The new measures, which can be applied to practices from October this year by the CQC, are designed to ‘drive improvement’ and consistency to general practice, according to the watchdog.
The introduction of the scheme will coincide with the CQC’s controversial new rating system, which will see practices labelled as ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’.
GP reported last month that the CQC planned on introducing special measures to under-performing practices, and the regulator has now confirmed this to be the case.
Six-month action plan
Practices rated as ‘inadequate’ will be subject to a six-month action plan detailing how they must improve. Should any fail to show a satisfactory improvement in care upon the CQC’s return visit by the end of that period, they will be placed under special measures.
Such practices will have a further maximum of six months to show improvement, and those that fail to do so could ultimately face the closure of their practice.
CQC chief inspector of general practice Professor Steve Field also said in a small number of extreme cases, practices could be put straight into special measures if the CQC was ‘very worried about patient care’ or was not confident the practice could improve on its own.
Most problems will be resolved
He added that the majority of issues which will qualify a practice for an ‘inadequate’ rating would be ‘easily sorted’ by most practices in that situation, and 'very few' would end up on special measures.
The CQC also said it would be working ‘hand in glove’ with NHS England, which will be responsible for providing support to practices subject to the measures and help develop action plans for improvement.
If after the predetermined time span for special measures, set at a maximum of six months, the practice in question has still failed to improve satisfactorily despite support, they will be subject to legal action.
This could involve the CQC revoking the provider’s registration or NHS England cancelling their contract, forcing practices to merge or sourcing new GP providers, as deemed appropriate by the local area team.
An NHS England spokesman told GP that it had begun to develop an operating framework for how it will work with practices rated as inadequate or put under special measures and how it will 'oversee and monitor this plan to ensure measurable improvements are made ahead of any re-inspection’.
Close tie between CQC and NHS England
He said: ‘NHS England is also starting work with the RCGP to develop a 12-month pilot programme of intensive peer support to practices that are placed in "special measures".
‘The programme will provide quality assured expert support from the RCGP and will enable practices to access a flexible package of direct support, mentoring and coaching. It is expected that practices choose to take up the support offer will only have to contribute half the costs.’
But GPC chairman Dr Chaand Nagpaul argued that, although patient safety and care was every GP’s ‘number one priority’, special measures could ‘wrongly damage patient trust’ in GP services.
‘It is important not to create a counterproductive blame culture based on isolated examples,’ he said.
Professor Field stressed that implementing special measures was not about ‘bashing GPs’, but improving patient care and ensuring ‘consistency’ across all practices across the breadth of England.
He said: ‘Most GP practices provide good care. We have confirmed this in our pilot inspections so far. But we can’t allow those that provide poor care to continue to let their patients have an inadequate service.
‘A relatively small number of practices have been failing for years and people have known this, but there's not been any consistent action. What we want to do is bring in some consistency and try to make this as fair as possible.
‘Special measures will firstly promote improvement, but where practices do not improve, working with NHS England we will call time on poor care. Special measures will be viewed as the final chance for a practice to improve.’
RCGP chairwoman Dr Maureen Baker agreed that ‘patients should expect high quality and consistent care from every GP practice’, and that it was important to support struggling practices to ‘bring them up to scratch’.
‘We welcome the opportunity to play a significant role in supporting GPs and practices to deliver the best care they possibly can to their patients. Our involvement will also ensure that the so-called ‘special measures’ do not become another stick with which to beat hardworking GPs,’ she said.