • A standardised ‘shared data set’ for GP quality information across CQC, GMC, NHS England and commissioners to avoid practices being asked for the same information multiple times.
  • For urgent and emergency care – including out-of-hours and NHS 111 services – inspect related services at the same time and strengthen how we work with our hospital inspection teams.

CQC chief executive David Behan said: ‘Inspection will always be crucial to our understanding of quality but we’ll increasingly be getting more and better information from the public and providers and using it alongside inspections.

‘And we’ll make more use of focused unannounced inspections which target the areas where our insight suggests risk is greatest or quality is improving – with ratings updated where we find changes.’

But GPC deputy chair Dr Richard Vautrey told Pulse the whole principle of inspection needed rethinking: ‘GPs have major concerns about CQC and would want to see a much more significant reduction to the burden of registration and inspection than what is being proposed and in particular abandoning the nit-picking clipboard approach to inspections and scrapping the evidence-free simplistic rating scale.’

This comes after the CQC announced it would hike its fees more than six-fold in the next two years, despite respondents to its consultation calling for the increase to be phased in more gradually.