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GP leaders ‘disappointed’ in CQC plans for practice inspection reform

The CQC’s plans to overhaul its general practice inspection regime to reduce the burden on practices do not go far enough, according to GP leaders.

In response to the CQC’s consultation on proposals, which closed earlier this month, RCGP and BMA both warned that it could even heap new work on practices.

As previously reported, the new regime will see less frequent inspections for practices rated ‘good’ and ‘outstanding’ but also introduce new annual reporting requirements.

And, despite not yet having responded to its own consultation, which closed 8 August, the CQC sent a letter to practices today reiterating the plans.

In the letter, chief inspector of general practice Professor Steve Field said that ‘during 2018 we expect to introduce a  new system of provider information collections – where the practice will be asked to share with us information on the quality of care – and annual regulatory reviews’.

But the RCGP, which said the CQC’s plans were ‘very disappointing’, suggested that the CQC should instead take a narrower focus on practices of concern.

Its consultation response said: ‘To have a greater impact on reducing the overall burden, we propose a more focused approach on the least well-performing general practices, perhaps the bottom 10-20% of the performance curve.

‘These practices could be identified by using routine data and local intelligence. This may reduce the overall cost of regulation and limit the burden on practices providing an acceptable or high standard of care.’

Professor Helen Stokes-Lampard, RCGP chair, said: ‘The CQC proposals are very disappointing, especially at a time when GPs are struggling to cope with unprecedented pressures of increasing patient demand, insufficient investment and severe GP shortages.

‘In the short term at least, the CQC’s proposals could result in an increase in the administrative burden on practices if they are expected to provide additional information and keep it up to date.’

The BMA also questioned why the proposed inspection frequency was not reduced and suggested GP practices should be treated like dentists, ‘where only 10% of providers are inspected each year’.

The BMA further called for clarity on what annual information practices would be asked to submit and assurances that this would not become an ‘informal QOF’ at a time when QOF is being scaled back.

The BMA’s response also questioned how the CQC’s new ‘Insight’ practice reports, which will include prescribing data and patient reviews and be published online, will show the full context of individual practice pressures and other mitigating factors impacting performance.

It said: ‘Failing to seek providers’ views on whether the current underlying approach to regulation is fit for purpose means any proposed amendments may only have a limited impact on areas where the current approach is not delivering for providers or patients.

‘As such, regardless of the proposed changes, general practice will continue to be regulated in a way in which general practitioners have little faith.’

In the letter to practices, the CQC said it expect to publish new guidance and methodology in October 2017, ‘taking into account the views that we have received’. It said any changes would be ‘phased in gradually’, with the first changes expected to ‘come into effect in November with the introduction of the new assessment framework, which will guide our inspections’.

Professor Field told Pulse: ‘As stated in the letter, the changes are subject to the outcome of the consultation which closed on Tuesday 8 August, the response to which has not yet been finalised so we are not in a position to say precisely what these changes will look like.

‘However, we are working closely with RCGP and BMA on the detail of our proposals so that any changes following the consultation are implemented in such a way that recognises the pressures faced by GPs and minimises the impact on their workload.’

The CQC also highlighted the ongoing work of the Regulation of General Practice Programme Board, which is looking at how CQC, GMC, NHS England and CCGs can avoid duplication and work in a more ‘aligned’ way.

A lighter touch?

Pulse revealed back in 2015 that chief inspector of general practice Professor Steve Field expected practices rated ‘good’ or ‘outstanding’ to have as much as five years between inspections.

Annual and six monthly inspections would generally be reserved for ‘requires improvement’ and ‘inadequate’ practices, respectively.

But Pulse revealed that 20% of practices rated ‘good’ and ‘outstanding’ – over 90% of all practices – will still be inspected each year, but this will be based on risk data drawn up from CQC’s intelligence gathering.

In addition to intelligence gathering annually there are new inspection standards coming in from November this year, including tougher regulation of data governance and IT systems.