The CQC forcibly deregistered at least 14 GP practices last year, the highest number to date under its three-year inspection regime.
The figures, revealed in board papers published this week, relate specifically to practices that had been placed in ‘special measures’ following an inspection identifying ‘serious failures of care’. It comes as the CQC directly cancelled nine practice registrations in 2015/16 and 10 in 2014/15.
The papers reveal that around a third of practices in special measures ended up deregistered, either by force or voluntarily, while two-thirds improved enough to be taken out of the programme during 2016/17.
Pulse also understands that some practice registrations were immediately cancelled by the CQC upon inspection without going through the special measures process but the CQC did not provide a figure for how many practices it closed down in this manner. Therefore, the number of practices which were stripped of their registration in the last year could be higher.
In addition, the end-of-year figures for 2016/17 reveals that a further 37 practices voluntarily deregistered their contracts after an inspection or whilst being in special measures, but the CQC highlighted that this could be due to practice mergers as well as closure.
The latest report showed that out of 133 practices which left special measures last year, two-thirds were taken out of the regime because they made significant improvements and were no longer deemed inadequate. The remaining third were either closed down by the CQC or have themselves deregistered, and 130 GP practices remained in special measures on 31 March.
CQC chief inspector of general practice Professor Steve Field said he found the process ‘enormously encouraging’.
He said: ‘What’s enormously encouraging is that our inspections are driving improvement – 90% of practices that we have re-inspected have improved since last October. Through their hard work and dedication, practices are making positive changes to the care they deliver.
‘However, we still see evidence of too much poor care. Since we began inspecting GP practices in October 2014 we have found over 200 practices to be inadequate.’
Professor Field said that ‘while this is a minority, this still amounts to over half a million patients in England who were not receiving the basic standards of care that they should be able to expect from their GP practice’.
But he added that he was ‘glad to say that we have increasingly found that most practices that are placed in special measures use the support that is on offer to meet those standards’.
GP leaders told Pulse that that while the profession does not tolerate unsafe care, the CQC’s regime was a ‘massive, expensive, destructive hammer’ to solve a problem that exisiting contractual levers can address.
GPC’s regulation lead Dr Robert Morley told Pulse while the ‘very tiny proportion portion of unacceptable practices must not be tolerated’ this regime was not the solution.
He said: ‘CQC is a massive, expensive and destructive hammer to crack a tiny a nut.’
‘If any practice’s position is truly irretrievable then commissioners have always had the levers to deal with the problem, so they question must be asked as to why they haven’t. The current regime of general practice regulation by CQC is both unfit for purpose and unnecessary.’
The news comes as a Pulse analysis, published earlier this month, revealed that the CQC’s first completed round of GP practice inspections concluded with 90% rated ‘good’ or ‘outstanding’ – and with a price tag of over £100m. At the time, the CQC declined to provide figures for how many practices it had closed down.
|CQC ‘special measures’ programme in 2016/17||GP practices|
|Remaining in special measures (at 31 March 2017)||130|
|Exits (of which:)||133|
|Registration cancelled by CQC||14|
|Deregistered before formally entering special measures||7|
What is the CQC process for deregistering a practice?
Practices placed in special measures are deemed to have shown long-term failures of care and lack of effective management and have been rated ‘inadequate’ by the CQC following inspection.
The process allows practices to access a 12-month turnaround support package, delivered by the RCGP, but they also face re-inspection after six months and if improvements are not made can have their registration cancelled, or conditions placed on their registration.
Practices can also opt to deregister, for example where they have been dealing with long-term recruitment or funding issues and feel they are unlikely to improve, a provider can also deregister as part of a merger.
Pulse reported in June last year that the CQC had immediately removed the registration of an Essex practice and sought a magistrate’s order to close it entirely.
On another occasion it sought a magistrates order to close a practice in special measures after two surprise inspections, however following a legal appeal by the practice it later admitted it had acted ‘prematurely’.