There is a ‘lack of consistency’ and transparency in CQC ratings of GP practices, a damning report has found.
An interim review into the effectiveness of the health and care regulator has highlighted serious issues with the way the CQC operates and rates providers, including low levels of inspections, a ‘lack of clinical expertise’ and a ‘lack of consistency’ in assessments.
The findings led health secretary Wes Streeting to take ‘immediate steps’ to increase oversight last week, declaring that the organisation is ‘not fit for purpose’.
Dr Penny Dash, the North West London ICS chair who led the review, found that staff who work across large groups of GP practices ‘report ratings differing from one site to the other’, when those differences are not observed in reality.
The review, published on Friday, also pointed out that ratings are calculated by ‘aggregating’ the outcomes of previous inspections, which Dr Dash said ‘cannot be credible or right’.
Concerns were also raised about the CQC’s new single assessment framework, including the heavy reliance on GP patient survey data to understand patient experience, which ‘may not be representative’.
Dr Dash said: ‘Many providers referred to a lack of consistency in ratings awarded to providers.
‘Those who work across multiple sites, for example, a large care home provider with multiple sites or a large group of GP practices, report ratings differing from one site to another, when they know (spending far more time with them) that the differences are not as being reported – and in all directions, for example, their poorer quality providers getting better ratings than their top providers and vice versa.’
The CQC’s performance was also reviewed by looking at the backlog of assessments, which found that there has been a dramatic reduction in the number carried out each year since 2019.
However, general practice has the highest proportion of providers with a published rating, at 97%.
Another concern about the single assessment framework was that the data the CQC uses to understand patient experience is ‘not sufficiently transparent’.
It comes after the CQC admitted it ‘got things wrong’ when implementing the new framework.
The review said: ‘It seems the majority of data considered is drawn from national surveys (for example, the NHS GP Patient Survey and the NHS England Personal Social Services Adult Social Care Survey), which may or may not be representative or statistically significant at a service level, and this is then supplemented by a number of interviews with service users.
‘The interviews could be as few as tens of users of a service when the service is looking after thousands of people a year.’
According to Dr Dash, this low number of case studies ‘may result in a lack of representativeness of responses which questions the robustness of the analysis’.
GP practices and providers must have an understanding of how ratings are calculated, Dr Dash argued, otherwise they may feel it is ‘impossible to change’ them.
Other concerns raised in the review included:
- Providers told the review that they can wait for several months to receive reports and ratings following assessments;
- The deployment of new IT systems resulted in significant problems for users – they cannot easily upload documents, there are problems if the named user is away or off sick and it can take hours to receive a password reset;
- The CQC’s current executive team is largely drawn from the social care sector with a noticeable lack of healthcare experience.
Responding to the review, the CQC said it ‘accepted in full the findings’ and is ‘committed’ to increasing the number of inspections and to increasing the number of staff working in registration to ‘improve waiting times’.
In a further update on Friday afternoon, interim chief executive Kate Terroni said: ‘We know that these recommendations chime with what we have already heard from the public, providers and our own workforce.
‘We know we need to listen better, work together more collaboratively and be honest about what we’ve got wrong.
‘Finally, I want to say again, I’m sorry we have got things so wrong in the implementation of our new approach, we’re not where we want to be, but commit the CQC to put things right by truly working in partnership with you and the people who use health and social care.’
” CQC said it ‘accepted in full the findings’ and is ‘committed’ to increasing the number of inspections”
Yes, because that’s what we need. Sigh.
Roy Lilley writes a good blog. I do not agree with everything he says, but his views on the CQC have always been damning. His view, and mine, is that punitive inspection regimes drive down quality, reduce morale and get in the way of people trying to do the right thing. The solution to problems with the CQC is not to do more inspections. Is it to get rid of the organisation, and inspections, altogether. I strongly suspect that Wes Streeting, a man who appears to have no understanding of anything, will no doubt ramp up the CQC and demand inspection after inspection. To show how tough he is.
The problem with quality inspection is quality inspection itself.
This information was easily available by just talking to any handful of gp surgery’s who have been inspected. Didn’t need an expensive report
Been there & got t-shirt. Was an inspector (once) & even reported a local practice as GP & the local OOH as father of user & would have got more sense/action from my dead pet dog
Complete chose & taking to me would have been cheaper & not a million miles away from my colleagues perspective.
The CQC email rate has escalated again! Honestly if I bothered reading all these rubbish communications I’d have no time to see any patients. They clearly have an inflated sense of their own importance, imagining that people with actual responsibility for providing good care would be even remotely interested. We have been gaslit by these people to the extent that we try to comply with their time-wasting and erroneous conception of what good care actually looks like. GPs need to grow some backbone and refuse entry to these turncoats.