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Impending GP access inspections will be ‘supportive’, says CQC


CQC


The CQC’s chief inspector of general practice has promised that upcoming unannounced inspections focusing on patient access will be ‘supportive’ to practices.

The CQC has been tasked with urgently developing new inspection methodology as part of the Government’s crackdown on GP practices which do not offer satisfactory levels of face-to-face appointments.

The NHS England’s rescue plan for general practice, announced last week, included proposals for the CQC to work with NHS England to ‘make the required improvements across those practices which are not meeting people’s reasonable needs’.

The plan said: ‘CQC is rapidly developing an inspection methodology with a particular focus on access to GP services. Wherever appropriate, it will make unannounced inspections.’

It is unclear what the new methodology will involve, what powers it will have, and whether the inspections will be random or targeting particular practices.

However, speaking on Thursday at a press briefing regarding the CQC’s annual State of Care report, chief inspector of primary medical services Dr Rosie Benneyworth explained that the inspections would be ‘focusing on’ where ‘we hear concerns’.

And she added: ‘‘We’re very keen to make sure that we support practices to identify areas that they need to focus on, and make sure that we can share that best practice and support practices to ensure that people get the right care in the right way at the right time.

‘We’ve seen some great examples across the country of where practices are working to look at how they manage access and how they really meet demands, but we have also heard, in some places, concerns around access for people and we need to make sure that people have the appropriate access to meet their needs across all parts of general practice. 

‘We have been following up on concerns that we’ve been hearing about access and we will continue to do that.’

The annual state of care report showed GP practices have continued to rate highly in CQC inspections. 

As of 31 July 2021, 90% of GP practices were rated as good and 5% as outstanding, a marginal increase from 31 March 2020, when 89% of GP practices were rated as good and 5% as outstanding.

But chief executive Ian Trenholm said the CQC has received record numbers of feedback and concerns about care this year.

He said: ‘As we go into winter, the health and care workforce are exhausted and depleted – which has clear implications for the vital care they deliver.’

He warned further instability on funding and workforce for social care ‘could result in a ripple effect across the wider health and care system which risks becoming a tsunami of unmet need across all sectors, with increasing numbers of people unable to access care.’

It comes as the CQC said it has stopped using QOF data to assess practices for ‘at least’ 12 months, because it is ‘not reliable’ and ‘many months out of date’.

In June, NHS England said it has ‘no plans’ to suspend QOF or income-protect it for GP practices this year.

The BMA said it was ‘seriously concerned’ about CQC’s remote monthly GP practice safety reviews that launched in July.

In June, a draft document revealed that the regulator planned to start carrying out remote checks on each GP practice every month to assess its risk to patients in July.

Meanwhile, the CQC has recently faced criticism from some GPs who perceived inspectors’ behaviour as inappropriate.

Last month, a small survey found that more than 70% of GPs from minority ethnic backgrounds described ‘CQC inspections and the behaviour of the CQC inspection team has been a traumatic experience, rather than a positive and constructive experience’.

READERS' COMMENTS [9]

David Turner 22 October, 2021 10:49 am

What a fantastic idea penalising struggling practices! Nothing can go wrong with that plan.

The boys and girls of the cqc must go home with a warm glow in their hearts at the end of a working day.
I wonder if ‘bulling and harassing your colleagues’ was specifically highlighted as a career option when they were at school?

Kevlar Cardie 22 October, 2021 12:49 pm

Ah, the gentle pitter-patter of the CQC’s jackboots in the corridor.

How we’ve missed it so.

Douglas Callow 22 October, 2021 2:11 pm

worry not none of this access stuff is enforceable

Repost of Ockham article

A Reminder of the Value of Independent Contractor Status
Posted by Ben GowlandBlogs, The General Practice BlogNo Comments
Last week NHS England published, “Our Plan for Improving Access for Patients and Supporting General Practice”. It is a document that lacks coherence, and is clearly a performance management document that has then been added to to try and make it ‘acceptable’ to the profession (e.g. add “and supporting general practice” to the title). This hasn’t worked, and, understandably, it has created an angry reaction across the general practice.

In the NHS direct performance management like this has been common for a number of years. Statutory NHS bodies such as Acute trusts, Community Trusts, CCGs (etc) receive edicts like this that demand certain actions and delivery on a reasonable regular basis. These are then reinforced by senior leaders not achieving the targets being summoned to local then regional then even national performance meetings. There was a time in the not too distant past when acute trust chief executives not meeting the 4 hour A&E target were being summoned to meetings with the then Secretary of State Jeremy Hunt.

This style of performance management is a particularly unpleasant side of the NHS. It comes because those in the highest positions of the NHS have to demonstrate they have levers they can pull to make things happen on the ground, when they themselves are under pressure. We have a new Secretary of State and a new NHS Chief Executive, and the bigger worry is that this is just the first taste of what life is going to be like under this new regime.

