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Surgeries get Ofsted-style ratings

GP services which are not providing adequate care to patients could be shut down, health regulators have announced.

Poorly performing practices will be put into a new failure regime and those that don’t improve will face closure, the Care Quality Commission (CQC) said.

GP surgeries will receive Ofsted-style ratings – where they are deemed to be outstanding, good, requires improvement or inadequate – and those that are given the lowest rating face being put into special measures. If they fail to make improvements following this they could be shut down.

Inspectors will assess whether England’s 8,300 GP practices are safe, effective, caring, responsive to people’s needs and whether or not they are well led.

CQC’s chief inspector of general practice Professor Steve Field said that from October this year failing practices will face being put special measures .

He said he wanted to “call time on poor care”.

When parts of a GP practice’s service are deemed to be inadequate they will have six months to improve their services and if after this deadline they have failed to get better they will be put into special measures.

If after another six months the practice has shown no signs of improvement, they could have their registration with the health regulator cancelled or their contract terminated by NHS England – meaning that they would be forced to close.

Those that are performing exceptionally badly will be immediately put into the failure regime, CQC said.

Pilots of the inspection regime, which see a specialist GP advisor join the team scrutinising GP surgeries, found that most practices are providing high quality care – but a small number are “very poor”, CQC said.

“Most GP practices provide good care,” said Prof Field.

“We have confirmed this in our pilot inspections so far. But we can’t allow those that provide poor care to continue to let their patients have an inadequate service.

“I want to do all I can to drive up standards in those that are not providing the services people deserve. We need to have a clear framework and a process to respond to those GP practices that are providing inadequate care to ensure that they can’t continue to provide inadequate care indefinitely.

“Special measures will firstly promote improvement, but where practices do not improve, working with NHS England we will call time on poor care.”

The regime could also see more doctors referred to the doctors’ regulator, the General Medical Council (GMC).

Niall Dickson, chief executive of the GMC, added: “Whenever CQC’s new inspection system raises concerns about the competency of individual GPs, the matter will be referred to the GP’s local responsible officer and if necessary to the GMC.

“Family doctors are now subject to regular checks, but the inspections in England are bound to expose areas of weakness as well as good practice.”

The move follows a similar regime introduced for hospitals which was announced after the Stafford Hospital scandal.

Putting hospital trusts in special measures was introduced as part of the Government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry.

The trust was at the centre of a series of probes after it was found that poor care could have led to the deaths of hundreds of patients as a result of maltreatment and neglect. The public inquiry highlighted the “appalling and unnecessary suffering of hundreds of people” at the trust.

Last month, it emerged that poorly performing care homes and home care services would also face the same sanctions as hospitals.

Dr Chaand Nagpaul, chairman of the British Medical Association’s GP committee said: “It is important not to create a counter-productive blame culture based on isolated examples that would wrongly damage patient trust in wider GP services.

“Where there are issues, we need to understand the reasons for any shortcomings. This is particularly important as GP practices are operating in a difficult environment and some are constrained from providing the care they want to.

“We need to focus on providing support and enabling improvement in those GP practices that need help.

“To solve these long-term problems, we need the Government to commit to long-term, sustained investment in general practice that addresses the fundamental challenges facing GP services. The last thing we want is for GP practices to close when what patients need is high quality, local services.”

Dr Maureen Baker, chairwoman of the Royal College of GPs, added: “There is occasionally a very real variation in the quality of care provided and this must be addressed.

“There are also a small number of practices who are struggling to meet quality standards, often due to factors beyond their control, such as lack of funding, significant increases in patient consultations and difficulties in trying to recruit sufficient GPs to meet patients’ needs.

“If this is the case, the solution is not to ‘label’ them but to look at what support they need to bring them up to scratch.”

She said that the College will ensure that the special measures regime does not become “another stick with which to beat hardworking GPs”.

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