The GP inspection regime has now been in place for almost 2 years. The general consensus is that practices are adapting to the new system and understand what CQC expect of them. Initially hesitant to engage with yet more external scrutiny, the efforts of the majority to demonstrate has paid dividends. The current trend is of somewhere between 75% and 80% of practices being rated Good or Outstanding.
One of the headlines of the recently published ‘Shaping the future: CQC’s strategy for 2016 to 2021’ (that CQC would move the inspection of general practices rated good and outstanding to intervals of five years) appeared to indicate significant confidence in the sector.
However, recent events may suggest that GPs should prepare for a new battle; or, more accurately put, a battle of which they are acutely aware but which is currently attracting a greater level of media and public scrutiny.
The failings by Southern Health NHS Trust in relation to the tragic death of Connor Sparrowhawk, the inquest finding of ‘severe failings’ by Mersey Care NHS Foundation Trust which ‘significantly contributed’ to the death of Laura Mottram, and the appalling delay in accessing Cambridge and Peterborough NHS Foundation Trust’s crisis intervention team which led to Edward Mallen’s suicide, are just three recent and much published examples of young people failed by our mental health services.
According to the Royal College of General Practitioners’ Mental Health Toolkit, “approximately a quarter of all people will experience a mental health problem in the course of a year, and 23 out of 30 who experience mental health problems will visit their GP”. ‘The Five Year Forward View for Mental Health: A report from the independent Mental Health Taskforce to the NHS in England February 2016’, noted that a quarter of people who took their own life had been in contact with a health professional, usually their GP, in the last week before they died; most had within a month.
Such statistics will come as no surprise to GPs, who regularly express their concerns and tell stories of tied hands; aware of the patients’ struggles but equally and acutely aware that the referral they prescribe is attached to a long waiting list.
CQC is notoriously sensitive to press coverage and have been known to adapt their priorities accordingly. As well as key areas of Safe, Effective, Caring, Responsive, and Well-Led, each practice’s inspection must scrutinise the effectiveness of a practice’s work with defined Patient Groups, one of which is Mental Health. It is therefore already a matter for CQC’s consideration and one which, with the recent spotlight, is likely to become more of a focus.
Keen to reassure that they understand the public’s concerns, GPs should expect CQC inspectors to place a greater emphasis on the steps practices have taken to address this specific Patient Group. GPs will (with no additional funding or resources) be required to demonstrate in inspections what in their policies, procedures, training and actions is specific to mental health.
One potential offering to both the very real issue of assisting patients with mental health concerns and the ability of GPs to demonstrate compliance with CQC’s expectation could be found in the aforementioned ‘Five Year Forward View for Mental Health: A report from the independent Mental Health Taskforce to the NHS in England February 2016’. A forward-looking report which set out new initiatives for the sector, it highlights that GPs are already perceived as more caring than many of the more acute mental health services. However, it noted that according to the Royal College of GPs 42% of practice nurses had no training in mental health and found the training of GPs to be lacking.
A central recommendation of the report was therefore to ensure that by 2020 all GPs, including the 5000 joining the workforce by 2020/21, must receive core mental health training; additionally suggesting the development of a new role of GPs with an extended Scope of Practice (GPwER) in Mental Health.
As with every aspect of a CQC inspection, preparation is key. By recognising the potential for greater enquiry at an early stage, practices can invest the time and resources into ensuring that their offering is up to CQC assessment and that their staff have the language to appropriately communicate this. If they find themselves wanting, they should take this opportunity to access the available resources, advice and consultancy services; better to do so now than to be forced to do so under the pressure of a negative CQC report and the burden of the Special Measures regime.