Some 68 GP practices were de-registered following a stint in special measures in the 31 months from October 2014 to May 2017, statistics revealed in the CQC's State of care in general practice report show.
The bulk of these (68%) opted to voluntarily de-register after receiving an inadequate rating and being placed in special measures.
The remaining third (32%) were de-registered by the CQC through enforcement action.
The report reveals that 329 practices were placed into special measures over the first round of inspections.
Most (71%) have since managed to improve sufficiently enough to be removed from the programme, with 138 of these now holding a ‘good’ or ‘requires improvement’ rating.
CQC special measures
As of the end of May, when the data was extracted, 88 practices were awaiting re-inspection after being put into special measures, and a further 35 remained in the scheme following re-inspection – putting the total number of practices in special measures at 123.
Under the current inpsection regime, a practice is automatically placed in special measures if it is rated ‘inadequate’ overall following its inspection, or if it is rated inadequate in one or more key questions consistently over two inspections.
These practices are inspected again within six months to ensure improvements have been made. During this time the practices can pay to receive specialist support to help them improve.
The CQC has suggested that this process for dealing with inadequate practices could change as it overhauls its inspection programme over the coming year.
A practice can only graduate out of special measures by securing a higher overall rating – and if it fails to do this the CQC looks to take action against them, including forcing them to close.
The CQC said that acknowledging problems at the practice was ‘important to improvement’ for those in special measures.
Key members of senior staff – including GP partners and practice managers – need to ‘embrace the findings from the inspection as an opportunity to improve’, it said.
It added: ‘If there is a culture of owning problems and reflecting on the things that haven’t gone well, then there is more likely to be improvement within the practice.
‘An initial rating of inadequate can be a shock to the practice, but this can be channelled into making improvements. Some practices were eager to protect their reputation, and were motivated to improve to "lose" the inadequate rating.’
Other key drivers of improvement include resolving governance issues, improving leadership and receiving support from external bodies.
The CQC said: ‘The strength of our regulatory action is always in proportion to the risk to the safety of patients. When we place a GP practice into special measures, we will re-inspect it within six months.
‘At this inspection we expect to see improvements to the quality of care: if the practice continues to be rated as inadequate and has not made sufficient improvements by complying with the legal requirements in the warning notice, we will take action in line with our enforcement policy. In some cases, this can mean cancelling the practice’s registration.’