CQC risk tool could make inspections unfair, GPC warns

The CQC's intelligent monitoring system could influence practice inspectors and put the impartiality of official ratings at risk, a GPC member has warned.

Dr Andrew Green: warning over CQC ratings

GPC clinical and prescribing lead Dr Andrew Green warned that CQC inspectors could feel pressure to rate practices in line with risk scores to mitigate claims that they misrepresent practices.

The CQC has been heavily criticised by GPs after publishing data from its monitoring tool that places each practice into one of six bands from high risk to low risk, although it has yet to inspect the vast majority of them.

Last week, the watchdog was forced to change the way it calculated the risk ratings, in a U-turn that saw 60 practices previously deemed 'high risk' moved into lower risk bands.

Many practices believe the risk indicators - which received widespread media coverage - were unfair and misrepresent their quality of care.

GP revealed on Friday that practices branded high-risk could have a legal case for defamation against the CQC if they were later found to be ‘good’ or ‘outstanding’ inspection, according to a leading primary care solicitor.

The watchdog has always insisted that only inspection ratings represent quality of care. But Dr Green aired fears that the impartiality of these official ratings could be compromised as inspectors attempt to damage control or justify the intelligent monitoring risk bands.

Viewpoint: CQC must offer GPs a fair trial

He said: ‘Even in the most minor of criminal trials steps are taken to ensure that those forming judgments do so without preconceptions, yet the CQC is sending inspectors into practices having done exactly the opposite, having primed them to expect a practice which might be putting its patients at risk. Even if they try to look at the practice with fresh eyes, it is inconceivable that they will not be swayed by their expectations on a subconscious level.

‘Added to that, the CQC is now under intense pressure about the validity of its banding process, and the easiest way to defuse some of the anger is to "prove" that the bandings predict performance. This need not be a conscious process for it to be important, there need be no conspiracy, nor any bad intent, only the natural workings of the human mind combined with an unwillingness to accept the possibility of error.’

In response to the concerns, a CQC spokesman said: ‘CQC's ratings of GP practices are based on the work of inspection teams with specialist knowledge of general practice, comprehensive key lines of enquiry for inspectors; intelligence-sharing with CCGs, quality surveillance groups, NHS England area teams, LMCs, GP practices and the public; and data collection from other sources such as NHS England’s primary care web tool, local Healthwatch, Public Health England practice profiles.’

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