CQC rejects call for independent review to look at BAME bias in ratings

The CQC has rejected calls for an independent review of its ratings process to look for potential bias against GPs from black, Asian or minority ethnic (BAME) backgrounds.

RCGP leaders voted earlier this year to demand an independent review after the CQC said it planned to investigate 'longstanding concerns' that GP practices with BAME partners may receive lower ratings.

The college's council called on the CQC to 'commission an independent review of inspections of GP practices rated "requires improvement" or "inadequate" over the past five years - including those practices which have been closed down due to CQC regulations - to assess if there is an association between the outcomes of inspections and ethnicity or country of qualification of the GP partners'.

The RCGP also called for the review to consider the impact of factors such as practice population size, numbers of doctors and levels of deprivation in communities served by practices that have received low ratings - and called for an explanation if an association was found.

CQC inspection

However, in a letter to CQC chief inspector for general practice Dr Rosie Benneyworth after a meeting this week the RCGP said it was disappointed that the regulator was 'declining the college's call for an independent review of the data in relation to ethnicity'.

The letter adds: 'Any exploration of the relationship between regulatory activity and ethnicity must be underpinned by a transparent process that is free from a conflict of interest that would undermine the conclusion of that investigation.

'While we understand that the CQC is undertaking work in this important area, there will always be the legitimate concern that any institution investigating its own activity will have an inherent conflict of interest. We believe that an independent review would go a long way to building better trust between BAME GPs and the CQC.'

The letter from RCGP vice chair for external affairs Gary Howsam added that the meeting with the CQC had made clear 'the strength of feeling concerning, and emotional cost of CQC inspections on frontline BAM-led GP practices'.

BAME concerns

He set out 'key themes' including problems with standardised quality markers being applied to practices that serve 'very different populations and very different areas', as well as the 'absence of a consistent and culturally sensitive support offer for practices'.

The letter highlighted the 'considerable impact' of challenges faced by BAME GPs on training; and warned that practices must not 'feel that the judgment of their performance has been made before the inspection happens, and that they are given the opportunity to engage with the inspectors looking at their work'.

Dr Howsam added: 'There was a clear sense from feedback in the meeting as well as written feedback from our members that many of our BAME members do not have confidence in the current system as yielding fair results and feel that BAME practices are less likely to receive favourable treatment.'

Dr Benneyworth said the CQC was aware of longstanding concerns that BAME-led GP practices were more likely to receive lower ratings and may also be more likely to be in deprived areas with less support.

GP regulation

She said the regulator had set up an independent advisory group with members including the RCGP 'so that we can hear from and work with people from across general practice to improve our understanding of their experiences and the role that a variety of factors could play in this – including ethnicity, social environment and local support'.

The CQC plans to recruit a specialist advisor within its primary medical services and integrated care directorate who will 'explore the experience of BAME GPs with regard to their experience of regulation and also the wider health system'.

Dr Benneyworth added: 'We don’t have all the answers but we are working with our partners, provider representatives and fellow regulators to understand and address the concerns that have been raised with us. The feedback of people working in services is vital to our role as a responsive regulator and helping us develop our regulatory approach. Together we are committed to understanding and addressing inequalities wherever they may occur in health and social care.'

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