From Dr Siraj Shah, Gravesend, Kent
Our first CQC inspection (carried out with just 48 hours’ notice) took place last November during the busiest season for the profession, and amid extensive redevelopment works at our practice. The CQC inspector responded to my suggestion to postpone the visit by warning that I would be liable for a huge fine because I had not informed the CQC about the building works.
The inspection itself was like a criminal investigation. The inspector frequently rubbed her fingers on desk surfaces looking for dust, despite witnessing the huge scale of ongoing building works. The disruption caused by the works, and the fact we had just 48 hours’ notice, meant we were not able to produce the patient survey report, recruitment or whistleblowing policies in time for the inspection – although none of these would have affected patient care at the time.
Despite all that, I was relieved to read in the draft inspection report that there were no shortcomings in our provision of care, or in the welfare of the people who use our services.
In my detailed response to the report, I sent the CQC all the missing policies and reports, and promised the two recommended actions (a lockable cupboard for scripts and a finalised recruitment policy) would be undertaken by 21 February. I also promised that the cleaning, infection control and legionella risk policies would be completed once the building was finished in August 2014 (they couldn’t be done any sooner).
I have never received any acknowledgement or feedback from the CQC. This shows that inspectors have not taken on board the new approach that commission has widely advertised. Had they taken notice of my detailed response, there would have been no need for them to re-inspect the practice in September.
Our second inspection took place while I was away on holiday. I am glad to say we have now ticked all the boxes – but having studied a 19-page draft inspection report and received feedback from staff, I am concerned about inaccuracies in the reporting and the inspectors’ nit-picking approach.
I was informed that during our second inspection, my partner had to go out of the consulting room to fetch some paperwork. Staff left in the room reported that the inspecting doctor on the CQC team grabbed the opportunity to sift through his desk drawers.
The second report, dated October 2014, said inspectors ‘found there was not an appropriate system in place to ensure staff learned from significant events. We saw records relating to significant event and accident recording and found no entries had been made since 2008’.
This is strange, since one of the main strengths of our practice is learning from significant events, as born out in my own revalidation appraisal in March 2014. Between January 2013 and March 2014 we have recorded, discussed and shared learning from nine significant events at the practice.
The long-winded, repetitive reports show that inspectors lack fundamental understanding and knowledge of GPs’ work, give more importance to a certificate or a policy rather than the service being delivered, misrepresent recommendations as requirements and, most pertinently, fail in their duty to provide accurate feedback about inspections to practices. So why do we have to pay a fee to an organisation that is not fit for purpose?
Having seen my practice undergo two inspections within 11 months, and meeting all the CQC’s requirements, I utterly fail to understand the purpose of these inspections.
GPs, struggling to deliver patient care given the recruitment crisis, also face overwhelming bureaucracy, political interference, fragmentation of care, lack of funding, unnecessary monitoring and micromanagement of practices. No wonder growing numbers of experienced GPs are taking early retirement, and the younger generation of doctors do not wish to take up general practice.
A spokesperson for the CQC said: ‘Under the new approach, experts from the GP sector join each Care Quality Commission inspection. These doctors play an integral part of the assessment of GP practices and will contribute towards the future ratings system.’