Dr Jamie Green shares the ordeal his surgery went through while waiting seven months for the results of a CQC re-inspection
In June 2023 our practice had a routine CQC inspection. We were downgraded from ‘good’ to ‘inadequate’ with two significant breaches of the Health and Social Care Act, and put into special measures.
Although surprised, we got to work, changing systems and making improvements. It was an incredibly large piece of work to get through but we put in the hours for our re-review. We were told we would be re-inspected within six months of the breach notices expiring – April 2024. In late May we were informed of our follow-up inspection, but were given seven working days notice instead of the promised ten.
The re-inspection took place in early June. With the previous one, we were told within a week about the breaches and downgrading – it was very quick. But this was not the case the second time around. We didn’t hear anything from the CQC. But we felt the inspection went well, and took it as a case of ‘no news was good news’.
We soon started to realise though that there were significant issues with having an ‘inadequate’ rating sitting on your report. I’m a GP trainer and also one of the associate deans for East Midlands. I had to have a conversation with the GP dean about whether or not we’d be able to continue to train GP trainees because of our CQC rating. The same happened when we applied to become an NIHR RSI research practice – one of my special interests. We had to really fight our corner to be able to carry on doing research; I created an 80 point letter outlining all the changes and modifications we had put into action.
There were also financial implications. Our application to be a yellow fever vaccination center was rejected. When hiring for nurses, we had two occasions where candidates turned around and said they didn’t want to join the practice because of the ‘inadequate’ rating. Trying to convince staff to join your team is difficult in that scenario. We currently have a partnership application out, and at least one of the candidates has pulled out after reading the CQC report.
At first, we didn’t want to chase it too much, because the CQC might just turn around and say: ‘Let’s do another inspection!’ We didn’t want that, because preparing for the CQC is so draining. But as the issues started racking up, financially and reputationally, it ended up being inevitable that we had to start tracing it.
When we first started chasing our results in August/September, we were told ‘the inspector is on holiday’ or ‘off sick’. On at least four occasions we were told we would ‘get it by the end of the week’. We went to our ICB to see if it could help, but were referred back to the inspector. We contacted the CQC helpline, and they assured us that if we had contacted the inspector, they should get back to us. We made an official complaint in November.
By December, we had still heard nothing. It was clear that we needed to take it further. I was vocal about the matter on social media, thinking the CQC might respond there. When that didn’t happen, I contacted GPC England, our LMC and local MP – all of whom wrote letters to the CQC.
What’s really disappointing is that the CQC responded to those letters saying it hadn’t received any complaints from us. We were given a copy of their complaints procedure and when I reviewed it, we had followed it to the letter. I honestly couldn’t believe it. If we as a surgery didn’t follow our complaints procedure, the CQC would rightly say we were in breach of the Health and Social Care Act. But who polices the CQC? Who marks their homework? It is absolutely gutting to be judged by an organisation that manages itself in such a way, when we put so much time and effort into doing things properly.
The CQC also claimed that it had been providing good communication with the practice all throughout the period. It pointed out that if we had read its press reports, we would have known that it had been suffering from IT issues. That may be so, but we only learnt about those IT issues in December. We were not – and still have not been – formally told that there was an IT issue with our report, and that’s why we hadn’t received it. All we ever heard was: ‘You’ll get it by the end of the week.’
We finally received our provisional report back at the end of January. We were rated ‘good’ which was a relief; I recently found out that our bank manager was not in a position to extend our practice building mortgage on the basis of the CQC report. If we hadn’t received the good news about our re-inspection when we did, we would have been put in a really difficult financial position when it comes to buying out partners – we would have ended up having to find the money ourselves, rather than from the business.
While we are glad to have our report back, the damage the delay caused has been immense. It has 100% affected patient relationships. We were open and honest about what the CQC has said about us; of course, we have to publish the report in our waiting area. When I call my patients in, probably one in three of them are sitting reading that inspection report before they come into the surgery. Who’s to say that that hasn’t put them in a negative frame of mind before coming to see us?
Because of good quality prescribing, we’ve also been cautious about reducing certain drugs that we give patients, or have had to change certain things about their care within national guidelines. Patients have then written a complaint saying the ‘only reason you’re doing this is because the CQC is following you’. In fact, every complaint we’ve had recently has mentioned the CQC in it – which is very interesting.
Essentially we’ve had almost two years worth of an ‘inadequate’ rating. I could go into a whole other discussion about how the issues we were originally picked up on were nitpicking and unfair movements of the goal posts. One inspector told us: ‘Although we expect this of you, I know we don’t do this in my own practice.’ The standards to which practices are held need to be realistic and evidence based – can practices actually deliver them? Because I can promise you, having had many conversations with other GPs through this ordeal, there are very few practices who can essentially say they do everything they are asked to do by the CQC.
CQC visits are incredibly stressful already and the delay we suffered just exacerbated it. I’m not sitting here and saying inspection doesn’t improve quality in care – but there is a better way of going about it. The human costs on our staff have been huge: it’s possible we’ve lost staff; it’s possible we’ve not had staff want to join us. Individually, every single one of us is absolutely shattered. We are working so hard and always looking over our shoulder, thinking to ourselves: What would the CQC make of this?
Waiting seven months for our report has caused us so much unnecessary stress. I could have understood it if the CQC told us there was an issue with the IT systems or the inspector, but the communication was terrible. Thank goodness they put the report through now, because we are literally about to apply for more credit within surgery, which we have to do every few years. If our bank managers had turned around to us and said that this couldn’t happen at the point of application because of our rating, we absolutely 100% would have had to have taken the legal route with this.
I’m conscious and really worried that there are other practices in our situation right now who are going to be under the same level of pressure. And who knows, they may not have the strength to carry on. They may just close.
Dr Jamie Green is a GP partner and trainer in Northamptonshire. He is also an associate dean for East Midlands
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Dr. Green and his team have clearly been through an exhausting and deeply unfair ordeal. They worked tirelessly to meet the CQC’s demands, only to be left in limbo for months due to administrative failings beyond their control. The financial, professional, and emotional toll on the practice is staggering—not to mention the impact on patient confidence. No GP surgery should have to fight this hard just to receive a fair and timely reassessment, especially when livelihoods and patient care are at stake. It’s a testament to their resilience that they’ve come through this, but the damage caused is undeniable.
The CQC’s handling of this case is nothing short of appalling. A regulatory body that demands accountability from others should be held to the same standard, yet here we see incompetence, poor communication, and a complete disregard for the consequences of its own delays. Ignoring complaints, making empty promises, and failing to provide timely updates is unacceptable—especially when a practice’s reputation, finances, and future are on the line. If the CQC cannot manage its own processes effectively, how can it expect to fairly assess others? This case raises serious questions about the organisation’s reliability and whether it is truly fit for purpose.
Discredited disrespected 5th columnists. The CQC. Any profession with a gram of self respect would have boycotted the CQC. It’s trespass on your premises without your permission to enter. You can call the police if they refuse to leave. They are a distraction from the provision of good clinical care. The time spent complying with their bullshit has unintended consequences, time not spent with patients, which is the bottom line.