Anyone who has dealt with a toddler will be all-too familiar with incessant questioning.
After many hours of patience, there is a stage at which your response to ‘why?’ changes from a ‘well, because, sweetie pie…’ followed by a detailed explanation (accompanied with the rationale that you want to harness their budding intellect) to a more prosaic and inevitable knee-jerk response: ‘because I said so’.
Are there parallels between toddlerhood and general practice management? I am guessing that the answer, sadly, is yes. The answer to the question of ‘why?’ for nursing teams working in general practice has come down to this, with a substitution of ‘because I said so’ for ‘because of CQC’.
Now, in principle I am a fan of CQC; I believe it has a vital role to play in the way practices offer services to patients.
However, as inspections loom I am only too aware that the exemplary care we offer has almost been shunted aside to make way for what seems to be the sole raison d’etre of our existence - that of providing evidence to CQC that we are actually making a decent fist of caring for our patients.
It is getting to the stage where any sense of togetherness and teamwork, any spirit of gentle enquiry, or any focus on staff development is achieved not because these factors in themselves make for excellence in practice but because CQC will need to see the appropriate paperwork.
“Is it wholly respectful or appropriate to make us jump through all these hoops in time for ‘that’ visit?”
Thankfully it hasn’t got to the stage as yet where practices are cobbling together quasi-truths about significant events in order to demonstrate proof that we have learnt that we will stop dosing patients with pink medicine because the white medicine didn’t work.
Where practice is poor, the CQC - if it undertakes its role properly - should hold those responsible to account, but where we already know that practice is good - for example, because of patient feedback, application of evidence-based decision-making, going that “extra mile” for patients and above all, truly understanding that every patient is our fellow human being. Is it wholly respectful or appropriate to make us jump through all these hoops in time for ‘that’ visit?
Yes, of course when you arrive I’ll shake you all warmly by the very clean hand, make you all a cuppa’ and show you where we keep our protocols, cold chain audit, minutes of clinical meetings, safeguarding algorithms, written evidence that we check our resuscitation equipment regularly, exemplary infection control records and anything else you wish to quiz me on. I may have a picture in my head regarding a certain set of Monty Python sketches consisting of nobody expecting the Spanish Inquisition but I do, like everybody else, expect that CQC visit. And apparently as with CCTV surveillance, if we are innocent, we have nothing to fear. Yet I believe that there are good practices up and down the country who are currently postponing forward-planning because they simply have to get their CQC inspection out of the way first.
I’m writing this piece because of CQC. Have a think about it.
Because I said so.
Jane Warner is nurse practitioner, Creech Medical Centre, Somerset