The Care Quality Commission will begin considering whether it should move to ‘more light touch’ regulation later this year, the chief inspector of general practice has told HSJ.

The work will be informed by its pilots of “place based” inspections, announced today.

Steve Field, speaking exclusively to HSJ, stressed there would “always be a role for looking at the institution that delivers the care”, but also mooted the possibilities of institutional inspections being less regular and/or more targeted on providers with known problems.

Professor Field said: “The question will be… what is the interval between rating [provider organisations]?

“If we’re looking at, say hospitals and GPs, if 80 per cent of [GP practices] are ‘good’ on our current ratings, are resources better spent looking at those which aren’t as good, and encouraging improvement, and having a more light touch [approach]?”

Professor Field, whose role at the CQC includes responsibility for integrated services as well as primary care, said there were “lots of questions about how we move [the inspection model] forward”. He said the CQC had not yet had in-depth discussions about these issues. It will be informed by analysis of results of inspections carried out so far as well as the place based assessments, and other considerations.

Steve Field

Steve Field was surprised about the opposition to inspections from GPs and professional leaders

He indicated there would be no major change to GP inspections before all practices have been rated once, however. The CQC’s current target date to achieve this is September next year.

The former Royal College of GPs chair indicated a move to assessment of whole areas was necessary to identify the causes of poor GP practice ratings in some areas.

He said: “I would be really happy if all those [practices] that have gone into special measures get out of special measures because they’ve improved. The fact is they won’t. We need to learn the lesson on why some won’t and some will.”

There were “some areas where the majority of practices are really, really poor,” he continued. “Why? Is that a commissioning issue? Is it the fact that the hospital is dumping lots of work into primary care?

“In some areas GPs refer everything to secondary care. In some areas they don’t take their own blood and everything is hospital based. Until we start to look at the place, we won’t know.”

HSJ asked Professor Field if he had been surprised about the strength of opposition to inspections from GPs and professional leaders. In June the Royal College of GPs and British Medical Association called for GP inspections to be suspended.

Professor Field said he was “not at all surprised” because it was a “sector that has never been regulated”. In “the majority of the country… people haven’t looked at the processes [in general practice] before”, he said.

He was also not surprised about the position of the RCGP, he said, because he knew how it functioned, but was “disappointed in that because the college should be really involved in promoting equality and zero tolerance for poor quality”.


CQC to assess whole health systems