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GPs go forth

Practices to be given 12 months before closure following poor CQC rating

GP practices that are judged ‘inadequate’ in a number of areas by the new CQC inspections will be placed in ‘special measures’ and given six months to turn things around before having their registration removed, the regulator announced today.

As part of the previously flagged proposals, the CQC has said that where ‘aspects of service’ are deemed inadequate, practices will have six months to make improvements before being placed in special measures.

The special measures will allow the CQC and NHS England to oversee the practice and set out clear expectations for improvement. If there are no sufficient improvements within a further six months, the practice will have its registration removed, the regulator has said.

The RCGP and BMA said it’s important to identify and tackle poor care, but warned that public trust could be damaged by highlighting isolated incidences of poor care.

The chief inspector for primary care, Professor Steve Field, has told Pulse that practices would have opportunities before inspection to highlight the pressures they were facing, including workforce, funding and premises, which would be taken into account.

In a statement released today, the CQC said: ‘The proposals suggest that where aspects of a service are rated ‘inadequate’, practices will have six months to improve.’

‘If they fail to improve they will be put into special measures and if after a maximum of a further six months they are still found to be inadequate, they will have their registration with CQC cancelled and/or their contract terminated by NHS England.’

The regulator said that, in the worst cases, practices will be put in special measures immediately.

It added: ‘Where, at the end of special measures, if the provider fails to improve and their registration is cancelled or where a contract is terminated by NHS England there would be joint planning between CQC and NHS England to ensure that patients registered at the practice continue to receive GP services,’

Professor Steve Field explained that a practice found inadequate in several areas would go to a national review board before they were placed in special measures.

Professor Field told Pulse: ‘We also want [practices] to tell us what the problems are, so if it’s a really lousy premises, and that’s causing them to be inadequate, we will be honest and report that. So they will get the chance.’

‘So I would imagine if we were going to the practice, like the Jubilee [Street Practice] with MPIG issues, they will have raised that before the visit, and they can tell us that on the visit.’

But he added: ‘There are some other practices which are just grossly inadequate; it’s not my job to build them a new surgery.’

But GP leaders warned that this announcement was not helpful at a time of ‘unprecedented crisis’ for the profession.

Chair of the GPC’s contracts and regulation subcommittee Dr Robert Morley told Pulse that the announcement was ‘sad’ and asked how the CQC proposed to succeed where NHS England had already failed.

He said: ‘It’s very sad that this is coming in now, in a time of unprecedented crisis for the profession, in terms of lack of funding, premises not being fit for purpose due to inadequate investment.’

‘The profession as a whole is really struggling with the increased blame culture in the NHS. I haven’t seen anything that says the CQC is either going to improve the overall quality of care, or be able to weed out the really bad practices, in the same way that NHS England hasn’t managed to do that.’

The RCGP chair Dr Maureen Baker, said that, though the RCGP would have no role in inspection: ‘We welcome the opportunity to play a significant role in supporting GPs and practices to deliver the best care they possibly can to their patients.’

‘Our involvement will also ensure that the so-called “special measures” do not become another stick with which to beat hardworking GPs, and that they do not damage patient care by increasing the already unrealistic workloads of GPs who are doing their absolute best to meet patient needs.’

The CQC announced the new inspection regime last year, showing GPs would be given an overall rating of outstanding, good, requires improvement, or inadequate alongside 42 other ratings.

The new regime will also include a GP inspector as part of every team, and gives practices a minimum of two weeks to prepare for routine inspections – though this can be waived where a complaint has been made.

However, the scheme has been under fire during its pilot phase, for claiming support for its OFSTED rating system, using inspectors with only marginal training and variable inspection standards that have seen the tops of cupboards checked for dust.

Related images

  • CQC -online

Readers' comments (40)

  • When the CQC inspected us we received a (glowing) report which falsely identified us as a two partner Practice despite the inspection team meeting all three partners and identifying by name a Practice Nurse supposedly employed by us despite her leaving the Practice two years earlier.
    My experience suggests that CQC is incompetent - can I put them into "special measures?"

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  • None of us would disagree that practices which are bad for patients should be stopped.

    What I question is CQC's competence to do this correctly. Having seen certain PCT staff transfer to become a CQC inspector, I have less than zero respect for their abilities, I should be sitting in judgement of them, not the other way around. Since the Telegraph turned up an admission by CQC that their flawed recruitment process meant that they had taken on 1 on 10 inspectors who are unqualified for the job and can't sack them, how dare they sit in judgement of us and who will trust these unqualified inspectors when they declare a practice as failing?

    "Failing" GPs must be stopped (whatever "failing" means?) but no-one can have any respect when that judgement is made by a regulator which itself is a paradigm of failure.

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  • According to Today on Radio 4, "special measures" could include sending in replacement GPs.
    This seems unlikely - even if the GPs recruited as inspectors were able or willing to take on the role.
    Does anyone know what "special measures" are planned to be in the case of a GP practice?
    In a previous article in July, CQC was 'considering' the matter...

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  • We should all shut down! let's take no risks with anything anymore.
    Then the public can bask in a country with a 3rd world health system and absent primary care.
    Who needs evil, greedy GPs when we have the genius known officially as THE DAILY MAIL !!

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  • This is actually quite good news for some GPs, from a strategic point of view. As has been previously pointed out, once you are put into special measures the liabilities for closure will pass to the organization now running the practice. In effect this is a get out of jail card for practices that have become financially unviable.

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  • this is all rather academic as it appears there will be few practices to shut down in two years time

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  • Peter Swinyard

    Labelling a practice as "failing", correctly or incorrectly, becomes a self-fulfilling prophecy.
    GPs will be impossible to recruit, practice nurses and managers will vote with their feet, morale will plummet and the practice will fold.
    Is that really what the government intends?
    On a related matter - are practices funded at £60 per patient per year expected to offer the same care standards as those funded at £120 per patient per year???

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  • Anonymous 11:00

    I would be grateful if Pulse could clarify this point. If indeed NHS England will take over the liabilities of a failing practice that may stop the exodus for the door to avoid being the last man standing.

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  • Is a failing practice an indictment of the individual practice or the DoH which fails to fund them?

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  • 1.17 I think this would need testing in court unless any solicitors out there know of the body of relevant case law. I would suggest that the GP/NHS interface is quite unique from the business point of view and that if you bring in a specialist team to make managerial decisions, it would only be fair for them to be liable for the financial consequences.

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