The new Chief Inspector of General Practice sets out his new approach for the inspection and regulation of GPs and GP out-of-hours services

The new Chief Inspector of General Practice sets out his new approach for the inspection and regulation of GPs and GP out-of-hours services

12 December 2013

Expert inspection teams that include GPs are at the heart of a new approach to inspecting general practice, set out today (12 December) by the Care Quality Commission's Chief Inspector of General Practice, Professor Steve Field.

The new style inspections will start in April 2014 and individual GP practices will be subject to the new system of inspections. Rather than look at practices in isolation, inspection teams will include a CQC inspector, a GP, a practice nurse or practice manager and a trainee GP. They may also include a member of the public with particular experience of using GP practices.

Professor Field intends to inspect practices from across a clinical commissioning group area. Inspectors will visit every CCG area once every six months, inspecting a quarter of the practices in that area. Every practice will have been inspected by April 2016 all inspections will ask five key questions of services: are they safe, effective, caring, responsive to people's needs and well led. They will focus on the care of the most vulnerable, including homeless people, people with learning disabilities and vulnerable older people.

From January, the new inspections will focus on GP out-of-hours services because the regulator feels that they are likely to put patents at a higher risk of receiving poor care than from other general practice services.

The Chief Inspector of General Practice will also explore how well people's care is organised when more than one type of service is involved. He will develop methods to look at the quality of particular services across an area. For example, seeing how all providers of maternity services work together, including GPs and midwives working in the community and consultants working in hospitals.

Patients and local communities will be involved in the inspections. CQC will gather views from individuals, families and carers and local groups before it carries out an inspection. The Commission is also improving the way in which it collects and uses information about services to help it identify practices where people may be more at risk.

Professor Steve Field, Chief Inspector for General Practice said: "We need to make sure that everyone, from the most well-off to the most disadvantaged, can get access to really good primary medical care; this is something which I intend to champion as Chief Inspector.

"When something goes wrong in general practice, it has the potential to affect thousands of local people. For example, poor storage of vaccines can lead to health problems years into the future and have a huge impact on the population as a whole.

"GPs don't work in isolation, so we will also be considering the quality of communication between out-of-hours care and other local services, including GP practices, care homes and emergency services.

"Before our new style inspection start in April we will be inspecting all out-of-hours GP services England. I will be looking back at the review I did for the government as we continue to have concerns about the quality of care that people receive from these services.

"I will also be carrying out reviews and inspections to look at key issues about health and social care services work together, as we know that when care is well integrated across services, people get better outcomes."

Jeremy Hunt, Secretary of State for Health said: "Patients have a right to expect the best care from their GP practice. That's why we have introduced this new, tougher system of inspection which will root out poor standards and celebrate the best.

"The new Chief Inspector will champion the views of patients, giving them more information so they can make better informed choices about services."

Since April 2013 CQC has completed 1,000* practice inspections. These have shown that many people receive good quality care from their GP; however they also highlighted areas of concern and some examples of very poor care, with 34 percent failing at least one of the required standards, and in nine practices there were very serious failings that could potentially affect thousands of people.

The findings from these inspections are helping the Chief Inspector to develop his plans for changing the way CQC inspects general practices, particularly focusing inspections on the things that matter to patients.

CQC's inspections to date have identified concerns about how some practices manage medicines; for example, finding emergency drugs being out of date or stored on the floor, and a lack of temperature checks of vaccine fridges. CQC says this is extremely serious; for example, if children are not immunised effectively because a vaccine has been stored incorrectly the result could be an outbreak of a contagious childhood disease, such as measles across a large population.

Some practices were visibly dirty, had dirty cleaning equipment with no cleaning schedules, and staff had no knowledge of infection control guidance.

Practices were not always doing the necessary employment checks on staff who may have access to sensitive patient information and be in contact with vulnerable people. Inspectors found some practices were not putting staff through the correct clearances or making sure staff had appropriate training and access to qualifications.

Although the general levels of care was viewed by patients to be good, issues around access to surgeries were routinely highlighted, with some patients at one practice saying that it could take weeks to get an appointment.

As with other services inspected by CQC, GP services will be given ratings. CQC will begin to give ratings from October 2014 and all practices will be rated by April 2016.

Next year, there will be further announcements around changes to the way dentist services, medical services in prisons, children's safeguarding and integrated care provision across health and social care will be monitored by CQC.


For media enquiries about the Care Quality Commission, call the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143. For general enquiries, call 03000 61 61 61.

* CQC has conducted 1,000 inspections, including 90 follow up inspections, where inspectors returned to check that improvements had been made.

Notes to Editors

Current proposed timeline for changes for the GP and out-of-hours care

The majority of these changes will be introduced from April 2014 and some of the changes will be introduced in phases. The following provides some detail of our timelines for introducing the changes to our approach.

GP practices

December 2013 – March 2014

  • Wide engagement with internal and external stakeholders on the five priorities

  • Department of Health consultation on the registration requirements

  • Regular meetings with external advisory groups and other working groups

Spring 2014

  • Begin testing our new approach in GP inspections from April 2014

  • Formal consultation on the standards, guidance and ratings system

Summer 2014

  • Evaluation of the new approach

  • Guidance and standards refined post consultation and published

  • Test our new approach incorporating lessons learnt from inspections earlier in the year

October 2014

  • New regulations in place and new model rolled out to all providers

  • Initial ratings confirmed and published

April 2016

  • Every GP surgery in England will have been inspected and rated.

  • GP out-of-hours services

December 2013 - March2014

  • Wide engagement with internal and external stakeholders on the five priorities

  • Begin testing new approach in GP out-of-hours inspections

  • Key national findings from first inspections published

Spring 2014

  • Formal consultation on our standards, guidance and ratings system

  • Begin inspecting GP out-of-hours services at the same time as we inspect GP practices within a CCG area

June 2014

  • Ratings of out-of-hours services begin

October 2014

  • New regulations in place and new model rolled out to all providers

  • We will publish further information and documents soon about our developing approach in dentistry and integration.

CQC top 10 changes

  1. Better, more systematic use of people's views and experiences, including suggestions and complaints.

  2. New expert inspection teams including trained inspectors, clinical input led by GPs and nurses, practice managers and GP Registrars.

  3. A rolling programme of inspections carried out systematically in each CCG area across England.

  4. Inspections of GP out-of-hours services to be incorporated into CCG area programmes.

  5. A focus on how general practice is provided to key patient groups, including vulnerable older people and mothers, babies and children.

  6. Tougher action in response to unacceptable care, including where necessary closing down unsafe practices.

  7. Ratings of all practices to help drive improvement and support people's choice of surgery.

  8. Better use of data and analysis to help us to identify risk and target our efforts.

  9. Clear standards and guidance to underpin the five key questions we ask of services: are they safe, effective, caring, responsive and well-led?

  10. Close collaborative working CCGs and Local Area Teams of NHS England to avoid duplication of activity.

There are over 8,000 GP practices 46 out of hours providers, registered with CQC in England.

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.