On 28 May 2020, the Royal College of General Practitioners (“RCGP”) responded to the NHS Digital Workforce figures which highlighted that there was still a GP workforce crisis during the COVID-19 pandemic.
Commenting on the figures, Professor Martin Marshall, Chair of the RCGP’s said, “It’s very concerning to see the number of full-time equivalent GPs in the profession continues to fall. We had 712 fewer fully-qualified FTE GPs in March than we did a year earlier. These figures show that while attention has been understandably focussed on the COVID-19 pandemic, workforce challenges have not gone away. This must be addressed – policy makers must not forget the promises that have been made for general practice, including 6,000 more FTE GPs, so that we can continue to deliver care to more than a million patients a day.”
If we consider Professor Marshall’s comments in the context of regulatory compliance, they are of significant importance. Over the last few years, CQC has ramped up its enforcement activity against GP practices. I recently assisted a GP practice in producing factual accuracy comments to a draft CQC inspection report. The GP practice was held to be in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 on the basis that it did not have it did not have, ‘Sufficient numbers of suitably qualified, competent, skilled and experienced persons.’ CQC’s main criticism was in relation to the number of GP’s on duty and also in relation to the competency of dispensers working in the practice, with one of criticisms in the draft inspection report being that, “…There was no evidence provided to demonstrate that dispensers had their competency regularly checked.”
The intention of Regulation 18 is to ensure that providers deploy enough qualified, competent and experienced staff to enable them to meet all the other regulatory requirements. If GP Practices are unable to comply with Regulation 18, although CQC cannot prosecute for breach of Regulation 18, it can take other regulatory action by using its civil powers to impose conditions, suspend a registration or cancel a registration. It is therefore essential that providers have a systematic approach to justify staffing levels which is kept regularly under review by practice managers.
CQC’s Emergency Support Framework
As a result of the coronavirus pandemic, on 16 March 2020, CQC paused routine inspections and introduced the Emergency Support Framework (“ESF”). For General Practice, this commenced on 18 May 2020. CQC’s position is that the ESF is a flexible and supportive process, it is not an inspection and performance is not being rated. However, CQC also state that it may carry out a focused inspection if serious concerns are raised during the ESF telephone conversation. Therefore, it is quite clear that this is much more than a supportive conversation.
CQC will assess staffing arrangements in General Practice by considering the following:
- Were there enough suitable staff to provide safe care and treatment in a dignified and respectful way during the COVID-19 pandemic?
- Have there been significant changes to staffing arrangements?
- If yes, what challenges has this presented?
- changes to staffing structure (including staff being furloughed, made redundant, recruitment of staff/volunteers)
- staff support where roles and responsibilities have changed, and new ways of working have been adopted (for example in relation to technology)
- supervision/training/oversight arrangements for staff
- arrangements for new staff and volunteers (including induction and employment checks)
- ensuring people get care and support from workers with the right knowledge and skills.
- Were there realistic and workable plans for managing staffing levels if the pandemic leads to shortfalls and emergencies?
- How has the pandemic affected your ability to staff the service?
- What has this meant for patients who use your services?
- What have you needed to do to mitigate any impact on staffing levels?
- Where do you go to seek support?
- Have you been able to engage with local system arrangements to share staff where required?
If a GP practice falls short in relation to the areas above it is likely to impact on future CQC ratings.
When considering the workforce crisis, Professor Marshall said, “…COVID-19 will continue to require attention and resources for the foreseeable future, and GPs and other healthcare professionals will have to balance this with providing care to patients with non-COVID-19 related health issues. It’s imperative that the GP workforce has the capacity as well as resources to handle demands post-crisis.” CQC’s ESF also makes it clear that it is imperative that the GP workforce is compliant with Regulation 18.
GP’s have always had to comply with Regulation 18. This is an ongoing requirement and one in which CQC has always taken a keen interest in. COVID-19 has increased the pressure on GP practices and it is even more imperative that practices are compliant. Otherwise, they could face enforcement action which could have serious implications for their business and a knock on effect to the communities they serve.
If GP practices face difficulties with CQC, seeking legal advice early on can help to prevent serious enforcement action further down the line.