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The Future of Primary Care 

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News and Comment from Roy Lilley

A previously unseen letter by Jane Austen in which she writes about Pride and Prejudice has gone on public display for the first time. The double folded sheet, sent by Austen to her sister Cassandra in January 1799, makes reference to the novel - 14 years before it was first published.


It is a rare opportunity to see such an artefact; it's about to be sold to secure a museum's future. It looks to me, if they sell-off all the good stuff there won't be a need for a museum.


There is another letter that is so rare that you will never see it. It is from David Behan, the boss of the CQC. It might say something like this:


Dear NHS


On behalf of the Board and staff of the CQC I would like to go on record as saying sorry for the damage we have done to GP reputations and to the service more generally in publishing inaccurate data about them.


We are very grateful to Sarah Bloch and the BBC for doing what we should have done; checked our data. It was stupid of us to publish what was little more than a rough risk analysis of practices and totally reckless of us to publish anything that was flawed.


We understand, absolutely, the difficult space we occupy in healthcare; seen as demoralising and demolishing reputations. If we are to hold ourselves out as paragons of quality then our mission starts at home, on my desk and on my watch.


I have failed in that task and this afternoon I will seek a meeting with the Chairman to resign my post as Chief Executive.


I have enjoyed the challenge and the task but recent events and other mistakes that I have presided over drives me to the conclusion, it is time for me to go.



David Behan.


Don't hold yer breath.


In the GP Magazine poll +90% of GPs think Field should resign.  The best the CQC could manage was (on Twitter) Mike Richards saying he was sorry for Inspector Field's errors and this gobbledegook from someone called Sparrow.


Sparrow's contribution is to blame 'myths', says banding is not judgement and to point out less than 1% of practices are involved.


First; it is a myth that inspection has anything to do with quality.  Second; if banding practices requires no judgement how is it done?  A lottery.  How stupid does he think we are? And third, we are talking about 60 practice reputations, 60 practice managers worried sick for no reason, three hundred GPs probably incandescent and if the practices are an average size, in total, some +550,000 patients left wondering if their GP is any good.  Plus, the rest of the NHS wondering are any of the CQC ratings correct; let's ask Sara Bloch.


The best Sparrow could manage was the bureaucrat's kiss; "We will contact each of those practices to apologise for any concern this may have caused GPs, their staff and their patients."  A hollow meaningless sorry. If I was the chairman of the CQC I'd get on my bike and visit the practices to say sorry, personally, or at the very least get on the phone.


As one Twitter-Wag put it; "If the CQC made beer, we'd all be stone cold sober!"


This is not the first time the CQC board has spectated whilst things have gone wrong. The Board comprises a politician, a professional NED and weatherman, a policy wonk, a psychiatrist, a journalist, an academic, a user champion and a lawyer. I'm not sure any of them have a got a grip on their executive. They must realise all reputation sensitive data should the subject of independent audit and not leave it to the BBC.


Yesterday, by the blessing of happenstance, the CQC trotted out its 'what to do about complaints' report. It is good and a very important first step in doing what the CQC should have done from the off; find out if people complain, what they complain about and are there any common threads we can learn from and how to fix it.


So, where are we? We end the year pretty much as we started. The 15th year of inspecting and what have we learned? The CQC continues to eat money, clodhopping across the landscape of healthcare telling us hospitals are busy, there are not enough staff and there is still no way for people to share good practice.


Perhaps there is another letter the Board of the CQC should think about signing, collectively. 


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