2. Professor Steve Field
The grand inquisitor
The reputation of the CQC chief inspector of primary care reached an all-time low with GPs this year, but there is no questioning his influence. As one nominator put it: ‘Undoubtedly the biggest impact on coal-face GPs – but for all the wrong reasons.’
The Birmingham GP incurred the wrath of his own profession with the misguided publication of internal CQC ‘intelligent monitoring’ reports for all practices. Practices that were rated in higher ‘risk’ categories were exposed on the front pages of national and local newspapers, even when some were found to be providing good care following an inspection.
Initially, after Pulse and others pointed out distortions and errors in the ratings – including one measure that was recorded completely the wrong way around – the CQC blamed the media reporting and said it had a ‘duty to be honest’.
But five months later, Professor Field apologised and removed the ratings. Nevertheless, for hundreds of practices the ‘risky’ label had already stuck.
And this completely overshadowed the good results that practices were getting under Professor Field’s new-style inspection regime. To date, more than 80% have been given a ‘good’ or ‘outstanding’rating.
Professor Field tells Pulse that his proudest recent achievement has been the ‘introduction of the first system for regulating GPs across England’ and that ‘it has been good to find many practices are good or outstanding’.
He has outlasted strong opposition this year. The RCGP called for an end to his ‘Ofsted-style’ ratings, while the BMA called for the whole CQC to be abolished.
In his defence of the inspection regime, he said: ‘When more than one in seven general practices is not delivering the care that patients have every right to expect, now is not the time for us to put a halt on our inspections.
‘In the last few weeks alone, we have found some seriously deficient primary care, which has led to us cancelling the registrations of some practices, in the interests of protecting the safety and quality of care for people who use these services.’
Professor Field is already making plans to develop the inspections after next year. He says: ‘I have started to look at how we will develop the regulatory model for GPs and for integrated systems post September 2016. We look forward to consulting the profession, patients and the public on how we develop our ideas. These groups have been integral in helping us develop the way we inspect.’
This may involve increased costs for practices, as the Treasury insists that all central funding for regulation is phased out, with some saying fees may have to double.
However, there are signs that the chief inspector is scaling back his ambitions. In a recent interview, Professor Field hinted that he was considering a move towards a more ‘light-touch’ regime, with resources concentrated on ‘encouraging improvement’ in practices with known problems.
And despite the grassroots objections to the CQC, Professor Field has strong support from the health secretary. Jeremy Hunt said recently: ‘we make absolutely no apology for giving the public clear information for the first time on the quality of their local GP services’.
He added: ‘To halt inspections now would be a big mistake, and slow down the process of improvement for those surgeries that aren’t giving the public the high standards of care they deserve.’
Like it or not, Professor Field is going to be a fixture of GP life for some time to come.