Simplistic CQC risk indicators 'misrepresent practices'

Practices with atypical populations or those opting out of the QOF are being unfairly misrepresented by the CQC's 'risk banding' system, GPs have warned.

Dr Chris James: anger over CQC risk score (Photo: Solent News)
Dr Chris James: anger over CQC risk score (Photo: Solent News)

University practices or those serving the homeless are likely to have skewed QOF figures, which will affect the authenticity of their CQC risk indicators, the GPC has said. This means many are being inappropriately called out as 'high risk' on its website.

Practices that have elected out of the QOF will also be impacted, deputy chairman Dr Richard Vautrey said.

Southampton GP Dr Chris James, whose university practice has been publicly branded in the highest risk category by the CQC’s Intelligent Monitoring system, said his practice had been judged as lacking on factors that were not relevant to its patient population.

Young patients skew risk rating

The risk report for his practice, the University Health Service in Southampton, suggests it is falling short on diagnosing heart diseases and COPD, without taking into account that the majority of its patients are aged 18 to 24.

In an admonishing letter addressed to the CQC, Dr James wrote: ‘I have no problem with you publishing data, but you are claiming to interpret it, claiming to interpret it intelligently, and passing judgement displaying risk levels.

‘The fact that you are telling the nation that my practice for University students is a risky practice due to us failing to diagnose heart disease and chronic obstructive airways disease in our young population is outrageous. It serves only to discredit your process.’

Risk scores for the CQC’s Intelligent Monitoring system, which are used by the regulator to prioritise practices for inspections, were controversially published online last week.

The watchdog maintains that the risk scores, which rank practices from band 1 (high risk) to 6 (low risk), do not constitute a judgment on practices.

But since being made publicly available, many GPs have expressed concerns after media outlets across England reported that practices given high risk scores were 'failing'.

Dr James said the CQC was ‘naïve’ to think that ‘the language and presentation they use will not be seen as presenting the quality of the practice’.

He told GP: ‘There is not a jot of intelligence deployed in its presentation. The outrageous thing is, that under the banner of intelligence, it uses judgmental words like risk, even quantifies the level of risk, and then offers a score for the entire practice performance.

'At the most, the only comment that can be made using this data is a degree of outlying – certainly not risk.’

Indicators too simple

Dr Vautrey said the CQC had ‘created confusion and worry in patients’ minds’, and the GPC had forewarned the regulator that this would happen if they pressed ahead with publishing the data.

He said: ‘There's a whole variety of reasons why individual practices will have slightly different QOF data and that’s just not reflected by the far too simple indicators.

‘Any practice with an atypical population can be affected by this. Even some mainstream practices with very good reasons why their QOF indicators were out of line during that time – we’ve heard of practices that have taken over failing practices, and they're deemed to be failing because of information that is out of date.’

CQC has said it is ‘disappointed’ with how the intelligent monitoring report has been interpreted.

It took to Twitter on Thursday to say: ‘We published our analysis of publicly available evidence on general practices because we are an intelligence-driven, transparent regulator.’

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