GP regulation: Duplication of checks on practices by CQC and NHS England must stop

Patient safety is key, but inspection of GP practices must be consistent and proportionate, says Medical Protection medico-legal adviser Dr Pallavi Bradshaw.

The CQC was recently described as 'not yet an effective regulator' by the House of Commons public accounts committee (PAC) and concerns were raised about accuracy and timeliness of inspection reports.

When a GP practice is inspected it is entirely right that where patient safety is at risk, appropriate regulatory action is taken. But this must be consistent, targeted and proportionate. The current regulatory processes often overlap each other and can be inconsistent and confusing, which we worry could have a detrimental effect on GPs’ health and practice.

This is one of the reasons why we have been calling on the government to resist introducing more healthcare regulation until it is established that current processes are effective.

Map: GP CQC ratings

There is duplication and overlap of activity that occurs among regulatory bodies and organisations. Many areas of practice are regularly reviewed by NHS England as part of audit and governance, only to be re-reviewed by the CQC. It is therefore surprising, but not unheard of, that a practice may be deemed to have met standards by one organisation only to be told that they are poorly performing by another.

This inconsistency can lead to a sense of unfairness and confusion. Duplication is unfortunately a feature in the new era of healthcare regulation, for example, an NHS complaint can be investigated simultaneously by the CQC and NHS England. Further overlap is possible if a concern is raised about a practitioner when they face investigation and sanction from more than one regulator. These areas need to be identified and streamlined where possible to reduce time, money, and the emotional effect on doctors.

With long hours, tough workload and rising patient expectations part of everyday practice, it is a challenging time for GPs. The regulation they face can seem overwhelming and difficult to keep up with. An over-reliance on regulation as a way to change behaviour also risks undermining a culture of openness and learning. It is in the interests of patients, doctors and regulators to ensure regulation is targeted, consistent and proportionate.

In my experience CQC inspection reports can contain factual errors, calling into question fairness and process. With published ratings this can have harmful repercussions for practices and create anxiety for their patients – which is why it is imperative that CQC inspections are thorough and accurate.

CQC inspection stress

From the first notice of an inspection, through to gathering preparatory materials and evidence and the often lengthy wait for the report, it can be an extremely disruptive and stressful process for the whole practice. A survey we conducted into the mental health of doctors earlier this year revealed that 54% of respondents believe high levels of regulation and scrutiny had a moderate or high impact on their mental health.

Being a doctor is not only physically and intellectually demanding, but also emotionally draining. We worry that disproportionate inspection regimes can have a detrimental effect on GPs’ confidence, concentration and morale.

The good news is that after over 2,000 CQC inspections, more than eight out of 10 practices have been rated as ‘good’ or ‘outstanding’. Practices should be extremely proud of this result, but unfortunately this positive message is often lost as the 4% rated as 'inadequate' make the headlines. The regular negative coverage about general practices does not reflect the high standards seen in primary care as rated by the CQC and understandably frustrates and demoralises the profession. It is important that GPs feel empowered and supported to do what they entered healthcare to do – care for patients.

We must promote collaboration among regulatory bodies and streamline existing processes wherever possible to ensure that the most appropriate body leads on a specific area, so that there is less overlap. We must also move away from a ‘one size fits all’ approach, as the same measures may not be appropriate for GP practices compared to hospitals. Safeguarding the public and improving patient care is, of course, a priority, but we must ensure the process is robust and effective for practices.

  • Dr Bradshaw is medico-legal adviser at Medical Protection

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