CQC reviewing process for dealing with 'inadequate' GP practices

The CQC is reviewing its GP special measures scheme and the way it deals with poorly-performing practices ahead of introducing a 'lighter touch' inspection model for GPs in October.

The CQC’s special measures scheme as it currently stands is due to be axed from October, the watchdog has suggested.

A spokesman told GPonline that the scheme – which provides a framework and timeframe for ‘inadequate’ practices to improve – was ‘being reviewed’ under CQC plans.

He added that it was looking into how it ensures 'requires improvement' and 'inadequate' practices make improvements.

NHS England announced last week that the support scheme run by the RCGP to help turn around special measures practices will be scrapped when the new scheme comes in, putting a question mark over how special measures will operate under the new regime.

GPonline reported in October that two in five practices placed into the current special measures scheme later closed down, although the majority of struggling practices showed clear improvements after just six months.

GPC deputy chairman Dr Richard Vautrey said that the ‘special measures’ label was ‘judgmental’ to practices, and the process should become more collaborative and supportive.

Map: CQC GP ratings

The watchdog is overhauling its whole inspection process for GPs in October 2017, three years after the launch of its current system – which introduced intelligent monitoring and Ofsted-style four-point ratings.

It will follow changes already made to the hospital and adult social care systems, which took effect this month.

A CQC spokesman told GPonline that the impending changes aimed to ‘reduce the burden of regulation on GPs while ensuring high-quality care’.

The watchdog has confirmed that inadequate practices will still be inspected again within six months after receiving their rating.

Requires improvement practices will be inspected again sometime around a year later.

The CQC will move to a more heavily risk-based model, with the frequency and scope of inspections dictated by previous ratings and up-to-date monitoring information.

As a result, with more effective monitoring information on hand, it will increasingly use surprise inspections when assessing practices.

GP inspections

Practices raising little cause for concern, such as those rated good or outstanding, will win a reprieve and not face inspectors again for a ‘maximum interval’ of five years – but they will be expected to send the CQC data on a yearly basis.

The watchdog is also fine-tuning its process for assessing federations and other new care models. Its proposed model will see it assessing its well-led domain at a corporate level, followed by inspections from ‘a sample of locations’.

The CQC spokesman told GPonline: ‘We will be considering how we ensure services continue to improve, particularly those rated inadequate and requires improvement.

‘The special measures guidance is being reviewed to make sure we can take necessary action when services fail to improve, but I can’t say what that will look like at this point.’

Dr Vautrey said: ‘We've raised concerns from the outset that the four-point scale rating system is far too simplistic and isn't helpful.

‘It’s unhelpful to label practices as "special measures", it becomes a judgmental process. What needs to be done is a recognition that these practices often get into difficult due to no fault of their own or long-term issues that haven’t been given support.

‘It’s about working alongside practices that makes the difference, it’s best to be supportive. There’s a variety of things – issues with premises, lack of investment, patient demographics – that the simplistic rating scale doesn’t reflect. We need the right support systems in place.’

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