But if nothing else, the document is a timely reminder of the benefit of the independent contractor status that general practice enjoys. The reality is that the Secretary of State cannot directly tell GPs what to do, or instruct how they should behave, in the same way that he can with NHS Chief Executives and senior leaders.

Whilst the document might feel like direct performance management (it is designed to), it is in fact an instruction for how NHS staff that are under the direct control of NHS England are to manage the contract they have with general practice. They are the ones who are to submit returns by the 28th October, not practices themselves. For general practice, its responsibility lies in making sure it delivers against the contract it has signed up to, nothing more.

For those who have not read the document (and it is not a read I would recommend), it essentially outlines a series of measures that it will introduce to try and increase the number of face to face appointments GPs hold with their patients. They will use the data practices are now submitting to publish waiting times at practice level, and send a ‘hit squad’ into the practices with the longest waits. The NHS is asked to compile a list of practices where the number of appointments is lower than pre-pandemic levels, of the 20% of local practices with lowest level of face to face appointments and with the most significant level of 111 calls in hours and A&E attendances compared to expected, and of where concerns have been raised with CQC and others.

The NHS is then to use this data to create an overall list (by 28th Oct) of local practices where “it will be taking immediate further steps to support improved access” (43). These actions are to include “partnering with other practices, federations or PCNs”, and “contract sanctions and enforcement” (45).

Pretty grim stuff. It is effectively an instruction for commissioners to use any contractual lever they can to make practices see more patients face to face. They themselves will be directly performance managed on this, as they are “required to produce a fortnightly updated report for their region” (48).

For GP practices the best thing to do is simply ignore it. As long as you are happy with the balance of remote to face to face appointments in your own practice and are confident you are meeting your contractual requirements, then don’t do anything. The worst thing that could happen would be for this approach to be effective, because it would encourage the new national NHS leadership regime to do more of the same in future. Practices have enough on their plate to content with right now, so let commissioners manage the flak that comes from above. The good ones do this regularly and they do it well.

If general practice was part of the NHS (as opposed to an independent contractor) it would be having to manage this itself. Independent contractor status is hugely valuable, and one general practice would do well to hold on to as long as it can.

Patrufini Duffy 22 October, 2021 3:37 pm

Access = for what?

For the ugly toenail – I’ve booked my holiday soon
Because you “think” you have diabetes after reading an article in the Mail
For a panic attack on the train
For “emergency UTI” antibiotics because you drank too much last night
For one hour of a fever and nursery sent you home
For a strand of hair that has gone white
For a cold sore on your mouth
For an itchy ear
For a bloating day after too much sourdough and smashed avocado and prosecco
For something your Consultant hasn’t done and the secretary only works Tuesday
For some paracetamol because you have “pre-pay”
For a mole that hasn’t changed by you wanted it checked because you’re on another holiday next week

Access – keep it up. Keep it nannying.
I feel immensely sorry for NHSE – you have no clue about logistics, supply, demand and education – it has no clue what the customer is coming in for, and has done NOTHING useful to curtail hypochondriasis and a culture of leeching the NHS dry.

More access = more referrals. And hey ho – the system is going to die, quite literally. Well done. We’ll all give you positive feedback for that.

Patrufini Duffy 22 October, 2021 4:17 pm

Idea for NHSE: Let’s start a whimsical campaign study.
“If you get tooth pain for more than 3 weeks or see blood when brushing you MUST call and see a dentist same day, because you can have a mouth or jaw cancer”: (you probably won’t but let’s just panic everyone).

Then, let’s see what happens to dentists.
Will they get busy? Will their phone lines jam? Will they feel angry? Will they think “what on earth?” and just refer everyone? What will happen exactly…hhhhmmmm.
Probably nothing in fact. Because they’ll all come to GP instead.

Then, let’s multiply that by hundreds of other conditions and talk about increasing access and how we should slag the diminished workforce off.

David Banner 22 October, 2021 5:27 pm

CQC inspections will be “supportive”? Let’s see, so if your practice is failing to provide enough appointments (it’s called a “recruitment crisis”, folks, you may have heard about it), then which of the “supportive” outcomes will the CQC provide?
1- free advertising for extra recruitment?
2- extra nursing staff to cover surgeries?
3- rank you as “inadequate”, put you in special measures, then give you 6 months to magic up more appointments or be shut down with probable bankruptcy?

Somehow I don’t see it as 1 or 2.

C P 22 October, 2021 9:00 pm

CQC porkies😂😂😂

Turn out The Lights 22 October, 2021 10:06 pm

In CQCterms supportive should be supplanted with destructive then it rings more true.

Christopher Jones 23 October, 2021 5:54 pm

As “supportive” as a noose during a hanging, I suspect.