Interview: Tackling the CQC's image problem

The CQC's chief inspector of GPs, Professor Steve Field, tells David Millett why it is vital GPs are involved in his new practice inspection regime.

'I inherited a system which didn't have clinical input to a degree that was acceptable,' says Professor Steve Field, the CQC's first chief inspector of general practice.

Professor Field, a GP in Birmingham and former RCGP chairman, was brought into the fold from NHS England in August 2013.

His appointment followed negative reports on practice inspections, which began after the CQC became responsible for regulating primary care in April 2013.

By December 2013, LMCs were warning that 'aggressive' and 'bullying' CQC inspectors had reduced GP partners and practice managers to tears. They reported that some inspectors had 'no background in general practice' and had 'demonstrated complete ignorance to what GPs should and shouldn't be doing'.

Six months on, Professor Field admits: 'It had a major image problem.'

Revamped inspections

His team at the CQC is now in the midst of piloting a revamped inspection scheme across 12 CCGs.

The first wave of these pilots began on 1 April this year, with a second scheduled to begin in the summer. The new system is set to roll out officially on 1 October, and will see GP inspectors swell the ranks of the CQC.

'GPs understand the context of how a practice is working in an area,' says Professor Field. 'They will understand what it's like to be a GP and any constraints the practice has got. They'll be more aware of issues about premises, and they'll be better at looking at clinical audits and sharing concerns with GPs.'

The six-month programme of pilots will assess what role these much-needed GP inspectors will have, as well as fine-tune how the inspections work, and how ratings will be classified.

GPs in 'an ideal position'

The chief inspector of GPs is also considering whether to use other specialists, such as pharmacists, to free up time for GP inspectors to focus on key areas where their expertise in general practice can be best applied.

'A GP is ideal for looking at clinical audit cycles within a surgery, but on the other hand so are pharmacists. If a practice has a higher than normal antibiotic use rate, could a pharmacist look at that or a GP? Where do we use one or the other?'

For the planned inspection teams to be successful, the CQC needs to recruit 'a whole lot more' GP inspectors before October, says Professor Field, who urges GPs to contact the CQC if they are interested in taking part.

In addition to GPs still in practice, the CQC plans to expand the search to include GPs who have retired within the past five years. 'We want to keep it to five years so they can still understand what it's like in general practice,' he says. 'This might be a way of GPs giving something back once they've retired.'

Professor Field emphasises that the CQC is looking for a cross-section of GPs to take up the role, not just those involved in academia. He is confident the CQC can recruit the large number of GPs needed, and promises that inspections would not go ahead without one on the team.

Early findings

Professor Field says the CQC has so far found examples of care across the full spectrum of standards, from very poor to excellent, but that 'care has generally been safe, responsive, effective, compassionate and well-led' overall.

All practices are scheduled to undergo inspection before April 2016 under the new regime - even those that were recently inspected under the old regime and regardless of whether they were found to be compliant or not.

It means practices inspected in March this year could be forced to undergo another inspection within just seven months. Professor Field says: 'We do have a note of who has been visited, but we have no plans either to visit or not visit those (practices).'

He says that '34% of all practices that have been visited have been found non-compliant in at least one area, so there'll be an action plan about revisits for them anyway'.

He adds that any practice reinspected would benefit from a new-style rating, as opposed to just being marked as compliant.

Under the revamped CQC rating system, practices' care will be rated across 42 categories to produce an overall Ofsted-style classification of 'outstanding', 'good', 'requires improvement' or 'inadequate'.

But the CQC has pledged to be sensitive to practices' situation and may change inspection days in consideration of local circumstances.

'Already our inspections were defeated by floods in Surrey. We felt we shouldn't visit one day because the out-of-hours provider was busy doing its work,' he says.

Professor Field believes recruiting GPs to the CQC will add credibility to the inspections and to general practice. 'We're not looking at inspectors to go in and look for disastrous providers. We're looking to celebrate what's good and outstanding about British general practice.'

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