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CQC-style inspections don’t raise standards or improve patient safety, say RCGP members

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4216 (Published 05 October 2018) Cite this as: BMJ 2018;363:k4216
  1. Gareth Iacobucci
  1. The BMJ

Inspections such as those carried out by the Care Quality Commission (CQC) are not effective in raising standards or ensuring patient safety, delegates at the Royal College of General Practitioners’ annual conference have argued.

The conference hosted a debate on the merits of inspection, in which Rebecca Payne, a GP and clinical adviser to the CQC, spoke in favour of the current regulatory model and Miles Mack, a Scottish GP, argued against.

After a passionate debate the delegates rejected a motion put forward by Payne that read, “This house believes that CQC-type inspection is an essential lever in raising standards and ensuring patient safety.”

Payne had argued that the CQC’s inspection regime provided the necessary means to expose poor practice and to provide “the right diagnosis” to help practices improve. “Where there is a CQC report, people take action and practices are supported,” she said.

She also argued that the systems and processes on which the CQC focuses “really matter.” Issues that the regulator picks up, such as out-of-date drugs and fridges at incorrect temperatures, are important for patient safety, she noted.

But Mack said he did not believe that the CQC’s style of approach accurately depicted the quality of GP services. “This can be a deeply demoralising practice . . . particularly at times when clinicians are working in extremely difficult circumstances,” he said. “It is wrong to believe that the CQC approach is the only way forward.”

Several GPs spoke from the floor against the motion, highlighting issues such as the inconsistency in inspections and the impact on GPs’ morale.

Mary McCarthy, a Shropshire GP, spoke against the motion, recounting how her own practice had been affected by the CQC inspection process.

“Before we were inspected, the CQC looked at their data and decided we were ‘inadequate,’” she said. “This information was splashed all over the front page of the Shropshire Star. When they inspected us three months later, we were rated as ‘outstanding.’ Staff were upset, patients were bewildered; it was just dreadful.”

She criticised the “tick box mentality, that somehow you can judge competence and kindness and caring and compassion by ticking whether you have a bucket the right way up.” “This is nonsense,” she said.

Terry Kemple, former president of the Royal College of General Practitioners, also spoke against the motion and highlighted the recent report from the King’s Fund,1 which found that the CQC’s inspection regime had had little measurable effect on services.2 “Ninety per cent of GP practices were rated ‘good’ or ‘outstanding,’” he said. “They had to go through a farce with no evidence of impact.”

Mark Sanderson, GP and deputy regional medical director for NHS England, spoke in favour of the motion. “We can’t rely on self regulation, and we can’t assume that every GP does all the good stuff that we all want to aspire to,” he said.

But Mack said that the CQC-style approach was using “a sledgehammer to crack this nut” and called for regulatory systems to focus on “professional values.”

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