Care Quality Commission chairman Baroness Barbara Young has a huge task ahead.
The watchdog she leads is just starting to register England's 44,500 health and social care organisations. Each - including 8,300 GP practices - must first meet the 16 core standards set out earlier this year by the CQC.But this is just the start - once registrations are complete, a cycle of monitoring and inspection will begin.
It's 8am, and Baroness Young says she has been working for an hour and a half already. No less an authority than prime minister Gordon Brown, she confides, once told her: 'We weren't put on this earth to enjoy ourselves you know.'
A sea of empty desks on the top floor of the CQC's London office suggests the rest of its workforce isn't quite as keen.
Crucial details outstanding
Practice registration is unlikely to start before 2012. But crucial details remain undecided, admits Baroness Young, such as how much of the data collected on practices will be available to the public.
Getting the balance right is a 'massive responsibility', she says. 'Our experience is that good providers like information being put in the public domain - they're proud of their record. But we certainly won't go as far as every complaint by a patient.'
It also remains unclear how tough registration will be, and how many GP practices will fail to meet CQC standards.
'There will be a proportion of GP practices failing,' she says. 'But I think we'll only get a feel for it when we start getting applications in 2011/12.'
Registration for trusts is just around the corner, however. Baroness Young believes half currently fall below CQC registration standards and will have 'to bust a gut' in the next six months to pass.
Then there is the uncertainty over what Baroness Young describes as an 'interesting pre-election situation'. She warns that should the Conservatives come to power next year and hand commissioning budgets to GPs, 'a huge amount of thinking' will be needed to monitor how GPs use the money.
Since its formation in April, the CQC also has found time to make recommendations on issues like GP prescribing and cardiovascular QOF thresholds.
Baroness Young disagrees with those who feel it should not be telling the health service's purveyor of clinical guidance, NICE, what to do.
'Our job is to look at quality, however it is delivered. If some of the tools being used nationally don't seem to be producing the right kind of results then we will comment. It would be wrong of us not to,' she says.
A key priority for the CQC is also 'championing joined-up care', a subject Baroness Young often returns to. Practices will have to demonstrate integration with social care to pass registration, she says - she is also keen to see social workers co-located in GP practices.
But are CQC standards achievable? GPs and practice managers have warned that some changes it expects, especially to premises, are either dependent on capital from their PCT, or impossible.
'Timescales for practices to improve will be realistic and justified,' insists Baroness Young.
'When money is so tight, we're going to have to take an educated judgment on the art of the possible. There's no point in us coming and saying we want everything to be diamond-studded.'
Improving poor practice
Conditions will be placed on poor practices, which will draw up action plans to improve in a set time. Inspectors will check on improvement, she says.
Baroness Young hopes a network of regional leads and area managers can 'develop a customer relationship with practices', so GPs do not just wait for inspectors to knock. But the CQC 'mustn't become a consultancy' on passing inspection.
However, she admits: 'There is still a big question around all this because we still need to negotiate the funding for GP registration.'
Last month Baroness Young told the NHS Alliance conference that inspections would be unannounced - and, she tells GP, she may take part in visits.
The CQC will try to cut the burden of registration by using existing data to decide if practices merit inspection. Those with RCGP practice accreditation are likely to avoid close scrutiny, for example.
Registration standards should not be too prescriptive either, she says: 'Regulation isn't a numbers game - have you got this and that - it's a judgement: is this service likely to produce good outcomes?'
Baroness Young believes CQC registration can be something to be proud of and hopes GPs will embrace it.
'The independent sector demands to be regulated; we have organisations queuing up - yet NHS providers go: "get away".
'It will be a challenge for the poorest providers. But that is right. It will be like a stamp for good GPs.'
