General practitioner England

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GP inspection scheme raises blame culture fears

A new ‘special measures’ GP inspection system must not create an unfair blame culture that will damage patient trust, the BMA warned today.

stethescopeThe CQC (Care Quality Commission) has announced it will introduce an Ofsted-style special-measures approach to practices in England for services rated ‘inadequate’ from October.

Practices with this rating will be given six months to improve or be put into special measures. If they do not make progress after a further six months, they face losing their CQC registration or closure.

However, in cases where a GP practice has such significant problems that patients are at risk, or there is little confidence in the practice’s capacity to improve on its own, the practice will be placed straight into special measures.

BMA GPs committee chair Chaand Nagpaul (pictured below) said it was right that patients received the highest standards of care but added it was important to understand the reasons for any shortcomings in services rather than creating a blame culture.

He said: ‘The overwhelming majority of the 8,000 GP practices across England provide an excellent service to the nearly one million patients who walk through surgery doors on a daily basis. Patient safety and care is every GP’s number one priority. 

‘However, it is important not to create a counterproductive blame culture based on isolated examples that would wrongly damage patient trust in wider GP services. Where there are issues, we need to understand the reasons for any shortcomings. This is particularly important as GP practices are operating in a difficult environment and some are constrained from providing the care they want to.’

Poor premises

Dr Nagpaul added that many GPs were struggling to provide services in poor buildings and recruit GPs owing to budget cuts and the focus needed to be on supporting and enabling practices to improve.

Chaand Nagpaul Arm 2013He said: ‘To solve these long-term problems, we need the government to commit to long-term, sustained investment in general practice that addresses the fundamental challenges facing GP services. The last thing we want is for GP practices to close when what patients need is high-quality, local services.’

Improving premises, developing the practice team to better meet patients' needs and attracting, retaining and expanding the number of GPs via long-term, sustainable investment for general practice are the goals of the BMA’s Your GP cares campaign.

The CQC will introduce its special-measures system alongside its new rating system for 8,000 England GP practices in October. From then, practices will be inspected and rated as ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’.

Those practices placed in special measures will be given a clear outline of areas to improve within a set timetable. This will be set by the CQC in partnership with NHS England.

Chance to improve

The CQC says pilots of the rating system have so far shown that the majority of practices are providing high-quality care.

Chief inspector of general practice Steve Field said: ‘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.

‘I would like to remind people that our inspection programme is not just looking at inadequate care, we are also looking for examples of good and outstanding care to share and celebrate across the system.’

GMC chief executive Niall Dickson said: 'Whenever [the] CQC’s new inspection system raises concerns about the competency of individual GPs, the matter will be referred to the GP's local responsible officer and if necessary to the GMC.’

NHS England is also working with the Royal College of GPs on piloting an intensive peer support scheme for practices placed in special measures.

 Find out more about the Your GP cares campaign

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