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Threat of legal action if GPs fail to follow NICE

By Nigel Praities

GPs will have to prove they follow NICE guidelines or face the possibility of suspension, prosecution or the closure of their practice, the Government's new health and social care regulator has warned.

Baroness Young, chair of the Care Quality Commission, revealed that guidance from NICE would become legally enforceable from 2009/10, with doctors to face tough annual checks on their compliance.

Pulse has also learned that the commission is determined to bring all GPs under its remit, having told the Government the ‘significant clinical risks' justify ‘system regulation of primary care as well as professional regulation of individuals'.

Baroness Young told last week's NICE annual conference in Manchester that policing clinical guidance was set to be a key part of the CQC's work, and admitted the commission had been handed ‘draconian' powers by ministers.

‘We want to raise the profile and highlight the importance of NICE guidance and build this into the new registration scheme,' she said.

Baroness Young added: ‘I have an image of a patient sat in front of their GP or consultant with a card with the NICE guidance so they can interrogate their healthcare provider.'

A CQC spokesperson said: ‘We expect providers always to comply with NICE guidelines and other national guidance unless they can show a good reason to vary from them.'

The CQC will select clinical topics for ‘special reviews' of implementation of NICE guidance, with a consultation to begin this month on those to be scrutinised in 2009/10. Failure to implement NICE guidance could bring severe sanctions.

‘The steps we can take range from a formal warning notice to prosecution and imposition of restrictions, or even closure of a service,' said the spokesperson.

The Department of Health is expected to announce details of a consultation process on the remit of the CQC in the new year, but the commission has asked for its remit to cover all doctors and dentists. It wants its responsibilities phased in, with GPSIs likely to be registered first, and other GPs to follow ‘after 2010'.

Val Moore, implementation director at NICE, said the institute was in talks with the commission over how the plans would work. ‘We are not an inspector or a regulator, but it would be very welcome to get going on topics together with the CQC.'

Some of NICE's recent decisions have been hugely controversial and GPs reacted sceptically to the prospect of guid- ance becoming compulsory.

Dr Pam Brown, a GP in Swansea and a GP appraiser, said: ‘We are not going to wilfully disobey NICE – it is just there are some disease areas where we feel it has not got it right.'

Dr Alun Cooper, a GPSI in osteoporosis in Crawley, West Sussex, and chair of the National Osteoporosis Society's primary care forum, claimed recent NICE guidance on osteoporosis was in direct opposition to clinical opinion.

‘We are going to be heavily policed and I don't have a problem with that if the NICE guidance is sensible. But here we are with the extreme example of guidance that took six years to develop and is completely unworkable,' he said.

Baroness Barbara Young, chair of the Care Quality Commission, said providers will have to demonstrate they adhere to NICE guidance Baroness Barbara Young, chair of the Care Quality Commission, said providers will have to demonstrate they adhere to NICE guidance Regulatory crackdown on GPs

• The Care Quality Commission will be the first regulator in the world to have such a wide remit over both health and social care
• The Department of Health says it expects all GP practices will eventually have to register with the CQC, but they have yet to announce how this will be rolled out from 2010
• Practices will have a mandatory requirement to register with the CQC or face sanctions, such as fines of up to £50,000
• The CQC will be able to issue a penalty notice in lieu of prosecution, suspend or cancel registration or prosecute for specified offences
Source: Care Quality Commission, draft enforcement policy document 2008

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