Exclusive Practices are set to be given an individual risk rating and be subject to inspectors making a judgement about how ‘caring’ they are to patients, under a package of changes to weed out bad GP care planned by the CQC in the wake of the Francis Inquiry.
The risk assessment is currently being developed for hospitals to determine the frequency of inspections, with those identified as ‘high risk’ inspected more often and more thoroughly than those at lower risk.
The CQC told Pulse that the risk ‘metric’ would extend to GP practices and that the regulator’s GP Advisory group had also decided at a meeting last week to begin work on introducing a ‘judgement element’ into GP inspections based on five domains – including how caring practices are to patients.
But the GPC said that there was a danger the measures would fail to capture the complexity of general practice and could be ‘misinterpreted’ by the public.
The move comes after NHS care came under increasing scrutiny following the publication of the Francis Inquiry into the failures of care at Mid Staffordshire NHS Foundation Trust.
In the wake of the report, health secretary Jeremy Hunt announced he was considering introducing a chief inspector of primary care who would oversee the regulation of GP practices and make the final call on poorly performing GPs.
Pulse reported in 2009 that the CQC wanted to develop risk profiles of practices in order to take action against those providing bad care more quickly, based on a raft of information, such as numbers of complaints, surveys of staff and patients and the commission’s inspections of practices.
The CQC told Pulse they were now developing this risk scoring metric and it would be based on the one developed in hospitals.
A CQC spokesperson said: ‘We are learning from the introduction of a risk assessment in hospitals and this will feed across the field. We expect this to evolve into a metric for primary care.’
The 20% of hospitals considered ‘excellent’ will be inspected once every five years, hospitals considered ‘good’ inspected once every three years and those performing less well inspected more frequently, depending on their stratification. Five national teams who will be sent to the most challenged hospitals to carry out ‘deep dive’ inspections.
But the CQC said it was not able to say whether low-risk GP practices would have a reduced frequency or depth of CQC inspections. GP practices are currently inspected once every two years, with ‘themed’ inspections at any point if there is a need across the NHS, and ‘responsive’ inspections if the CQC feel there is a problem that needs to be followed up on.
They also confirmed they are considering introducing a ‘judgement element’ in GP inspections – as first proposed by Mr Hunt, who said it would prevent mere ‘box-ticking’.
The element will be based on five domains – including how caring, well-led and responsive services are to patients – will form the basis for how practice performance will be made public on the CQC website, in an effort to make the process more accessible to the public.
They added: ‘The GP Advisory group is working with the CQC to match outcomes to the five domains. This will be a co-operative project with the profession, it won’t be forced on GPs.’
But Dr Richard Vautrey, GPC deputy chair, said the five domains over-simplified general practice, and the CQC should be cautious about how these questions are used in inspections.
He said: ‘There’s a danger if general practice is being boiled down to those five questions. General practice is very complex, having simple answers to those questions, the complexity won’t be captured. The detail of how GPs will be measured against those questions will be important.’
He voiced concern about a risk metric to categorise practices: ‘There would be a concern if practices were being judged in that way, causing consternation amongst patients.
‘It would be extremely important to explain to patients exactly what the judgement meant. GP practices are not hospitals, and shouldn’t be measured in the same way. GP practices are much more vulnerable to judgements that are misinterpreted by the public.’
The five domains inspectors will measure practices on as part of the ‘judgement element’ of inspections:
Are services safe?
Are services effective?
Are providers caring?
Are providers well-led?
How responsive are providers to feedback from users?
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