Exclusive A revamped CQC inspection regime will not be ‘punitive’, will not force practices to open seven days a week and is likely to identify only a ‘tiny’ proportion of practices who need to make major improvements, the new chief inspector of general practice has told Pulse.
In an exclusive interview on the first day of his new role, Professor Steve Field sought to allay GPs’ fears, setting out details of more targeted inspections and claiming he hoped to be an ‘advocate’ of the profession who would raise concerns about resources and workforce.
Professor Field contradicted reports based on his interview with the Guardian at the weekend in which he was quoted as claiming as many as one in ten GP practices could require major improvements. He said this estimate was based on the CQC’s first 287 inspection visits at practices which had for the most part already declared non-compliance with one or more CQC standards.
‘The message that 10% of practices have major problems is wrong,’ he said. ‘I believe that overall the proportion of practices which have big issues is very small.’
‘I honestly believe that there is only a tiny, tiny percentage of practices which are unacceptable.’
Professor Field also moved to reassure GPs over the prospect of the CQC for the first time assessing practices on access. He said that while he supported the move towards seven-day working, practices would not face action over failing to provide extended hours - a service he admitted his own practice in Birmingham was currently unable to offer.
The CQC would only take action over access in extreme cases, he said: ‘The sort of thing which will really worry us will be if lots of patients are saying that they’re turned away from their GP. Or if we read significant events or court cases of children who’ve been abused or killed, and there’s a history of GPs turning patients away.’
‘I wouldn’t personally expect your average practice to be working longer hours and seven days without working in partnership with other practices, unless they want to,’ he added.
‘I support the move towards seven day working, but practices like ours can’t provide that at the moment, we’re not resourced for that at the moment, and we would need to work with other practices.’
Professor Field also detailed the CQC’s new inspection regime for GPs, which will come into effect next April and was first outlined in the regulator’s ‘A New Start’ consultation earlier this summer.
The new strategy will see the CQC take a more targeted approach, where only a sample of practices where no specific concerns have been raised will be inspected.
‘If you take a CCG area, from April we will come and look at a CCG and we will sample a proportion of the practices in the CCG over a week or two,’ said Professor Field. ‘On a two-year rolling programme we might be back to that CCG area a few times but not check all practices in one go because we have to inspect the whole country. This will be our routine programme, going alongside targeted inspections where we are looking at specific problems.’
‘We are going to divide all CCGs into ten regions and in all ten regions we will do the same. We will look at a proportion of the practices.’
The regulator will also look at broader cross-cutting ‘themes’, such as out-of-hours care, access to IAPT and medication in care homes. CCGs will then be expected to raise standards over the two-year inspection period based on findings.
Professor Field said under the new scheme inspections of practices were likely to last for a day, and be carried out by a team of three or four, which was likely to include a senior manager, a primary healthcare professional and a patient.
‘My plan is always to have a GP [as part of the inspections team], if we can practically get it,’ he said.
‘We are not looking for punitive stuff, we are looking at real issues. Looking at the inspections to date some of the key things we found were issues about training for safeguarding, out-of-date drugs, people who had not recorded the temperatures of fridges that hold vaccines. That is a serious issue. We have been to surgeries without doors on their consulting rooms and found surgeries that are dirty, or have carpets in treatment rooms. Things which are not acceptable.’
‘My worry is that people are concerned that we are going on a witch hunt, but we are not at all. This is really basic stuff and practices which are losing their licenses have been warned on many occasions. One [practice] going through this at the moment was warned on seven occasions.’
He further stressed that, under him, the ideal process would be led by GPs at all levels.
He added: ‘We want an inspections system that is professionally led in the new system, which it isn’t at the moment. We want a new system where we want GPs to be engaged in and leading the visits.’
‘For me the big change will be more GP involvement and we are going to resource it heavily. I want a GP in each of the regions and we want to be advocates for practices.’
Professor Field also said he hoped to use his new high-profile role to champion general practice – and even help it fight for better support and resources.
‘I think increasingly we will be an advocate, because I believe that general practice is at the centre of everything we do, and whilst the focus in this first week in the newspapers has been around standards and stopping people from work, we want the best care possible.’
‘So I think you will find us making statements about resources, about contracts, about lack of workforce and the fact that perhaps Health Education England might need to think about for example improving the nurse training in primary care so that practices can deliver and perform on long-term conditions.’
‘For me the fundamental is I want the best general practice in the world. I think we have some of the best general practice in the world and I have travelled extensively looking at general practice, but it is not universally brilliant. It isn’t anywhere - but I want us to be the best.’