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At the heart of general practice since 1960

Regulator plans risk profile for every GP

By Gareth Iacobucci

Exclusive: The Government's new health and social care regulator is to draw up a risk profile for every practice to allow it to spot poor or potentially dangerous GPs, Pulse can reveal.

The Care Quality Commission, which assumes regulatory responsibility this week, plans to assess practices using a Framingham-style risk tool based on a series of indicators of poor performance.

Practices identified as at high risk could expect to face a toughened-up inspection regime while low-risk practices might enjoy a lighter-touch approach.

Risk scores would be based on a raft of information, including numbers of complaints, surveys of staff and patients and the commission's inspections of practices.

Baroness Young, chair of the CQC, told Pulse risk profiling would allow the commission to build up a comprehensive picture of the quality of general practice, as a first step to taking regulatory action where necessary. She said: ‘Of all the elements of the healthcare system, general practice is the one with least information for patients and least assurance on the quality of services.

‘What we'll develop is a risk profile. Over time we'll get to know the indicators of highest risk – what the things are that would make you think a service might have problems or be a risk to patients.

‘We'll be able to spot risk with greater accuracy and work with those poor providers to help them improve. Or if they won't – if they're really providing very poor services – we'll take regulatory action and enforcement.'

She said enforcement powers at the CQC's disposal would include making GPs work under special measures or ‘as a last resort' withdrawing their registration.

A CQC spokesperson said: ‘We will use an array of NHS numeric data sets. There is considerable expertise within the CQC's ranks in assessment of risk, and we will build on the Healthcare Commission's hist-ory of working with academic departments.'

The Department of Health revealed this week that the CQC would have access to a range of data from other organisations, including PCT ratings of practices on balanced scorecards and prescribing and referral patterns. The DH, in its response to a consultation on how registration with the new regulator would work, said it planned to hand the CQC access to comparable data on the QOF, practice accreditation and the GP patient survey.

Professor John Appleby, chief economist at the King's Fund, who has researched use of balanced scorecards, said it would be difficult to get a definitive picture of GPs' performance using a risk-profiling system. ‘How do you reach an opinion on quality when GPs seem good at some things but not so good at others?' he said.

Professor Mike Pringle, professor of general practice at the University of Nottingham and a member of the GMC, said good GPs should have nothing to fear from the plans, but warned over-reliance on profiling could lead to misleading conclusions. ‘There is a leap between profiling and identifying poor performance,' he said.

The DH said the earliest the CQC could begin registering GPs was April 2011 and that the job might not be finished until a year later.

Baroness Young How the CQC will monitor GPs

• Registration requirements include assessing and monitoring quality of provision, infection control, complaints processes, safety of premises and co-operating with other providers
• Information will be gleaned from QOF data, practice accreditation and GP patient survey results, plus PCT data on prescribing, referrals, clinical governance and complaints
• Risk profiles will be developed using levels of complaints, surveys of patients and staff, regular CQC inspections and PCT balanced scorecard assessments
• GPs judged to be failing face statutory warnings and cautions, cancellation of their registration, fines of up to £50,000 and, in extreme cases, imprisonment

Source: DH consultation response

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