You may or may not have read my previous blogs giving a PPG Chairman’s perspective of a CQC inspection, but I promised a final installment to review our report. Observant ones among you will wonder why the delay, especially considering the first two blogs were published last Autumn? With Spring now sprung the simple answer: the CQC took five months between their inspection and publication of the report!

150 days to be precise! Therein lies a multitude of problems as follows: 1) the CQC simply don’t play fair – they expect practices to dance to their tune but for them it is a case of ‘do what we want, when we want’, 2) our delay was particularly galling given other local practices were inspected after us but had their reports before us and 3) we know improvement starts with access to current data and feedback. 150 days is a lifetime in general practice!

Sadly the problems did not stop once I was able to read the report. Inevitably, the PPG’s first task was to review what they had said about our patient group. Overall summary: nothing. Section asking ‘are services responsive to people’s needs’: nothing. The bit on ‘what people who use the service have to say’: jackpot! One line in effect saying the CQC spoke to the PPG members and that the PPG viewed care as appropriate and staff approachable. This prompted much head scratching as we told the inspector that we were not satisfied with the practice and the PPG was ignored!

I’m afraid it gets worse… towards the end of the report our PPG are commended for running a regular walking group for patients. ‘Bravo’ I here you cry… problem is, we don’t run a walking group and never have! One must only wonder where this information came from? I suspect the CQC inspectors mixed us up with another practice. Genius!

And we continue…the report rates the practice ‘good’ overall and ‘good’ across all domains. To give context: this is a practice operating the most confusing and chaotic appointments system on planet earth! This is a practice that has never scored above the lower-quartile compared to like-for-like practices in their annual survey. This is a practice that average less than 2 (out of 5) across over 100 NHS Choices comments. Indeed the last ten patient reviews scored the lowest rating and include an array of comments highlighting: rude receptionists, inability to access appointments, management refusing to meet patients and a general theme that ‘this place is getting worse’. Add in the less than positive feedback bestowed on the practice by our PPG at the inspection and you have to wonder how low the bar is set to attain a ‘good’ rating?

A few final thoughts… I honestly want to be positive and say the CQC visit was a worthwhile experience, but truth is it wasn’t! My assessment is that the CQC are an expensive bureaucratic behemoth. There is part of me that feels we’d all be better off if the CQC were scrapped and their funds re-invested in general practice. But clearly that’s not going to happen! Like it or not, the CQC are here to stay. So with that in mind, what could be done to improve their work from a PPG Chairman’s limited perspective? I’m told the CQC love a good action plan so here is mine:

1. Institute a simple rule: the CQC only ask for data that they will read and use. Replace the carpet bombing with targeted precision
2. No more than 3 months from inspection to publication of report
3. Replace the current ratings with something more sophisticated. I would suggest: inadequate, requires improvement, satisfactory, good, very good and outstanding. Currently over 80% of practices are rated ‘good’. Pull the other one!
4. Make all inspections unannounced. I suspect this will be a controversial recommendation, but does anyone honestly believe a planned CQC visit provides a true picture of any practice? Don’t tell me rude receptionists don’t change their behavior and or unpunctual clinicians don’t miraculously run to time! Research tells us that when being watched the Hawthorne Effect kicks in (look it up if you don’t know). Unannounced visits would end that and stop the pre-visit stressing out that many practices must inevitably suffer from. Of course an unannounced CQC visit would hamper the opportunity for inspectors to speak to the PPG, but from my experience that would be no bad thing given they didn’t listen to what we said!