The CQC’s approach to reviewing ICSs will focus on reducing inequalities, it has said after admitting its inspection and monitoring methodology for GPs ‘may inadvertently disadvantage’ ethnic minority-run practices.
Published today (19 January), the report came in response to concerns that practices led by GPs of an ethnic minority background could receive less favourable regulatory outcomes.
The report looked at reviews of CQC’s data and processes, an online community of 36 ethnic minority GPs, a survey of 771 GP practices a survey of CQC inspectors and focus groups.
The interviews with the ethnic minority GPs revealed that ‘the majority’ had concerns ‘around racial discrimination leading to unfair treatment from regulators, including CQC’.
The investigation suggested that ethnic minority GPs felt that CQC inspections were intrusive and ‘punitive processes rather than an opportunity to review, learn and grow’.
It added that ethnic minority-run GP practices are more likely to be found in deprived areas and therefore have lower funding and face greater health inequalities, both of which are burdens that will affect a surgery’s ability to evidence it is meeting regulatory requirements.
Additionally, interviews with the CQC’s own inspection teams suggested that poor practice management, such as relying on staff who are less familiar with regulation, could impact an inspection.
CQC to review its approach
Under the Health and Care Bill, the CQC will acquire a new duty on CQC to review and assess ICSs.
Following its review, the CQC said it intends to address where local systems need to provide ‘more support’ to ensure that primary care meets the needs of everyone in their population.
Meanwhile, the CQC said it will review and refine how it assesses GP practices, including by:
- Ensuring it reflects factors that could disproportionately disadvantage ethnic minority-led practices
- Consider whether it can do more to remove the risk of potential bias
- Reviewing how it uses evidence about the efforts GP practices make to respond to local health inequalities, and those outcomes.
Dr Farah Jameel, BMA England GP committee chair, welcomed the recognition that a ‘a one-size-fits-all approach’ does not work.
She said: ‘This change in approach is vital for understanding the pressures all practices, including those run by ethnic minority doctors, are under.’
The report ‘underlines the need to address wide-ranging structural inequalities’ in the health sector, she added.
The report comes after a survey last year suggested seven-in-10 GPs from minority ethnic backgrounds would describe CQC inspections as ‘traumatic’.
What did practices say?
As many as 31% of ethnic minority-led practices believed their inspection outcome was adversely affected by ethnicity, the CQC said.
To support its report, the regulator surveyed more than 750 GP practices, of which 51% (390) met its definition of being ethnic minority-led.
Some key findings include:
- 38% of ethnic minority-led practices reported that one or more GPs in their practice experience an adverse impact on their mental health because of an inspection, compared to 26% of those who aren’t
- 23% of respondents reported adverse physical health problems because of the inspection process, compared to 7% of those from non-ethnic minority-led practices
- 52% of ethnic minority-led practices believe their inspection report accurately reflected their practice, compared to 65% of non-ethnic minority-led practices.
A survey of GP inspectors found that 26% agreed that ethnic minority-led practices were more likely to have poorer ratings, while 37% disagreed.
Last February, the CQC committed to collecting practices’ ethnicity data in response to concerns this was a ‘factor’ in inspection ratings.