GPs reveal grim experiences of 'aggressive' CQC inspections

Practice staff have been left in tears by CQC inspections that felt aggressive or unfairly negative, according to accounts collected by GPs - while one report accused an inspector of racist and sexist comments.

GPs highlight CQC pressure (Photo: Nora Carol Photography/Getty Images)
GPs highlight CQC pressure (Photo: Nora Carol Photography/Getty Images)

GPs who collected the accounts as part of a campaign to end a ‘culture of fear’ around CQC inspections have said ‘enough is enough’ - urging the watchdog to take notice of negative experiences raised by practice staff to avoid deepening problems with burnout and low morale in the profession.

Responding to the comments, CQC chief inspector of primary care Dr Rosie Benneyworth said that unprofessional behaviour or discrimination of any kind was unacceptable - and that the regulator worked with providers to ensure the inspection process worked for inspectors, staff and patients.

However, comments from around 140 GPs and other health professionals - seen by GPonline - who have signed an open letter to the CQC as part of the campaign, show that for some practices, the experience of an inspection has been deeply damaging.

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GPs demand end to 'culture of fear' around CQC inspections

In one case, a member of practice staff felt under such intense pressure ahead of an inspection that they took an overdose of medication. The member of staff is understood to have quit working in primary care since that experience.

One account said a CQC inspector was ‘racist and sexist’ during an inspection.

A doctor who backed the campaign commented that they left general practice last year after an ‘aggressive and unfair’ CQC inspection that caused ‘serious damage’ to staff confidence.

Another GP said their practice had made a formal complaint about bullying after an inspection left practice staff low on confidence, but felt it was ‘brushed off’ - while one comment said a practice was accused of bribery after offering sandwiches to inspectors.

RCGP called for investigation

The accounts of experiences of CQC visits come after the RCGP called earlier this year for an independent review to investigate whether ratings awarded to GP practices are biased against partners from black, Asian and minority ethnic (BAME) backgrounds. The CQC itself has also announced plans for a review into 'longstanding concerns' over potential bias against BAME GPs.

GPonline has attempted to confirm more details around the account of racist and sexist comments raised through the current campaign but has been unable to contact the healthcare professional who raised the concern.

Signatories to the campaign have also voiced concern over the decision to continue with some CQC inspections during the COVID-19 pandemic.

Dr Shan Hussain, one of the GPs behind the grassroots campaign, said: ‘Speaking to my colleagues and co-authors, we feel that we have collectively reached the point where enough is enough.

Burnout concerns

‘GP teams are working extremely hard during exceptionally challenging times, and we urge the CQC to reflect on its attitudes and behaviours toward us.’

One GP partner who commented on their experience of an inspection said a lead inspector who had ‘no experience of working in general practice’ left staff in tears after a ‘barrage of negatives’ in a debriefing delivered to all practice staff.

‘We thought that the CQC would be recognising what we were doing well but also directing us on what we can improve on,’ the GP wrote. ‘This was not the positive process it could have been.’

Another GP said: ‘After 31 very happy years as a partner/senior partner working in a challenging area...I left in 2020. This was the final event in a cascade that started with an aggressive and unfair CQC inspection that placed us in special measures.’

CQC inspection

The GP said that an initial inspection was ‘characterised by aggression and bullying of staff, leaving several in tears’ - an experience that was ‘profoundly detrimental to morale’. A follow-up inspection months later took a ‘completely different tone’ - but the practice team had been destabilised by the earlier experience.

CQC chief inspector of primary care Dr Benneyworth said: ‘Our inspection teams understand the pressures that GPs and practice teams have faced, during this unprecedented time as well as before.

‘That is why we suspended routine, frequency-based inspections in March 2020. It is also why we worked with the sector to respond and adapt – finding ways to support providers while balancing our duty to provide public reassurance.

‘Unprofessional behaviour or discrimination of any kind is not acceptable. We work closely with the providers we regulate to make sure that the relationship between a service and the inspection team works for them, for CQC and the people who use services.’

Pandemic impact

She added: 'We would urge anyone with concerns about their inspection to raise those with us so they can be properly addressed – this can be done locally with the inspection team or the inspection manager, or through the dedicated complaints procedure.'

As of 12 March this year the CQC had carried out 132 on-site inspections since the start of the first UK lockdown on 16 March 2020 - representing a huge reduction compared with the same period last year, when 1,646 inspections were conducted.

The watchdog announced last month that it would step up practice inspections from April, targeting practices rated 'inadequate', 'requires improvement' or 'good' with breaches of regulation - and some with no breaches. 

Around 95% of GP practices in England are rated ‘good’ or ‘outstanding’ by the CQC - with just 4% scoring ‘requires improvement’ and 1% ‘inadequate’.

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