NICE targets drive up CQC costs for GPs

Care Quality Commission (CQC) registration will cost GPs far more than the £1,000 annual fee as practices take on extra work and staff to hit tough NICE quality standards.

Dr Grewal: says practices are at breaking point in terms of workload and questions the extra targets (Photograph: Nathan Clarke)
Dr Grewal: says practices are at breaking point in terms of workload and questions the extra targets (Photograph: Nathan Clarke)

By April 2012, all practices must be registered with the CQC and will have to pay an annual fee, expected to be around £1,000.

But the CQC has now revealed that it will also require practices to satisfy NICE's new quality standards or face being investigated. The disclosure comes after it was announced that practices may be forced to release clinical data for publication or face legal action and pay suspension.

Hidden CQC costs

The true cost of CQC registration and deadlines:

  • £1,000 - expected annual cost, based on costs in pilots and charges for dental practices.
  • Staff costs - hospital trusts had to take on extra staff to show they had met NICE quality standards.
  • Opportunity costs - with no new resources allocated to meet targets, practices will have to reassign resources.
  • Deadlines - practices must register with CQC by April 2012 and the full set of 150 NICE quality standards are due by 2015.

GPC deputy chairman Dr Richard Vautrey said the new standards would 'undoubtedly' have an impact on practices.

'It is not acceptable to expect general practices to pick up more and more unresourced workload,' he said. 'Any recommendations by NICE must be costed and should be proportionate to the available resource.'

NICE quality standards use existing guidance to define a gold standard of care. Eight have been published so far, but 150 are expected by 2015.

The NHS Commissioning Board will use these standards to produce indicators to monitor GP commissioners and calculate quality premiums.

NICE is now in talks with the CQC about how its standards will sit alongside the commission's essential standards of quality and safety.

Performance against NICE standards will form part of CQC 'intelligence' on each practice and failure to comply may 'trigger a review', a CQC spokesman said.

Dr Fergus Macbeth, director of NICE's centre for clinical practice, told its annual conference last week: 'For NICE quality standards, you can only say you are delivering high quality care if you are actually delivering high performance across all those 10 to 15 measures.

'Conversely, if you are performing poorly on some or all measures then it might well be that you are at risk of failing some of CQC's essential standards of quality and safety.'

The conference heard that NICE quality standards had led to hospital trusts having to hire staff and divert resources to hit 'tick box' targets, with no evidence of improved care.

Dr Tony Grewal, medical director of Londonwide LMCs, said practices were already at 'breaking point' in terms of workload and questioned the need for extra targets in a time of reduced NHS resources.

'It may be heralded as a way of encouraging best practice - in fact extra standards are another stick to beat general practice with,' he said.

GPC negotiator Dr Chaand Nagpaul said any move to incorporate NICE standards into CQC registration would 'entirely change' the institute's remit.

A NICE spokeswoman said: 'High quality care and safety are inextricably linked, and we are looking forward to exploring ways we can work together more closely with the CQC.'

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