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CQCMay 25 2016

The Care Quality Commission’s new five year strategy includes the intention to make more use of unannounced inspections.

It also intends to make greater use of information from the public, providers, other regulators and oversight bodies so it can better target resources where the quality of care is at higher risk. This could be identified, for example, by a sudden spike in people reporting poor care from a service.

As a consequence, the CQC has said that there will be longer intervals between inspections for services rated good or outstanding if they can continue to demonstrate that they are providing good care.

The CQC has summarised the main changes in methodology in its new 2016-2021 strategy, saying:

  • more resources will be targeted on assessing the quality of care for services with poor ratings and those whose rating is likely to change, and less on those where care quality is good and likely to remain so;
  • there will be more use of unannounced inspections focused on the areas where insight suggests risk is greatest or quality is improving, with ratings updated where inspectors identify changes;
  • a more robust registration approach will be used for higher-risk applications and a more streamlined approach for those that are low-risk;
  • the focus on the quality of care that specific population groups experience will increase as will the assessment of how well care is coordinated across organisations;
  • the QCQ will support the process of ‘learning alongside’ providers who offer new care models, to encourage innovation by flexibly and effectively registering and inspecting such new model;
  • it will develop a shared data set with partners, other regulators and commissioners, so providers are only asked for information about care quality once;
  • new ratings of how well NHS trusts and NHS foundation trusts are using their resources to deliver high-quality care will be introduced.

CQC Chief Executive David Behan said: “Inspection will always be crucial to our understanding of quality but we’ll increasingly be getting more and better information from the public and providers and using it alongside inspections to provide a trusted, responsive, independent view of quality that is regularly updated and that will be invaluable to people who provide services as well as those who use them.”

A couple of days before the CQC’s announcement, the BMA’s Annual LMC Meeting heard GP Committee Chairman Dr Chaand Nagpaul reiterate the BMA’s insistence on there being a complete overhaul of the CQC’s inspection process.

The proposals in the General Practice Forward View to reduce inspections to every five years “totally misses the point,” he said. “We don't want to simply reduce the frequency of a process which is utterly flawed and damaging to GP practices. We’re calling for it to be decisively expunged and replaced with a system that’s proportionate, targeted, understands context and supports practices rather than threatens them.”

The GP Defence Fund is funding a judicial review challenging the CQC’s “heavy handed processes that are neither fair, equitable nor reasonable which we believe falls foul of the basic principles of natural justice. And a system in which we’ve this week exposed that their rating of a practice correlates with its level of funding, and which penalises and shames those that are the most disadvantaged already,” he said.

The BMA will fight for inspection fees to be fully reimbursed, but the true cost of CQC goes far beyond its fees both in terms of “the days and weeks of stress and preparation taking GPs and staff away from patient care” and the “tens of thousands of GP appointments cancelled weekly to accommodate inspection teams”.

“This is why the current process absolutely needs to be culled, and put millions of pounds squandered in nit-picking senseless processes back into patient care instead,” said Dr Nagpaul.

Links:

CQC announcement

CQC strategy documents

BMA GPC LMC Meeting 2016 speech

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