DH report strengthens case for scrapping CQC ratings, says GPC

BMA leaders have called for CQC ratings on GP practices to be scrapped after a DH-commissioned report strongly advised against the use of 'composite measures' to show practice performance.

Dr Chaand Nagpaul: 'The DH should abandon simplistic ratings for GP practices'
Dr Chaand Nagpaul: 'The DH should abandon simplistic ratings for GP practices'

A report published by the Health Foundation think tank on Monday advised against the development of practice 'scorecards' and composite performance indicators, and called for NICE to develop a new system for measuring practice quality.

BMA leaders said the report confirmed their view that 'simplistic' CQC ratings should be scrapped, but the watchdog and the report's authors denied it was critical of the current system.

The report is clear that composite ratings - like the outstanding, good, requires improvement, inadequate scale used by the CQC - have flaws, but is careful not to reject the existing ratings system outright.

Map: GP CQC ratings

It says: 'Composites aggregate information which can mask specific aspects of the quality of care, falsely reassure and thus be misleading.'

The report adds: 'Composite indicators have superficial allure because of their simplicity. In theory, this simplicity could help the public gain a rapid view of the quality of care in a general practice and help practices and others identify priorities for improvements more easily. It could also help organisations accountable for primary care to ‘see the wood for the trees’. However, we strongly recommend that composite scores (over and above the existing CQC rating) are not developed and published.'

GPC chairman Dr Chaand Nagpaul said: 'It is encouraging that this report confirms the BMA’s view that the services GP practices provide are far too complex to be arbitrarily reduced to a single "quality" measure.

'As we have seen with the CQC’s troubled inspection regime, it is not transparent to present a range of quality measures in populist categories without context, which can be misleading for patients and professionals. We  endorse the report’s rejection of "scorecards", and  agree that data should be used in a learning environment to support improvement, as opposed to erroneously judging practices.'

Simplistic GP ratings

Dr Nagpaul added: 'We expect the health secretary will listen to this report and the BMA, and rapidly abandon the concept of simplistic ratings for GP practices.'

But the CQC accused GP leaders of misinterpreting the Health Foundation report. A spokeswoman for the watchdog said: ‘The BMA is taking the HF report out of context. What it specifically advises against is the creation of an additional composite measure based on data indicators over and above the CQC rating.

‘The HF report acknowledges that the CQC rating is a better assessment of quality than could be achieved by data alone and that we shouldn’t create a data one separately, so in no way does it recommend any stopping of CQC ratings.’

A Health Foundation spokesman said: 'We believe the CQC ratings are the best that are available at the moment, based on a range of information (quantitative data, qualitative intelligence and inspection findings).'

He pointed to a passage in the report that offers some backing for the CQC's ratings system: 'While a small set of indicators could be valuable for the public, there would be little value in publishing a composite score over and above the existing CQC rating. This rating is based on a wider range of information (quantitative data, qualitative intelligence and inspection findings) and is currently the better assessment of quality. Publishing a composite score as well as a CQC rating could confuse, especially if the results were conflicting.'

Earlier this year, Dr Nagpaul won a standing ovation at the 2015 LMCs conference for a speech in which he called for CQC ratings to be scrapped

Photo: Pete Hill

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