The CQC's transitional regulatory approach is being rolled out to general practice from 19 October 2020. The approach builds upon the regulator's emergency support framework which it introduced when the COVID-19 pandemic struck. The CQC's intention is to move away from fixed timetabled inspections and towards inspecting based on presenting risk.
The CQC has indicated that it will be running pilots with adult social care and general practice to explore ways of gathering evidence without physically being on site. While technology is making this increasingly possible to do, and current circumstances demand that this is required, depending on how this is implemented and constructed could be potentially concerning to practices.
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Under normal circumstances the CQC has extensive powers to inspect practices, request information and take civil and criminal enforcement action should it feel that the care is falling short of the relevant regulations.
Such interventions can have a significant knock-on effect for GPs and their surgeries, including referrals to the GMC, NHS England and other relevant stakeholders. It can even result in the closure of the surgery itself.
Risk-based approach
The CQC has said it now may not even have to cross the threshold to assess practices so there is a potential risk that evidence could be taken out of context – accessing documentation, including clinical records, without discussion might mean information is looked at in isolation, and incorrect conclusions be drawn as a result. Practices should be alert to this possibility and be prepared to set the record straight.
The CQC has stated that it will target providers based on risk and, where it sees that there is a risk to patients, this may lead to an on-site inspection. When site visits are needed, the CQC has said it will focus on areas where it cannot collect data in other ways.
Under current methodology, the CQC is supposed to start an on-site inspection looking for good, but this new system appears to be a shift in approach and inspectors will be looking to see whether they can confirm the perceived risk.
Poor ratings, informed by non-triangulated or incorrect evidence, can have a knock-on effect in the form of low-level enforcement and urgent action, including suspension. Ongoing low-level enforcement can also lead to the CQC taking more serious action so regulatory breaches or warning notices should not be ignored.
What about practices that have improved?
This new approach could also impact on surgeries that have improved. Whilst we await further information from the CQC on how the system will work in practice, the fact that it is focused on identifying practices that pose a risk potentially places those surgeries that have undertaken work to improve their services at a disadvantage – particularly those rated ‘requires improvement’ looking to increase their rating to ‘good’ and those rated ‘good’ looking to increase their rating to ‘outstanding’.
Practices could be left with a rating that is not reflective of their service for a significant period of time. This could potentially make the practice less attractive to new patients and partnerships, which in turn could lead to practices missing out on income streams they may otherwise have obtained.
At present, it is at least theoretically possible for the timetabled inspections to be brought forward where the CQC’s monitoring information ‘indicates a potential significant improvement’. It is unclear if this will remain in the new system, but current communications from the CQC seem very focused on risk, with a view to dealing with concerns arising rather than rewarding improvement.
Under its new approach the CQC will be reviewing current intelligence to determine whether it needs to take action. During the COVID-19 pandemic 35% of all inspections the CQC carried out were triggered by information of concern – whistleblowings, safeguarding and complaints. At the CQC's September 2020 board meeting, the chief inspector of primary medical services Dr Rosie Benneyworth noted that the CQC was looking into concerns raised about patients being unable to access their GP practices during the pandemic. The CQC is keen that service users’ voices guide its regulatory activity.
Practices need to be aware of this shift in approach by the CQC and how it might impact them. If the CQC does raise concerns about a practice these should be carefully considered by the practice involved. If the practice believes the CQC’s conclusions are wrong, it should firmly defend its position at the earliest opportunity.
Without early intervention, a potentially incorrect narrative will be created by the CQC which can lead to significant enforcement action being taken putting a strain on the practice and its staff but also ultimately impacting the patients.
- If your practice is affected by a CQC inspection or enforcement action, please call Ridouts on 0207 317 0340, who can help explain your available options.
