The new chief inspector of general practice could mean too much emphasis on accountability, leading to GPs having to duplicate information and diverting time away from patient care, writes Dawn Brathwaite
The spotlight on the NHS is more intense than ever and analyses of its shortcomings are coming thick and fast. No one can deny that in some cases the care provided by the NHS is not reaching its goal of meeting the needs of everyone. Some patients are not receiving the level of care they deserve, or indeed, have a right to expect.
‘The health secretary called for a return to the idea of the family doctor who would be “a champion for their patient”’
We have had inspections, investigations and reviews with the promise of more to come. None of the providers, commissioners or regulators in the frame have emerged from this scrutiny unscathed − not even the trusted family doctor. Despite being recently entrusted with so many new responsibilities, GPs are allegedly failing to provide appropriate and timely care and this is forcing more patients into accident and emergency departments.
We now know that the government has embraced recommendations from the Nuffield Trust and will appoint a chief inspector of general practice, to be based in the Care Quality Commission. The question is: will the chief inspector at the CQC simply be another person GPs have to be accountable to, alongside the General Medical Council and NHS England?
Can all these roles sensibly co-exist? What will the chief inspector and the CQC do to bring GPs to book when the GMC, as the ultimate regulator, is already exercising its powers to ensure patient safety is protected?
The chief inspector will devise and implement a new system so that GP practices are given Ofsted style ratings. We have been promised that this will lead to “a rigorous system of inspection” to ensure effective and responsive care is provided to all patients.
When Jeremy Hunt announced the new system, the health secretary called for a return to the idea of the family doctor who would be “a champion for their patient rather than simply a gateway to ‘the system’”. If GPs can meet the needs of more of their patient population, this should reduce the burden on an already stretched A&E service.
‘There is a danger of regulators tripping over each other and reducing the ultimate effectiveness of the whole system’
Many people have commented on these proposals and the King’s Fund’s response encapsulates many of the observations and general concerns: there is widespread variation in the quality of care provided by GPs and regulations and inspection can only provide − at most − a backstop. The main responsibility for quality and care has to reside with doctors and their practices, so the GP contract must change to enable the necessary improvements.
Currently, the GMC regulates GPs and it is clear how to raise concerns about whether an individual practitioner is “fit to practise”. NHS England also maintains a list of GPs who provide primary care services and manages this list in accordance with the NHS (Performers Lists) Regulations 2013, monitored through their local area teams.
‘All the institutions of the new NHS are desperately trying to get on top of their new roles in the full glare of public scrutiny’
The notion of a chief inspector giving Ofsted style ratings runs the risk of ignoring the existence of these regulatory frameworks. There is a danger of regulators tripping over each other and, in doing so, reducing the ultimate effectiveness of the whole system.
It seems at the moment that everything is hitting the NHS at the same time. We have recently seen the introduction of significant changes that have had a major impact on GPs. What all NHS bodies now require is clarity. The GMC, NHS England, the CQC and the chief inspector need to understand how the new regulatory landscape will be shaped and what their respective roles will be.
Too much change
All the institutions of the new NHS are desperately trying to get on top of their new roles in the full glare of public scrutiny; they need to know whether further significant changes will be made and how to account for those changes as they put new systems and structures in place.
When time is at such a premium, should they really be asked twice to invest their resources in preparing for a new system?
GPs urgently need to get to grips with their new commissioning functions and have just completed the process of becoming registered with the CQC. They have to hold difficult discussions with their providers as they renegotiate contracts and they are working with new organisations and partnerships, trying to forge relationships, not jeopardise them.
With yet another change, GPs and their practice managers are at risk of having to provide the same information to different bodies, at different times, thereby diverting valuable time from what matters most − looking after their patients.
Dawn Brathwaite is a partner at Mills and Reeve