There has been much written about CQC, most of it negative with good reason. ’An irrelevant exercise like inspecting the internal decorations when the house is falling down,’ as one colleague put it. Now I’m not about to defend CQC or its relevance (or absurd cost) in the current GP meltdown. But I can say that, as a practice that was in danger of being closed down last year, it was important to us to make a case for a good rating as a vindication that we needed to stay open to serve our patients.
For us, the ‘show’ had meaning
We had time on our side – years of knowing it was coming and a slot in the quieter summer months so we were already prepared to some extent. But the activity in the two weeks before the inspection became a huge and surprising boost to practice morale. Every day we ‘huddled’, defining and allocating tasks and checking in. We had a giant wipe board to record our progress. We had a business student on secondment to our practice at the time (a yearly placement we find invaluable) and he helped shape the activity. We have an idea-crazy partner who reeled off literally hundreds of e-mails packed full of ideas and reminders. Her daughter’s friend also put together a beautiful video about the care of older people and end of life care in the practice.
We gathered testimonials from patients, from attached staff, from local colleagues, from people in the community we have worked with, from everybody. Just reading what people wrote and shared was a tremendous fillip and sometimes made us cry, in the way that patients’ letters of appreciation often can. We all need to celebrate what we do well and this is so often neglected, crowded out by the sheer pressure of getting the job done.
The greatest joy through all of it was watching our staff. They were determined to give everything – gathering in groups throughout the day, setting up a group chat for quick information sharing like the in-house ‘what to do if the lift gets stuck’ video. They stayed late, came in early and on their days off, they made banners and put up displays. They even created cupcakes on the day, decorated with a special logo. It was like being in the Great British Bake Off except as a team. A great spirit of collectivism was harnessed for the CQC project and we found that we could rise to the challenge. Everyone was appreciated for their part in the ‘show’.
Sadly, for many, CQC can be literally the last straw. Putting on a ‘show’ is the last thing they need, especially when facing crippling demand. But for us, the ‘show’ had meaning because we were in a position to demonstrate what we know is our value, and the CQC validated that. But the CQC does not always validate those who also work hard and deliver the goods but don’t have the time to gather the evidence.
We have been able to do this as a practice and that is why morale is high despite the enormous work pressures, the long days and the relentless flow of need amongst our inner-city population. I would love every practice to be in that position and to be able to demonstrate that what we do has value, and for others to recognise that value. Validation is vital. There must be much better ways than the current CQC inspection to achieve that goal however.
Did we need CQC? No. Does it make any difference to our care? No. Did it matter to us? Well, yes, for particular reasons and yes, we are celebrating our result… for the moment.
Dr Naomi Beer is a GP in Tower Hamlets and a member of Tower Hamlets LMC