'High-risk' GP practices face unannounced visits as CQC revamps inspections

The CQC has pledged to 'make more use' of unannounced inspections by targeting practices that are considered to be high risk, as part of plans released on Tuesday to overhaul its regulatory process.

Plans to overhaul the way the CQC inspects practices will see inspections 'continue to be central', while data will play a much larger role, the watchdog has said.

The CQC said its new strategy will put greater emphasis on targeting practices that have been previously given a low rating, or those in which intelligence suggests standards may have slipped.

Practices given higher ratings of ‘good’ and ‘outstanding’ can expect a reprieve from further inspections for up to five years – providing they send comprehensive annual data to the CQC.

‘Inadequate’ practices will be revisited within six months and ‘requires improvement’ within a year, as in the current regime.

The measures will not go far enough to satisfy BMA demands for the watchdog's inspection regime to be scrapped in favour of a new, stripped back system. The GPC has confirmed a ballot over potential industrial action will go ahead unless NHS England agrees to changes including the CQC overhaul.

Map: CQC GP ratings

The CQC's new approach to scheduling inspections will herald heavier use of unannounced visits to practices that are considered to be providing poor care or to be at risk of doing so based on intelligence – such as following a spike in patients reporting poor care.

Highly-rated practices will be expected to demonstrate there is no cause for concern by providing the CQC with data on an annual basis that the watchdog deems is not cause for alarm.

This should include a description outlining ‘their view of the quality of care they are providing’ against each of the CQC’s five key questions – is the practice safe, effective, caring, responsive and well-led?

Practices should also inform the CQC what has changed over the past year and detail their plans to make improvements over the next, the watchdog said.

All newly registered practices should expect an inspection within 12 months to award them a ‘baseline rating’.

The overhaul comes close on the heels of an unprecedented fee hike from the CQC, after the DH withdrew the grant-in-aid funding it provided practices.

This saw fees charged to GP practices more than triple in April – with them set to double again from 2017/18.

Despite these huge rises in cost to providers, the CQC said its overall budget will fall by £32m by 2019/20. It will therefore implement cost-saving methods to cope with this, it said – which will include measures to produce ‘shorter, more consistent’ inspection reports more quickly.

Dr Richard Vautrey, GPC deputy chairman, said: ‘As was clearly expressed by those attending the LMC conference 2016, GPs have major concerns about CQC and would want to see a much more significant reduction to the burden of registration and inspection than what is being proposed and in particular abandoning the nit-picking clipboard approach to inspections and scrapping the evidence-free simplistic rating scale.

‘They have talked about reducing the number and frequency of inspections before and moving to greater reliance on remote monitoring, but this means that they should make significant reductions to the cost of regulating general practice and this should be reflected in a cut to the fees unreasonably imposed on practices.’

CQC new regime

CQC chief executive David Behan, said: ‘We’re developing our approach to reflect changes in the sectors we regulate – effective regulation doesn’t occur in a vacuum.

‘But our role remains the same: consistently assessing quality of care using the information we and others gather; using what we know to help drive change and improvement; and acting swiftly to ensure people are protected from poor care.

‘Inspection will always be crucial to our understanding of quality but we’ll increasingly be getting more and better information from the public and providers and using it alongside inspections to provide a trusted, responsive, independent view of quality that is regularly updated and that will be invaluable  to people who provide services as well as those who use them.'

This regime will be implemented from this year and remain in place for five years until 2021. It replaces the current system, which was launched in October 2014, and was originally projected to have inspected all practices by April 2016.

This deadline has been extended twice, and the CQC now says it will have carried out comprehensive inspections and rated all GP practices, urgent care centres, out-of-hours and 111 services by April 2017.

Photo: iStock

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