Nobody disagrees that a very high-profile problem of unethical or otherwise incompetent doctors can tarnish the reputation of the entire medical profession. There are, without question, a small number of such physicians, and when they are identified they must be dealt with. While the methods must be consistent with the principles of due process and natural justice, the overarching objective must be to protect the public.
But, after over a decade of CQC existence, isn’t it time to admit inspection doesn’t protect the patients nor improve the quality? The CQC inspections are one of the most dysfunctional and wasteful ways you can try to address quality.
CQC exists to insult, denigrate and put the boot in
The complexity and technicalities of regulatory demands shift the focus of the hard pressed professionals to compliance with the CQC – ’passing’ inspections and getting a good ‘rating’ – rather than meeting residents’ needs. Ask a GP how much time and resources away from clinical work is wasted to meet the unrealistic expectations of the CQC inspectors.
Inspecting GP surgeries and hospitals sounds good in the headline world of newspapers and sound-bite public opinion. Politicians play to the gallery; the staff at the CQC are the luckless cast who know in their hearts they are in pursuit of a foolish enterprise.The GPs and hospital doctors I meet tell me that CQC exists to insult, denigrate and put the boot in. In my view, the practices providing an inadequate service are usually doing so because they were struggling to recruit GPs or nurses, or were being denied necessary resources by the NHS.
For 15 years, we have inspected the NHS and gained nothing. Inspection helps no-one and has been abandoned by the bulk of service industry. You’ve got to get to a point where people say they have a problem and ask for help. You need a self-correcting system that relies on the individual professional, then on their team, and then on their CCG or board. We are driving that out of the system. What’s more, we pay an enormous cost for deluding ourselves that we are successfully improving care.
There are good reasons for having some kind of inspection system.There are dangers that are particular to general practice that demand that we provide safe and quality care to our patients. But the bureaucratic maze that is the CQC is never going to be able to deliver on those reasonable expectations. The Quality Emperor has no clothes. It distorts the whole primary care sector, and the organisation is blinkered, risk averse, top-heavy and bureaucratic.
It’s time to replace the CQC. Let’s find local solutions responsible for the quality of GP and hospital safety and quality. The key, as I see it, is to get more local and to humanise the whole process. The funding currently wasted on CQC could be reinvested in a locally rooted system where inspectors have real relationships with local population, like local Healthwatch.
Dr Kailash Chand OBE is a retired GP in Tameside