GPs: Be Very Careful With CQC Allegations

Topics covered: challenging cqc, CQC enforcement action, CQC inspection reports, GP, GP Practice, gp services, GPs

Ridouts have observed that the CQC have intensified the aggressive presentation of inspections and inspection reports over recent months. This is particularly noticeable in the CQC attitude to primary care and GP practice interactions.

Unsurprisingly, but, most unfortunately many of those engaged in front line inspection lack any medical qualification or experience, and, when that qualification and experience is held, it is rarely by practitioners with up to date current practice experience.

Regulation will always be behind on thoughts and mind-sets rooted in established practices rather than new developments. This is disappointing as it acts as a brake rather than a spur to practice development in a modern environment.  A change in this attitude is vital if medical practice is to meet the challenges found by today’s practitioners.

Our experience is that this regulator is focused on closed culture self-defence rather than a forward thinking and reflective approach to new challenges and 21st century issues.

Practices, which have helped support medical management from being overwhelmed, particularly during the pandemic (e.g. online diagnosis and prescribing) have been viewed with a deep sense of suspicion based upon practices learned and adopted in a different and bygone time.

There is no doubt that the wide publication of judgements and ratings has and will continue to have very serious impacts on registered practices. If those judgments and ratings are adverse the impact of publication in a wide variety of contexts will be damaging and may be disastrous.

Important decision makers will rarely take the time to digest the whole content in the round, but will make their own judgements upon the headlines. Few will read beyond the summary and some not beyond the rating of which the stark one or two word labels may themselves be wholly misleading, when read alone.

The current law gives little realistic opportunity for practitioner to challenge with a prospect of some success, unless that practitioner is prepared to commit significant resource into mounting the challenge. The CQC has co-instructed a structure which operates to stifle disagreement and views different to its own. It appears more concerned to support the findings of an inspector rather than objectively to challenge those findings even where the evidence given for those findings is slim. A plain example is that provider challenges to inspector findings are reviewed by the same inspector who made the findings. Many of us characterise this as “marking your own homework.” It would not be tolerated in most investigative methodologies. However, the CQC have stood by this one sided and unfair approach.

Following the delivery of a draft inspection report there is a one-time opportunity to challenge findings and judgements. Whatever CQC may say, is it not obvious that if findings change should it not at least be considered whether or not there is an impact on ratings. The poor quality of evidence relied upon can be seen as less evidence than conjecture opinion and hearsay.

  • Undue reliance upon the negative without considering intellectual contextual balance;
  • Acceptance of anonymous criticism by service users; so called supporters who may not even have a close connection and may be influenced by subjective and ill-founded opinion or extraneous irrelevant material; reliance upon anonymous reports from staff and former staff who are reported as credible without that credibility being tested;
  • Treatment of very small samples of evidence from documentary records as being undoubtedly indicative of performance of a whole service of significant size;
  • Failure to consider in context the balanced risk revealed and rush to place the maximum adverse potential outcome to circumstances, which if properly examined, would appear less of a concern then when taken at first.
  • Total acceptance of an individual’s subjective reaction to contents of written documents without troubling to take any steps to reflect, examine, or provide an opportunity for explanation.

All of these serious failings are a regular feature of CQC draft and finalised reports which are then treated as incontrovertible by the CQC.

The response to factual inaccuracy perceived within a CQC draft report must be delivered within 10 working days from receipt. It is the one opportunity that the provider practices will have to put an alternative case.

It is absolutely vital that providers take this tiny opportunity to advance reassured and well-argued challenges by way of disagreement supported by documentary or witness evidence (in the form of a signed statement).

The (“Findings”) are characterised as:

  • (un) Safe
  • (in) Effective
  • (un) Caring
  • (un) Responsive
  • (not) Well – led

My parenthesis is added to show the change to the word in a negative context. The (“Ratings”) ratings are:

  • Outstanding
  • Good
  • Requires improvement
  • Inadequate

The Ratings will be an individual inspector’s judgement upon their recorded findings. Some of the findings will relate to professional medical judgements upon which the Inspector may or may not have a legitimate expertise to form a judgement.

If a provider disagrees with any of those judgements it is vital that that disagreement be advanced clearly firmly and directly in the challenge. Fudging will never work.

The CQC almost never enter into any form of discussion so they must understand the exact nature of the challenge particularly if there is any thought of taking the challenge to such higher level as exists.

It is obvious that a finding of ‘Inadequate’ or ‘Requires Improvement’ is likely to have a devastating impact on the way in which stakeholders perceive the service under review.

Challenges made late, or, with less than blunt directness are likely to be dismissed. “Well that is my view and I stand by that.” The Courts, the media, and, the public will give significant deference to the views of someone advanced as an expert.

Do not miss your chance and take such little opportunity to put your case clearly and firmly. At the very least, having done that, you can publish alongside the CQC report your reasoned response so that readers, at least have the opportunity to read both sides of the argument, and, form a balanced judgement as opposed to an instant reaction.

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