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Practices usually rated inadequate due to processes and not care failures, says CQC



Practices labelled inadequate by the CQC during inspection are very often providing compassionate and respectful care, but let down by not having simple governance processes in place, according to the CQC’s deputy inspector of general practice.

Ruth Rankine, who is responsible for GP inspections in the South of England, admitted the quality watchdog could do more to take account of its own ‘caring’ domain when inspecting.

She added that they were also looking at how they took account of the financial context each practice is working in, after practices on several inspections raised a lack of investment as reason for underperforming in some areas.

The GPC said that the latest comments demonstrate that the CQC’s rating regime is ‘misleading and unfit for purpose’.

Pulse has reported that many practices placed in a ‘special measures’ improvement regime after being found inadequate had failed on their recruitment policy, but found to have ‘no evidence of clinical risk to patients’.

Speaking at the at the Urgent Health UK 2015 conference in Macclesfield last month, Ms Rankine said that practices were often marked down on issues around ‘medicines management, out-of-date drugs and fridges not being monitored’, and acknowledged that this approach might seem ‘picky’ .

However, she said that they added up to raise questions about a practice’s leadership, and said she was frustrated that simple things were often not in place.

Ms Rankine said: ‘Very often when we look at inadequate providers, the ”caring” domain can be good. That’s quite difficult for us, because patients are saying “I’ve been with this practice, this provider for 40 years, they’ve seen all my family and they know my first name.”

‘So the piece of work we need to look at is how we more adequately look at and assess the caring domain, what more information do we really need to get to the bottom of whether a provider is really caring, and what caring looks like.

’For [inadequate practices] it’s weak leadership and governance, and often really basic systems and processes are not in place. Really simple things which on their own may not be significant, but when you continually find them on inspection it says something about the overall leadership, organisation and management of the provider.’

On the issue of practice funding, she said the inspectors hear practices cite a lack of funding, and CCGs failing to sign off business cases for premises upgrades for any failures, ’so there’s questions about how much we look at money and budgets’.

But chair of the GPC contracts and regulation subcommittee Dr Robert Morley said that Ms Rankine’s comments show the problems with the inspection regime.

He said: ’It’s rather ironic that the CQC finds that the quality of caring is invariably good and yet the practice is deemed inadequate.

’The bottom line is that CQCs entire inspection, judgement and simplistic single rating regime is misleading and unfit for purpose, a point GPC has repeatedly made.

’CQC can never truly measure the quality of care, it merely makes judgements based on box-ticking exercises, many of them arbitrary and lacking validity, which it uses as a proxy for demonstrating quality.’

The CQC’s inspection regime focusses on five domains – whether a practice is ‘safe’, ’effective’, Responsive, ’well-led’, and ’caring’, which is defined as ‘staff involving and treating people with compassion, kindness, dignity and respect’.

A CQC spokesperson added that further work will look at how inspections ‘distinguish between “good” and “popular” from a patient’s perspective.’