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GP practices face contract breach probe upon ‘requires improvement’ rating

Exclusive GP practices could face being automatically assessed for a breach of contract when they are rated ‘requires improvement’ by the CQC, Pulse has learned.

As it stands, national guidance says practices rated ‘inadequate’ should receive a breach notice. But in London, NHS England’s regional team is planning to also assess ‘requires improvement’-rated practices for breach of contract.

It argued that this was necessary due to the higher-than-average number of practices receiving a ‘requires improvement’ rating in the capital. This would apply both to practices receiving the rating in future, and those that have received it to date.

Under the plans, contract holders are advised to read CQC reports and told they can automatically give a breach notice if it shows the contract has been breached, without a need to visit the practice – however NHS England said it would always advise gathering supporting evidence where possible.

Handing a breach of contract notice to a practice gives NHS England’s local team and CCGs, where these are the commissioner of GP services, the remit to get involved in the issues identified.

Londonwide LMCs, which are being consulted on the proposal along with CCGs, told Pulse that it was resisting the move on the basis that a practice could end up having to deal with three different bodies simultaneiously over the same issue.

The plan, sent to all CCGs in the London area, said: ‘Technically, when a practice is in receipt of a CQC report indicating that they require improvement, they have immediately breached their contract.

‘It follows that NHS England may be justified in issuing a breach and remedial notice without conducting a practice visit where a CQC report identifies and evidences matters which are contract breaches.’

In a letter accompanying the draft plan, NHS England (London) told CCGs this guidance would also apply retroactively, with practices having received a ‘requires improvement’ rating to date to also be investigated.

Head of primary care Jill Webb said all practices that have had 12 months to remedy the issues uncovered in their CQC inspection should be assessed, adding: ‘If there is no evidence that necessary actions have been taken to address the concerns identified, and/or a GP contractor cannot provide demonstrable mitigations as to why their action plan is outstanding, a retrospective breach notice may be considered’.

The plan said that London is a ‘significant outlier’ compared to other regions when it comes to practices receiving ‘requires improvement’ ratings – 17.6% compared to 10% average across England.

But a spokesperson for Londonwide LMC said: ‘Essentially issuing the breach gives NHS England (London) and the local CCG the remit to get involved in the issues that the CQC has raised, so potentially all three bodies could be simultaneously placing demands on a practice.’

Londonwide LMCs medical director Dr Tony Grewal said this was ‘completely unnecessary additional jeopardy for practices, at a time when general practice is on its knees’.

GPC chair Dr Chaand Nagpaul, a GP in north west London, said: ‘I think it is tragic that we have and NHS where practices are operating in a climate of fear and threat. This is a culture that needs to be reversed, and NHS London automatically issuing breach notices – or assessing for breach notices – is an extremely counter-productive approach that is going to lead to more GPs wanting to leave the profession.

‘I think the last thing that a practice that requires improvement needs is a breach notice. I think it is unacceptable and we need to challenge it.’

NHS England (London) told Pulse it has a ‘statutory duty to investigate and respond to contractual compliance issues and when a practice receives a rating of inadequate or requires improvement from the CQC, technically, it has immediately breached its contract’.

It added that ‘in practice, CQC reports are always reviewed alongside associated evidence and are not immediately served breach notices’.

A spokesperson said: ‘Our aim is always to ensure that patients are receiving the safest and best possible care, wherever they live in London, not to create unnecessary hurdles for a practice which needs to make improvements.’

They added: ‘NHS England may be justified in issuing a breach notice without a visit, however, we would always advise gathering the evidence to support any decision and all decisions are taken on a case by case basis, this is not a blanket approach applied to all inadequate CQC ratings.’

CQC inspections destabilising struggling practices

The GPC has said it will campaign for struggling practices not to have to go through a CQC inspection, as the first step of its attempt to get the whole regime replaced, after finding CQC inspections have been the ’final nail in the coffin’ for some struggling practices.

Evidence of this was seen when Pulse reported in May that a practice had been closed down by the CQC while waiting for funding promised as part of NHS England’s vulnerable practice fund.

Meanwhile, the body that funds the GPC – the GP Defence Fund – is funding a judicial review against the CQC, while also last month, the GPC released a report showing that practices with poor CQC ratings receive less funding.