I am an enthusiast for quality improvement and have led my practice in external validation of our quality for 30 years. Among other quality tests this includes completing the Royal College of General Practitioners’ Quality Practice Award (QPA) three times. The QPA was difficult but fair. All the criteria and standards were explicit and took about a year to complete and document in advance of a full day inspection of the practice by a team of thoughtful QPA inspectors.
In contrast, I am dismayed by the mission creep of the Care Quality Commission (CQC) inspections,1 some of its faux quality and its ratings approach to improvement at a time when general practice is struggling on so many fronts (such as, workload, recruitment, and morale). I worry that CQC is currently causing more problems than it is solving (such as, workload, recruitment, and morale) which, in turn, may worsen quality. There are many ways that quality can be assessed and although it’s reasonable to expect that a practice is safe, effective, caring, responsive to peoples needs, and well led; you also need explicit criteria that are good ways of assessing these CQC five key questions, and you need sensible standards of achievement for each criteria. It is then reasonable to publish a practice’s achievement against each criteria and standard. We should never be surprised that 50% of practices are rated below average for one or more criteria, or that 25% of practices are in the lowest quartile. At the time of writing my practice has not been inspected but we know that next week we might be told we have 2 weeks to prepare for the inspection. The CQC may consider itself a powerful agent for change but in our preparations for a CQC inspection I haven’t found the CQC helpful in responding to my enquiries about what they think is good practice. There must be a better way, and in the meantime, I question whether the CQC itself is really safe, effective, caring, and responsive to people’s needs, and well led.
- © British Journal of General Practice 2015
