GP practices could have an extra year to register with the Care Quality Commission (CQC), after the regulator asked the government to move back the current April 2012 deadline.
The CQC says it wants more time to "improve the process for GPs", to allow more time to embed compliance monitoring in the sectors it already regulates and to make sure registration is more closely aligned with accreditation schemes.
A CQC spokesperson confirmed the proposal "to extend GP registration beyond the current deadline of 1 April 2012", and suggested that this could be put back until 2013. However, the current deadline "is set in legislation and is therefore subject to further discussion with the Department of Health," the spokesperson said.
The Department of Health (DH) said that the CQC have made a "number of suggestions" about the registration of primary medical service providers.
A DH spokesperson told Management in Practice: "The Department is considering the issues that CQC has raised," but added: "Any change to the April 2012 start date for registration would require a change to legislation, which would be subject to consultation and debate before Parliament."
The DH confirmed that registration will still open in October 2011 for dedicated out-of-hours services, but said "the timing and make-up of subsequent batches is still to be confirmed."
The CQC strenuously denied that this had anything to do with the government's 'pause' over the passage of the Health and Social Care Bill through Parliament.
A CQC spokesperson told Management in Practice: "The aim of this proposal is to ensure that the process works as smoothly as possible.
"We've been working with hospitals, nurses, dental practices, and have been learning from this process. We want to lighten any potential burden and ensure that we add as little extra work as we can onto GPs."
However, Dr Richard Vautrey, Deputy Chair of the British Medical Association's (BMA) GPs' Committee, said that if a delay resulted in no change in the guidance GPs would not necessarily be better off.
"We have been raising concerns with both the CQC and the Department of Health about the huge workload practices will incur and costs, both in registration and delivery. If there is a delay, and that's not been confirmed, then there needs to be an opportunity to review the expectations on practices."
Would you welcome more time to register with the CQC? Your comments (terms and conditions apply):
"If the CQC publish the recommendation guidelines then i cannot see why GP commissioning cannot start in 2012" – Laura Ruddy, Eastbourne
"Don't need more time if CQC publishes or recommends a template" – Steve, West Mids
"A sensible suggestion like Simon Royal's [see first comment below – Ed] with the addition of sensible and relevant separate protocols for smaller practices would be far too much of a 'no brainer' for anyone involved in 'protocol-itis'/bureaucracy to actually implement. If this had been thought out right in the first place there would have been no need for more time. Does no one recognise that overly complicated bureaucracy takes time away from clinical care? It is time to do away with tick boxes" – Alan, London
"Yes, I would welcome more time to register as mine is a single-handed practice and do need more time to establish the process. This is going to put considerable burden on our manager. I agree with Simon Royal [see first comment below – Ed] that why all the required work is not commissioned by the DH and all practices are provided with the standardised policies/procedures/protocols and individual practices can localise their functions as add ons. This will ensure that all practices are working with the same guidelines towards the same required standards" – Dr T Bassan, West Bromwich
"Yes and no. Additional year would be convenient but of no use if the requirements are not discussed as some of them are very difficult to achieve for a small practice with old premises. Additional cost has to be considered as well" – Muhammad Kader, London
"If the work is to be done, we would rather be getting on with it than putting it off until a later date. With reference to Simon [see first comment below – Ed], would we all wish to work to standardised national protocols into which we may not have any input?" – Sue, Yorkshire
"I agree with Simon Royal [see comment below]. It would have been good to get standard policies issued to us, although by now I imagine most practices will have already found companies that are supplying toolkits for this, we have already purchased ours, as have several other practices in the area" – Nikki Hall, Gloucestershire
"I would welcome more time to register as we are a small practice and struggle as it is to maintain the work standards already with the current staffing levels" – Carolynne Sargent, Wellingborough
"Reading through the provisional guidelines, i am still unclear as to what additional work would need to be done. As stated by others it is my belief that GP surgeries are already working to certain guidelines, protocols and policies which match up with the essential standards anyway. Although I understand a need to possibly update the information, I'm not totally clear about how much extra work there would be and therefore would prefer more time to understand the specific requirements rather than actually doing the necessary work!" – Barry, London
