Pulse editor Jaimie Kaffash argues for the removal of the CQC, an institution founded on a mistrust of doctors
The news, broken today by the HSJ, that the Government is undertaking a review of the CQC is about 12 years too late. The commission has been beset by problems from the start, seen by most within the profession as a barrier to safe patient care, rather than promoting it.
Much of the dislike is based on the actions of the CQC itself. It has continually shot itself in the foot, from its focus on trivial issues (such as carpets in treatment rooms and the prevalence of cuddly toys) to the horrific intelligent monitoring scheme, which named and shamed practices based on flimsy data. Then there is the reluctance to apply context to its inspection, factoring in deprivation, the staffing crisis and the like. This comes from the leadership, and has led not only to hostility from the medical professional but low staff morale, too.
But in fact, the actions of the CQC aren’t the problem here. The problem stems from the whole concept of this regulatory body. It is based on the premise that health bodies – and especially GPs – cannot be trusted. GPs and doctors, in the Government’s world, are continually looking to cut corners, play fast and loose with patient safety, and try to avoid protocols whenever they can get away with it.
This leads to a tick-box regime, where every little process is put under a microscope. Of course, 99.9% of GPs and medical directors know what good practice is when it comes to these processes. But more importantly, they also know why protocols are put in place and when they are inessential.
However, many inspection teams do not have this knowledge, and are so bound by their inflexible checklists that they are unable to engage with the ‘whys’. Only this week, I heard more horror stories around a fundamental misunderstanding of MHRA drug alerts and a failure to review context when looking at why patients aren’t coming in for diabetes checks.
The worst part about the inspection regime is, of course, the effect on GPs. The amount of time lost to preparing for inspection, and the stress involved – which no doubt accelerates burnout – in itself jeopardises patient safety. Whenever I speak to grassroots GPs in England, the CQC is almost invariably top of the list when it comes to problems within general practice.
Its attempts to reform the inspection regime will always fail because it is, at its heart, a body founded on a mistrust of doctors.
It doesn’t need to be this way. Inspections could be targeted only to practices where there are genuine concerns. The one area where the NHS excels in the world is the sheer amount of data it collects. It is very easy for local commissioners to identify practices and hospitals that are genuinely putting patient safety at risk (without publicising this information through league tables).
And, if they want to extend beyond solely relying on data, any GP or secondary care doctor in the region can tell you where there are issues around patient safety (this latter approach does have problems with groupthink and even unconscious bias, but it only needs a little refinement to be a huge improvement on the status quo.) The inspection teams would then always include medical professionals (plural) who would understand exactly what they need to look out for, rather than relying on tick boxes.
It may have taken a long time, but the Government has finally shown some common sense. The very concept of the CQC requires more than improvement – it requires removal.
Jaimie Kaffash is editor of Pulse. Follow him on X (formerly Twitter) @jkaffash or email him at editor@pulsetoday.co.uk
I don’t agree its not because of a lack of TRUST but instead it’s because of a lack of CONTROL
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I have a suggestion tha would solve a number of current problems.
A CQC inspection involves attendance by 1 or more Doctors from CQC along with other staff at a Practice for a day (or a half?), plus escorting around by practice staff/Manager and meeeting at least some Partners. Taking a lot of time out from their availability for patient care.
Instead, why not have the CQC pay for a locum from NASGP to attend the Practice and work for 1-2 locum sessions, and also provide a Nurse for the day to help out with Practice Nurse duties?
As a locum, we are practised at noting variations between Practices in how they run systems and manage issues, and can make recommendations if there are any major issues, whilst actually helping out with the workload at the same time. We already share best practice points between the practices we work in, and at NASGP peer review meetings as well.
One could go so far as to suggest that any practice refusing to accept 1 day a year of free locum input ought to be closed down by CQC for lack of common sense?
Declaration of Interest : I am a GP Locum.
Prompt access and continuity of care. The two fundamentals of care quality. Neither of which are now within our control. Both of which are falling off a cliff due to government incompetence/deliberate destruction (take your pick). The CQC exists to distract attention for the real enemy of good care. The Tories.
And that distrust is expensive: All that money (88% CQC revenue is paid by clincial provideds) is of little if any benefit.
Spot on Dr No