CQC inspections are designed to identify quality in general practice, but it’s questionable whether they really focus on the stuff that matters, argues Virginia Patania, Jubilee Street Practice manager.
Six years ago, my practice obtained the RCGP’s Quality Practice Award (QPA). More than 18 months of work, spread almost evenly across our team of 43, earned us a little logo that we have proudly kept on display since 2010, in the practice, on the website and on any printed materials.
The process for gaining this award was bonding, enriching and exciting. There was some box-ticking, but lots and lots of narrative around the quality of care we provide, both to our patients, and to each other.
When we tried to re-qualify for the award (the validity spans five years), we learned that the QPA was no more, and that it was unlikely to be resurrected in the future. As an alternative, the Care Quality Commission (CQC) would be visiting practices and ascertaining quality across the board. For this reason, rather unusually, I had very much been looking forward to our CQC inspection.
The day arrived. We received notice of inspection and went all out, including funny gimmicks such as cupcakes that said ‘CQC’ for our staff and huge umbrellas with the practice logo for GPs undertaking home visits.
The CQC’s own website defines its function as ‘(to) monitor, inspect and regulate health and social care services’.
Quality, from a quick Google search, would appear to be ‘the standard of something as measured against other things of a similar kind; the degree of excellence of something’, or ‘a distinctive attribute or characteristic possessed by someone or something’.
From my one day in the CQC’s company, I am unsure whether monitoring, inspecting and regulating are the same thing as valuing distinctive attributes and degrees of excellence.
‘Hard to measure’
The list of what we were asked to do to demonstrate quality did not always resonate with my understanding of what quality is. Whether we are measuring the temperature of the water coming out of the taps with a probe did not feel like a reason to visit my surgery. I soon realised that everything that made us special for the QPA was less relevant for CQC – things like our data walls, our happiness officer, the huge amount of outreach community work we engage in. There was no box to hold this in.
Our seasonality supply driver tools, our multi-trained clinical admin staff, the literature we produce in house for our patients, our micro-team approach to managing the vulnerable, our systems and so much more – all this is very hard to measure. How do I count the benefits of walk-in phlebotomy services? What am I measuring this against, when it’s the only type of service we’ve ever offered? How do I measure the value of thousands of patients marching to save this surgery when we were at risk of closure due to the removal of our Minimum Practice Income Guarantee? How do I explain that one of our patients went to court to defend our funding – and won?
The CQC inspection was ultimately valuable. We learned a lot, and found a few blind spots we were inadvertently carrying. Regardless of our rating (outstanding) it left me feeling, sincerely, somewhat thoughtful. As the day went by, I kept wondering why we had not been asked to submit all compliance evidence electronically, so we could focus on the stuff that matters; on what we see as quality.
As the inspectors left the building, my concern was that we had demonstrated strong compliance, but that this was but the smallest part of what defined our quality. The story behind this is alive in our microsystems and teams, always generating progress and development.
It is in tangible and intangible ways, some of which can be counted and others that cannot, because they take the shape of a story. That is what I think should matter most to the CQC.