CQC data reports risk 'skewed impression' of GP practice quality, warns BMA

The GPC has expressed 'significant objections' to the CQC's planned replacement to its controversial Intelligent Monitoring scheme, warning that the scheme could unfairly skew patients' impression of practice quality.

GPC chair Dr Chaand Nagpaul (Photo: JH Lancy)
GPC chair Dr Chaand Nagpaul (Photo: JH Lancy)

In a letter addressed to CQC chief inspector Professor Steve Field, GPC chair Dr Chaand Nagpaul warned there were ‘a number of fundamental flaws’ in the watchdog’s plans to make greater use of 'intelligence' data to inform GP inspections.

The letter says: ‘In light of recent correspondence between the BMA and the CQC I would like to formally raise on behalf of the GPC Executive our significant objections with the current proposals from CQC to make greater use of intelligence in the way it regulates general practice.’

The CQC is developing a new system known as ‘GP Insight’ to replace its current Intelligent Monitoring process - which labelled many GP practices 'high risk' before they had even been visited by the watchdog's inspectors - and inform the prioritisation for the next phase of physical inspections. It will be rolled out from next month.

Map: Find out GP CQC ratings in your CCG

As part of this new scheme, each practice will be given an individual ‘insight report’. This will be drawn up based on NHS data from a number of sources, including prescribing data and patient experience. Practices will be invited to verify this data in advance of publication.

The CQC maintains that the data within the reports does not constitute a regulatory judgment on performance, but the GPC warned that it will ‘inevitably’ be interpreted as such by patients and the media – especially as some of the points are linked to the CQC’s key questions such as effective and caring.

They added that the parameters ‘are likely to represent a form of informal QOF framework’ at a time when this system is being scaled back.

The planned Insight reports also do not supply sufficient context, the GPC said, and the use of z-scores and benchmarking against local and national averages ‘will give a skewed impression of achievement’ – as half of practices will inescapably be noted as ‘below average’.

General practice data

Dr Nagpaul said: ‘I would urge you to halt any plans to distribute GP Insight reports to practices in their current form and ask that you reconsider the overall approach to the use and publication of general practice data that can so easily be misinterpreted.’

Professor Steve Field said: ‘In our strategy for the next four years CQC has committed to provide a more targeted, responsive and collaborative approach to regulation, so that more people get high quality care at the same time as reducing the burden on providers.

‘One of our priorities is a greater use of data to determine changes in quality and to help guide our regulatory approach. GP Insight does not determine the judgement we make of a practice’s quality, it is there to inform it.

‘As part of this approach, we will produce an individual Insight report on each GP practice which brings together existing national data in one place. We are planning to send the individual reports out to GP practices next month to allow them to verify the data before it is published.

‘We have been working closely with the BMA and RCGP about our approach to this new model and we will continue to talk to GPs about this process.’

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