GPs feel CQC checks are unfair and lack cultural understanding, survey reveals

Nine in 10 GPs say CQC inspectors showed no understanding of the 'diversity and cultural aspects' of their teams or patients during inspections - while four fifths said checks were not ‘fair, transparent, objective, or replicable’, a survey has found.

In a survey of 130 GPs by the British Association of Physicians of Indian Origin (BAPIO), half felt that smaller practices in inner-city, and rural areas received disproportionately poorer outcomes.

Three out of four respondents said inspections were ‘intense’ and took staff away from direct clinical care. Over 85% of GPs said inspections did not add value to clinical care or prevent harm - and 70% found the experience to be ‘traumatic’.

BAPIO warned that the inspection system doubly punishes GPs from black, Asian and minority ethnic (BAME) backgrounds. The association said BAME GPs are more likely to work in areas of high deprivation and to struggle to absorb additional workload linked to preparing for inspection - and then to receive disproportionately lower ratings.

CQC inspections

The survey findings come just a week after the CQC outlined plans to begin investigating concerns that GPs from ethnic minority backgrounds may receive poorer practice ratings or regulatory outcomes.

In 2019, the GMC's 'Fair to Refer' report highlighted concerns that BAME GP partners may be more likely to receive lower ratings following CQC inspections. The RCGP called earlier this year for an independent investigation into concerns of an ethnicity bias in CQC ratings - and GPonline has reported on GPs' accounts of their experiences during inspections, including one claim that an inspector had made racist comments.

BAPIO president Dr Ramesh Mehta said he was ‘appalled’ that concerns around a disparity in ratings and unfair penalties for single-handed practices had not improved, despite the group first raising these issues over five years ago.

BAPIO members said the results of the survey revealed the ‘shockingly disparate impact’ of CQC inspections on general practice. BAPIO chair Dr Kamal Sidhu added: ‘The survey confirms our worries that inspections are simply a burden on general practice and a huge source of strain on the staff.

‘It is unfortunate that so many feel unable to challenge CQC decisions and do not have confidence in the ratings. This has to lead to positive change especially with massively overstretched and exhausted staff who have been working very hard throughout the pandemic.’


Nottingham GP and BAPIO GP forum executive member Dr Kalindi Tumurugoti said suggestions that practices led by BAME GPs may receive disproportionality poorer outcomes were 'alarming' and a 'double whammy, with the additional regulatory burden, for BAME GPs who have historically staffed areas of high deprivation’.

In March, dozens of GPs called for an investigation into the CQC's approach to practice inspections, arguing that current methods used by the watchdog had created a 'culture of fear’.

The CQC has said previously that unprofessional behaviour or discrimination of any kind is unacceptable - and that it works closely with providers to ensure its inspection process works for inspectors, staff and patients.

In an update earlier this month, CQC chief inspector of primary care Dr Rosie Benneyworth said: ‘One of the challenges my team and I have been reflecting on, is concerns that practices led by GPs from an ethnic minority background receive poorer CQC ratings or regulatory outcomes.

Regulatory reform

‘Over the next few months, we will be carrying out work to understand this issue and the impact of our current regulatory approach. This will include looking at evidence we and other organisations hold, previous research and listening to the experiences of GPs from an ethnic minority background, including through surveys and focus groups. We will also be examining our own diversity and methodology through an equality lens.

‘We will also be looking at other factors that may have an impact, including deprivation, the demographics of a local area and how the wider health and social care system works in partnership. This work will help us understand what impacts and influences regulatory outcomes.

‘The findings of this work will directly feed into the implementation of our new strategy and will help us shape what the regulatory approach for primary care looks like in the future.’

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