"Totally agree with Simon [first comment below]" – Teresa Talbott, Great Missenden
"Yes, definitely. More time would help with the massive amount of work required to put the process and policies/protocols into a suitable format. It is currently causing a considerable burden on managers" – Renata Johnstone, London
"Certainly would. Wholeheartedly agree with Simon Royal's comments [see first comment below – Ed] – the whole process is about standardisation, so why not give us the standards and policies? I think the CQC has lost people's confidence over the last few days' news, that they can cope, so what will they do when primary care join them? Hope they are a more robust organisation by then, otherwise we will doubt the validity for needing to register" – Philippa Smith, Bedfordshire
"I agree delaying would not really improve things, if we delay the process we could run in to the start for GP commissioning, which will probably mean even more work for PMs. So we need CQC registration out of the way before we start. If we have to do it let's just get on with it" – Alan Morton, Oldham
"YES" – Gordana Stojanovska, London
"I totally agree with Susan [comment below] – small practices will be greatly affected as there is only the manager to trudge through all the work. Surely the DH understands that it is easier to provide everything we need in order to be ready by way of templates which we can just adapt – with the added
advantage of everyone starting at the same level?" – Melanie Jones, Manchester
"The scandal in the news this morning, of patients in a care home in Bristol being abused by staff, and the CQC failing to do anything about it even though they had been alerted, indicates the hopelessness of trying to bureaucratise bad practice out of existence. The burden of bureaucracy placed on the NHS and other care agencies by 'watchdogs' such as the CQC is actually part of the problem, not part of the solution: the gap between
paper protocols and real practice on the ground is getting wider every day. If 'watchdog' agencies laid down a code of expected practice, and made unannounced visits to check whether the code was being adhered to, they would be far more effective" – Julian Le Saux, Kent
"Because we are a small practice and there are not many staff it is not possible to delegate some of the work out, therefore it falls to one person, that being the manager. This year time is already at a premium with all the current changes to QOF and LES/DES's so I would welcome more time to prepare" – Susan Riley, Liverpool
"Yes, I have a practice to run – though given all the stuff in the news this last few days it is not the GPs who need to put their house in order, is it?" – Name and address withheld
"Definitely – the process is overburdensome and costly and more importantly it appears to be creating an unnecessary layer of bureaucracy" – Lesley Mayo, North London
"I would like to second Simon Royal's comments [below] with the only addition that this extra time will allow CQC to iron out the requirements and remove all the duplications" – Yasin Husain, Birmingham
"Completely in agreement with Simon [comment below]" – Ali Shariff, Southwark
"Delaying the process will not decrease the workload if the details of what is required are not firmed up and published at the earliest opportunity. A template of what is considered necessary in terms of policies etc would be helpful, but why reinvent the wheel? A drawful of templates are already available" – Alan Moore, Cheshire
"I agree with Simon Royal [below]. Surely the whole point of the excercise is countrywide standardisation. The costs involved in the preparation for CQC are going to be a burden for all practices no matter what size they are. The timing of CQC could have been considered more carefully, surgeries are under pressure with having to watch every penny as it is. The government pushing the whole of the NHS into state of flux with massive cutbacks, change and now indecision. I think most would agree GPs have enough to be considering at present" – Angie Hope, Gloucestershire
"Yes, more time would help with being able to prepare for the mass work required to put all the process and protocols together in to a suitable format. Since the main concerns are with the workload and costs incured, why doesn't the DH and goverment use their brains and commission someone to write all the protocols/procedures and policies required to cover the CQC for practices that way costs would be minimal, protocols/procedures and policies would be standardised the huge workload would get smaller for practices, in which all that would need to be done would be a small amount of work making the protocols/procedures and polices match what is done in practice or marking out where they are at and plans for improvement to meet CQC guidelines. Surely all GP practices should be working with the same quidelines with add ons to what functions locally" – Simon Royal, Burnley