The news that GPs are to face ‘Ofsted style’ inspections can come as no surprise - the Government has been manoeuvring for this broadside for months, marshalling the fleet and bringing them into line. Jeremy Hunt believes he has evidence from the Francis report that the NHS harbours ‘staff members of mass destruction’ and will stop at nothing to seek them out; he has reconnaissance reports of patients stacked a dozen high in A&E to stimulate the war effort and has the shock troops of the CQC ready to board any flagging enemy vessel. And now we hear that the fleet is to receive its first Admiral - the Chief Inspector of General Practice.
I’ve seen it coming - but still it sends a shiver down my spine.
Not that I mind being inspected. If someone were to come tomorrow and genuinely examine my ability to do my job then, as with most GPs, I would say bring it on. They would have to be able to assess the immeasurable -like the indefinable support GPs give every day where they don’t appear to do anything concrete to a patient’s treatment, but the encounter somehow makes all the difference; or the ability to help a patient with medically unexplained symptoms whose health needs can’t be defined by a disease register, because they don’t fit neatly into that sort of box; or the experience needed to handle the high level of uncertainty GPs juggle every day, without resorting to defensive investigations and referrals. Is that what the inspectors will look at when they come calling, though? I very much doubt it.
SPOD is an acronym which has become popular among teachers lately. It stands for Show Progress Or Die - because that is what Ofsted feels like for teachers. Progress has become everything; data the only measure by which a school will stand or fall; SATS tests the de facto definition of a school’s worth. There is a passing nod to the spiritual and emotional development of children, a fleeting glance at any creativity in the curriculum, a wry smile at a school’s efforts at physical education - but in the Ofsted process it is the results in reading, writing and mathematics that reign supreme and all else counts to naught.
What will be the equivalent for GPs in a few years time I wonder? ATOD - Achieve Targets Or Die? CROD - Cut Referrals Or Die? What about SOD - Screen Or Die? Maybe we won’t die, maybe we’ll just wish we had.
The Government relishes the idea of putting GPs back in their box, reducing practices to an Ofsted-style scoring system and coming down hard on those put into Special Measures. We can expect local newspaper headlines about practices that Require Improvement. Of course, some practices could be improved - no, all could be improved, including my own. We should always be trying to do better for our patients and strive to improve the care we offer. What worries me, however, is the inevitability that inspection criteria will be reduced to Government-driven targets, which will always be dominated by what can be measured - like prescribing rates, diagnosis rates, mortality data and referral data - while what cannot be measured will be pushed aside.
Before we send the inspectors in, we need to ask ourselves if we want to promote a general practice where the doctor still knows your name - and your mother’s your step-father’s, your Auntie Betty’s and the challenging neighbourhood you live in - or do we want doctors who are target-driven box-tickers who barely look up from their computer screen to acknowledge the patient sat before them, focused more on their own ratings than their patients’ real needs?
Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.
