GP chief inspector pledges to stand up for practices

England's first-ever inspector of general practice has pledged to speak out strongly in defence of GPs if external factors such as funding cuts or workforce shortages undermine quality.

Professor Steve Field: inspector of general practice
Professor Steve Field: inspector of general practice

Inspections must be sensitive to problems practices face because of their location, the population they serve or factors such as workforce or funding, Professor Steve Field told GP.

Professor Field, who took up the post on 1 October, said his inspection teams would be ‘loaded’ with GPs.

His comments on understanding the circumstances practices are operating in come after GP reported that practice income has dropped 25% in real terms since the 2004 contract deal.

Meanwhile, both the BMA and the RCGP have warned of a ‘crisis’ in general practice because of rising workload, bureaucracy and a dwindling workforce.

Professor Field said he would use the role not just to target individual practices over poor performance, but to suggest improvements across whole health economies that could raise standards.

Speaking exclusively to GP, Professor Field said the inspection regime would not be a ‘witch hunt’, and that his role would involve not only flushing out poor practice, but also highlighting excellence.

He said his goal was to make British general practice the best in the world, and to make the service ‘uniformly good for the public and patients across England’.

He told GP: ‘I see the role as putting a spotlight on poor practice so people can sort it out, but also pointing out good practice and helping others understand what it is so they can move in that direction.’

The vast majority of GP practices are good and some are outstanding, Professor Field said.

But he added: ‘In many parts of the country GPs know of practices they are worried about.’

CQC registration checks had identified practices with no doors on consulting rooms, and others where temperatures on fridges had not been checked. ‘So we don’t know if vaccines work or not,’ he said. ‘We are talking about really poor practice.’

Practices performing as poorly as this needed to know that these standards would not be tolerated, Professor Field said.

He added that poor standards were ultimately the responsibility of practices.

But he said: ‘We have to be sensitive to problems practices have because of the area they are in. I see myself highlighting where problems are, but if there are difficulties with workforce numbers and they can’t deliver what patients need, we might have to challenge Health Education England or NHS England or other agencies.’ Professor Field added: ‘If we find areas where the funding makes it difficult to deliver care, we are independent and will make statements about that. Maybe an area needs more practice nurses but there aren’t any - and we will say the NHS must prioritise that.’

The inspection regime will be ‘clinically led at all levels’, he said.

‘I want to reach out to GPs and say this is something we need your help with, to ensure safe practices and promote great practices,’ said Professor Field.

‘We will need a lot of GPs to help – we are going to load this with GPs. I believe it should be led with excellent management, but by GPs.’

The inspection system under Professor Field will operate across ten English regions, with around 20 CCGs in each.

Piloting of the plans will begin around Christmas, but he told GP he was looking at a two-year rolling cycle of inspection.

Areas being inspected would have two or three visits to a number of practices over a one-year period, initially likely to be those where concerns had been identified via CCG ‘intelligence’ or through CQC registration.

‘We will start to look at themed ideas that might help, like the links between mental health and general practice in the area, or out-of-hours provision.’

Professor Field has welcomed DH plans to invest in extending GP hours across England, and said ‘brilliant access’ would be a key feature of inspections.

‘Brilliant access might mean practices take on the ‘doctor-first’ model where a GP does triage of all calls,’ he said.

But the right model would not be for an inspector to impose, he said. ‘We need to be more sensitive to patients and the public across an area, and in practices, more sensitive to what GPs want and can do and the sort of investment needed to deliver that.’

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