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30.03.16

CQC presses ahead with fee hikes in controversial two-year model

Despite widespread and fervent opposition, the CQC has decided to hike its fees from 1 April, and will do so with the intention of achieving “full chargeable cost recovery” within two years rather than four.

Last year, it emerged that some providers could face near seven-fold increases in CQC fees after changes took place in 2016-17, while the fees that mid-sized NHS trusts and foundation trusts must pay ran the risk of nearly trebling.

At the time, the CQC, which must increase fees so that it can move towards fully recovering the cash received from Department of Health grants, outlined two scenarios for future provider fees. The first, preferred by consultation respondents, sought to achieve full cost recovery within four years, while the other would do it in two.

Today, it said that despite strong preference for the four-year option, cuts made to the regulator in last year’s Spending Review mean that it must recommend the two-year option to the health secretary – except for dental and home care providers.

For NHS trusts, today’s changes will see providers with an income of £125m-£225m pay fees increased by almost £59,000 to around £137,000 – an increase of 75%. Across single-location GP practices with 5,001-10,000 patients, the fee increase will be nearly £2,000.

David Behan, the CQC’s chief executive, said: “We understand that the scheme that has been put forward is not the one the majority of those who took part in our consultation would have preferred.

“In order to achieve our requirement to the government and commitment to the taxpayer, we need to work towards reaching full cost recovery while reducing our overall budget by at least £32m.”

According to the inspectorate, the two sectors furthest from full cost recovery are GPs and the community social care sector, such as home care agencies. These agencies will be subject to fee changes on the basis of the four-year option.

The government, which agreed to allow the CQC to hike fees, has also injected another £220m into GP cash pots, part of which will be used to mitigate increases in regulation costs.

‘Sour’ plans face continued backlash

Today’s confirmation that the regulator will press ahead with fee uplifts has not been well received by providers, some of which had already lashed out at this decision when it was still in consultation phase.

Rob Webster, outgoing chief executive of the NHS Confederation, said the major hike “will leave a sour taste” for the group’s members, who will “not be able to recognise how their views reflected in the final decision taken”.

He argued that the “stated reality” that the Spending Review settlement requires a two-year recovery period “clearly risks jeopardising the goodwill of our members towards the CQC”.

“Much faster progress towards ensuring value for money from CQC’s new approach to inspections is essential, as well as far greater consistency between the different national bodies in the requirements they place upon the NHS,” he added.

The NHS Clinical Commissioners, which had already said higher fees will put “yet more pressure” on GPs, reiterated today that the regulator’s decision is “very disappointing” given the financial challenges the whole system is currently facing. Its outgoing co-chair, Dr Steve Kell, pointed out that the decision to press ahead despite intense opposition cast doubts on whether this was a genuine consultation process.

 “Although there has been additional funding announced for GP practices to cover these fees, this money would be better spent on direct frontline patient care rather than supporting a regulatory regime that has yet to prove itself to be efficient in carrying out its statutory duties or effective in delivering meaningful improvements in quality.

“Given that the consultation on the CQC’s strategy for the next five years has only recently concluded and will not be published until May, it still feels premature to set fee levels and therefore an estimated budget for an organisation that has not as yet determined its structure and functions throughout the period.”

Dr Chaand Nagpaul, GP committee chair at the BMA, which had also already criticised the CQC during consultation phase, added: “GPs have long since lost confidence in a cumbersome, time consuming CQC process that has been beset by U-turns and mismanagement, including the withdrawal last year of part of the inspection programme which ludicrously allocated ratings to practices before inspectors had even arrived at the practice.

“At present there is little evidence that the public is benefitting from this over bureaucratic and expensive system. The CQC needs to listen to grassroots GPs and the BMA’s response to its consultation and reverse these unacceptable proposed increases.”

A calculator will be made available on the CQC’s website to help providers work out their exact fees for 2016-17.

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