Earlier this year the British Social Attitudes (“BSA”) survey found that public satisfaction with GP services had hit its lowest point since the survey first began in 1983. Satisfaction with GP services dropped to 65% in 2017 – down seven percentage points compared with the previous year, and the biggest one-year change since the survey started.
This has potentially wide-ranging implications for GPs in their regulatory compliance with the CQC. Higher dissatisfaction levels could give rise to an increase in complaints which, in turn, could trigger CQC inspections.
This is because the CQC is now adopting a risk-based strategy and is relying on data in order target inspections on those practices that it believes could pose a risk to patients.
Why is a rise in complaints a concern?
CQC site visit-based inspections will likely now be reserved for those practices which cause the regulator’s internal systems to alert them to an unacceptable increase in risk. My colleague Nythan Smith has published an in-depth article on the CQC’s inspection approach here.
If dissatisfaction levels from the public do give rise to an increase in complaints, these complaints will highlight to the CQC that there may be an increased level of risk – especially for practices where a large quantity of complaints are received.
To reduce the number of complaints, it is important for practices to understand where the public’s dissatisfaction stems from. The BSA survey showed the main reason people give for being dissatisfied with the NHS overall was waiting times for GP and hospital appointments, with 65% of surveyed participants citing this. This was closely followed by staff shortages, which 46% of participants selected.
Therefore, GPs should pay close attention to staffing levels and accessibility for in-person appointments. Addressing these two sources of public grievances may help to reduce the number of complaints.
The importance of Regulation 16
The CQC has revealed that it received 8,267 negative comments from the general public between January to November 2021 on its ‘Give Feedback on Care’ portal, compared with a total of 3,001 for the same period the year before.
While not the same as formal complaints, it does show how low levels of dissatisfaction give rise to an increase in forms of complaints/negative feedback. My colleague Gemma Nicholas published an in-depth analysis of how the CQC expects practices to respond to complaints here.
As that article makes clear it is more important than ever to ensure your practice has adequate provisions in place to ensure you are compliant with Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which deals with complaints.
Regulation 16 requires GPs to establish and effectively operate an accessible system for identifying, receiving, recording, handling and responding to complaints. The CQC can ask practices to provide data on how many complaints it has received, in addition to deciding whether the complaint has been appropriately dealt with. If an on-site inspection is triggered, there is a high probability that the CQC will seek to determine whether a GP service is compliant with its own policies.
To reduce the chances of on-site inspections, GPs should take complaints seriously at the initial stage and have adequate recording systems that can clearly document responses to complaints. Failure to do so could increase the chance of the CQC inferring there are levels of unacceptable risk, demonstrated not only by an increase in complaints, but especially if these are unresolved or not adequately documented.
The importance of Regulation 17
Compliance with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance, is just as important in reducing the chance of triggering an on-site CQC inspection.
This Regulation requires GP services to have adequate quality assurance and auditing systems in place. These allow the GP to demonstrate that it mitigates risk and is proactive in assessing and monitoring the quality of service provided. With increased amounts of complaints expected, it is important GPs demonstrate they have sufficient auditing systems which investigate grievances raised. Failure to do so, or failure to adequately document this, could trigger an inspection with the CQC deeming the GP service to be high risk.
Understanding where dissatisfaction stems from allows GPs to be proactive in ensuring concerns are addressed, reducing the risk of complaints occurring. GPs should also not underestimate the importance of complying with crucial Regulations such as 16 & 17, which have major implications for how the CQC assesses levels of risk.
Practices that understand both these areas will reduce the chances of triggering an on-site inspection by the regulator.
At Ridouts we specialise at providing GPs with bespoke advice tailored to their needs to help navigate the regulatory demands of the CQC. This includes challenging the CQC via the Factual Accuracy Comments process following an on-site inspection, assisting GPs in managing complaints, and providing advice on governance systems.