Poor GP practices will not be tolerated, warns GP inspector

Chief inspector of general practice Professor Steve Field has warned GPs who deny there is a problem with variation in primary care standards are wrong, and vowed to close poor-quality practices.

Professor Steve Field: hailed as weapon against variation in GP quality

Health secretary Jeremy Hunt told the NHS Alliance conference in London that Dr Field's inspections were more important than the CQC’s hospitals regime because variation in quality among GP practices was less well understood.

CQC inspections of general practice, said Mr Hunt, were ‘probably a little bit brutal’, but remained the best way to ‘spread best practice’.

‘Look at what happened in Ofsted when they allowed Ofsted to fail schools,' he said, arguing that grading was the best mechanism to drive up standards.

There was widespread concern over variability of standards in general practice, said Mr Hunt, and Dr Field’s work would be ‘one of the biggest weapons we have’.

Also speaking at the NHS Alliance event, Professor Field said data showed there was huge variation between practices.

‘For those of you, including my own college, who deny there is unacceptable variation, you are wrong,' said the former RCGP chairman. ‘We need to up our game as GPs.’

‘We won’t tolerate poor practice,' he said. ‘We’ve already initiated the closure of a number of practices.’

Professor Field said he had already come across examples of poor practices where they did not know what a ‘significant event’ was, claimed not to have received any complaints, did not know how many children were on their safeguarding at-risk register, had not had any safeguarding training, and where the practice nurse had had no CPD training for twenty years.

The chief inspector suggested GPs who did not involve patients in practice development should not be allowed to practise. ‘How did they get feedback? Have they done any audits? Any significant event analyses? Do they have a patient group? The answer is "no",' he said. ‘The question is, should they be allowed to continue to practise?’

Professor Field acknowledged his inspection regime alone would not drive quality improvement, and called for closer working between practices and with community trusts.

Problems often arose with handovers between hospitals, GP practices and community services, he said.

Professor Field added that he hoped CQC inspections that reveal problems with variations in quality could 'kickstart NHS England to do what they should be doing and support practices, and look at how they finance practices'.

RCGP chairwoman Dr Maureen Baker said patients should receive high quality and consistent care, wherever they live.

'GPs are keen to provide this', she said, 'but patients' needs are changing and the health service urgently needs to adapt.'

Dr Baker said current workload pressure were unsustainable and called for an urgent funding increase.

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