‘This is not a witch hunt... we are looking at real issues’
Sofia Lind speaks to the new chief inspector of general practice as he takes up his role and begins overhauling the GP inspections regime at the CQC
Just hours into his new job, Professor Steve Field is already on the defensive. He is anxious to clarify a newspaper claim, based on an interview with him, that early CQC inspections show one in 10 GP practices needs to make ‘major improvements’.
‘I was a little disappointed when it was translated as such,’ he says. ‘Those visits have largely been targeted at practices that said in registration that they were non- compliant or had issues. It is not true to say that 10% of all practices had major issues.’
Having been in the public eye for several years, Professor Field is careful about what he says to journalists – and probably with good reason.
The former RCGP and NHS Future Forum chair has been appointed as the first chief inspector of general practice at a time when the CQC finds itself in the spotlight as never before.
Speaking at the CQC’s headquarters in the City of London – under the watchful eye of a press officer – Professor Field is keen to play down the impression that he is about to begin a major crackdown on general practice.
He says one of the most important messages he wants to get across to GPs is that the overall proportion of practices that have real problems ‘is very small’.
‘No practice is perfect and that is fine – we are not asking for perfection,’ he insists. ‘Those who say they have issues, that is really great, because it shows they have noted the issues themselves and they want to deliver.
‘My worry is that people are concerned we are going on a witch hunt, but we are not at all. This is really basic stuff. We are not looking for punitive stuff. We are looking at real issues.’
Figures obtained by Pulse last month reveal there have been nearly 600 practice inspections since March. Inspections on one standard have seen as many as a third of practices failing. But the CQC says it is inspecting the most risky practices first, and that it expects the overall level of non-compliance for GPs to be lower than for hospitals and care homes.
Professor Field says the inspections have found some areas where GPs are not achieving the minimum standards set by the CQC.
He says: ‘We found issues of safeguarding. There were out-of-date drugs, people who were not recording the temperatures of fridges that hold vaccines, surgeries without doors to their consulting rooms, dirty rooms and carpets in treatment rooms. Things that are not acceptable.’
But Professor Field tries to reassure GPs over patient access, saying that while he supports the move towards seven-day working, practices will not face action if they do not offer extended hours – something he admits his own practice does not find it easy.
‘I wouldn’t personally expect your average practice to be working longer hours and seven days without working in partnership with other practices, unless they want to,’ he adds.
‘I support the move towards seven-day working, but practices like ours can’t provide that at the moment – we’re not resourced for that, and we would need to work with other practices.’
He says: ‘The sort of thing that will really worry us will be if lots of patients are saying they’re turned away from their GP. Or if we read about significant events or court cases of children who’ve been abused or killed, and there’s a history of GPs turning patients away.’
Professor Field is tight-lipped on the new ‘Ofsted-style’ ratings system for GP practices he will be heading up, saying only that the details have yet to be thrashed out and Pulse readers should not be unduly worried. But he offers details of the CQC’s new inspection regime for GPs, which will come into effect next April and was first outlined in the regulator’s A new start consultation document earlier this summer.
The new strategy will see the CQC take a more targeted approach; unless specific concerns have been raised, only a sample of practices will be inspected.
‘From April, we will come and look at a CCG and sample a proportion of the practices in the CCG over a week or two.
‘On a two-year rolling programme we might be back to that CCG area a few times but not check all practices in one go, because we have to inspect the whole country. This will be our routine programme, alongside targeted inspections where we are looking at specific problems.’
The regulator will also look at broader cross-cutting ‘themes’, such as out-of-hours care, access to psychological therapies and medication in care homes. CCGs will then be expected to raise standards over the two-year inspection period, based on the CQC’s findings.
Professor Field says under the new scheme, inspections of practices will probably last for a day and be carried out by a team of three or four, which is likely to include a senior manager, a primary care professional and a patient.
He stresses that, under his leadership, the inspection process will ideally be led by GPs at all levels, and that he hopes to use his high-profile role to champion general practice – and even help it fight for better support and resources.
‘While the focus in this first week in the newspapers has been on standards and stopping people working, we want the best care possible. So I think you will find us making statements about resources, about contracts, about lack of workforce, and the fact, for example, that perhaps Health Education England might need to think about improving nurse training in primary care so practices can deliver and perform on long-term conditions.
‘For me the fundamental is that I want the best general practice in the world.’
• Chief inspector of general practice, CQC
• Chair of NHS Future Forum from 2011 to 2012
• RCGP chair from 2007 to 2010
• Practises at Bellevue Medical Centre in Birmingham