Pulse takes on August’s talking points – what is the relationship between the Government and BMA after a month of collective action, and what does the CQC’s latest announcement actually mean?
What are relations like between the BMA and the Government?
It was reiterated by the BMA in the run up to collective action that patients ‘would not come to harm’ as a result of GPs’ actions. GPC England chair Dr Katie Bramall-Stainer stressed that the movement was aimed at NHS England and the Department of Health and Social Care. So, a month into collective action – what are relations between the union and the Government looking like?
The official line is that the BMA is ‘in dispute’ with the Government. GP leaders have said that the goal of collective action is to ‘put pressure on the Government’ and get ministers ‘back around the table to negotiate in good faith with the GPCE.’ Once sat at the table with the Government, GPCE wants to negotiate a new contract that guarantees the investment needed to rebuild and transform general practice.
One of the long-yearned-for changes that GPs asked for was the inclusion of the profession in the ARRS. The BMA first argued for this in January (though it would be remiss of us not to note that Pulse editor Jaimie Kaffash got there first). This began a lengthy war of words between GPs and the previous government, with NHS England stating that GPs would not be added to the scheme because they were ‘not additional.’ Cue laughter.
Fast forward a few months and we wind up with a new government – one that pledged to review the ARRS in the run up to the election. New health secretary Wes Streeting started with a focus on general practice with his first official visit in the role being to a GP surgery, and meeting with Dr Bramall-Stainer later that month. Then, on the eve of collective action (and before BMA ballot results had even been confirmed)…
‘Practices can hire GPs under ARRS this year’ sounded the klaxon. Well, perhaps a siren is a more accurate term given that it was stressed as an emergency measure. The Government stated that under this system, £82m would be added to funding in order to hire 1,000 more doctors this year – that is the 2024/25 cycle. The money would be given to PCNs to employ newly-qualified GPs from October onwards.
While a step in the right direction, the limitations are obvious and remain unanswered. Our very own Copperfield did some haphazard mathematics and worked out that between 1,250 PCNs there would be 0.8 GPs per PCN; so one must wonder how these new hires will be divvied out. ‘Newly qualified’ has not been eexplained (those who CCT’d this year? Last year? Five years ago? Whichever window of eligibility you take, the odds of being hired through the ARRS still seem slim.)
For GPs who are hired through a short-term expansion of the ARRS, there are queries, mainly whether or not they will be hired for more than a six-month contract: employment is great but retention is crucial. The BMA picked up on these concerns and emphasised that it expects ‘any GP to be employed on the salaried GP model contract or equivalent terms’.
Since then, the BMA has remained vocal. The union has asked the Government that ARRS funding be directly given to practices, rather than at the PCN level, in an effort to target GP unemployment to the places most affected. On the same day, the BMA also warned practices against ‘plugging gaps’ in services which may have emerged in the wake of collective action.
But there has been little word from Mr Streeting since the announcement a month ago. We do know that the BMA and NHS England will need to work together to make changes to the network DES to allow PCNs to hire GPs. But it is uncertain what the future beyond this might look like.
Collective action is set to continue, and there is expected to be an uptick in involvement from practices in September. Streeting’s quiet complacency in the month since announcing ARRS expansion suggests that only an escalation of sorts will get him to come back to the table with the BMA. If not, he may have to start preparing for an escalation to phase two of collective action – one which could involve contractual breaches and actual strike action.
To use a perhaps a now defunct turn of phrase: BMA and Government relationship status? Well, it’s complicated.
What can GPs expect from CQC inspections?
Earlier this week, Kate Terroni, interim chief executive, of the CQC announced in the HSJ that it would be scrapping its ‘generic’ inspection team model in secondary care in favour of giving trust CEOs named inspectors with whom they could raise concerns – reverting back to the system previously used. This move has been touted – by the organisation itself – as a way to ‘build back trust.’
It comes in the wake of a bumpy few months for the health and social care watchdog. Health secretary Wes Streeting declared the CQC ‘not fit for purpose’ in July, following criticism from an independent review of the body into its regulation of primary, secondary and social care. To list all the failings and misgivings identified by North West London ICS chair Dr Penny Dash would be a lengthy task, but a non-exhaustive list includes:
- Lack of consistency in inspections – for example, multiple sites owned by the same provider would have stark differences in their rating despite the level of care being reported as very similar by the staff working there;
- Lack of clinical expertise – some inspectors visiting hospitals without having ever been to one before;
- Low levels of inspection – of the providers that CQC has the powers to inspect, around one in five had never received a rating.
And that’s all before we even get to talking about general practice specifically. Last year, the CQC announced a new GP practice inspection framework. It began trialling the model in the South of England in November as part of a ‘single assessment framework’, which was rolled out across England by the end of March. Ratings and five ‘key questions’ were kept, but the changes introduced six new ‘evidence categories’: people’s experience of health and care services; feedback from staff and leaders; feedback from partners; observation; processes; and outcomes. These were not particularly well-received at the time.
However, in July, it admitted that it ‘got things wrong’ in implementing its new approach, and as a result had ‘lost the trust’ of providers in both primary and secondary care. However, at the same time as doing this it also said it would be increasing the number of inspections it would carry out – much in the same way that when one might ‘get things wrong’ by crashing their car into a building, and then consequently start offering lifts to their friends and family. Furthermore, it also flies in the face of the CQC wanting to reduce GP inspections so that practice staff can solely focus on delivering care for their patients.
Pulse reached out to the CQC to ask whether this week’s announcement of ‘scrapping the generic inspection model’ would apply to GP inspections. We were told that this was a pilot that was ‘exploring improving relationships with Trusts’ but that it would also be looking at how the CQC ‘can improve relationships with other registered providers, including GPs.’ So, despite the report finding multiple failings in the inspections themselves, the CQC at present seems most concerned with managing the relationship between itself and secondary care providers, rather than renovating inspection procedures.
So to answer the question: what can GPs expect from CQC inspections? Well right now, it seems like a whole lot of the same, which is bad news for everyone.
Preparing for CQC inspections is a gruelling process for practices, taking a toll on staff health and patient care. But right now, we don’t know whether the CQC is actively looking to address these shortcomings. While addressing problems with secondary care is vital, it seems as though general practices is an afterthought.
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