Primary care faces a tougher monitoring regime following the government's response to consultation on the new super-regulator.
Primary medical care is not currently regulated by the Healthcare Commission, but the government wants it to register with the super-regulator it has named the Care Quality Commission.
Formerly known as Ofcare, the new commission will incorporate the Healthcare Commission, Commission for Social Care Inspection and the Mental Health Act Commission in an attempt to streamline health and social care regulation.
The government's response to the consultation document The Future Regulation of Health and Social Care suggests that its resolve to regulate primary care has strengthened since its draft response was leaked to HSJ in the summer. The draft said the government would 'consider' bringing primary care within the remit of Ofcare, 'but only after consulting more widely on the form that regulation should take'.
But the latest version, published last week, says: 'Services that might once have been provided in hospitals are now being provided in the community or through primary care services. Patients need to know that, whatever type of provider is delivering their care, the same general requirements will apply.'
Practices offering more complex interventions are likely to be a priority for monitoring, it says.
NHS Alliance chief officer Michael Sobanja welcomed the move but said the new regulator should build expertise as sometimes regulators 'haven't been that knowledgeable' about primary care.
King's Fund deputy policy director Anna Dixon suggested a system where only those services that had a large impact on well-being were regulated. She said: 'It needs to be focused on the areas it is in the best public interest to spend money on regulating.'
Other proposals in the government's response include powers to fine and close under-performing services, although the latter is only likely to be used in the last resort.
Healthcare Commission head of strategy Jamie Rentoul said: 'The option of deregistration does need to be part of the framework but the interests of patients should come first. It's a backstop power and is likely to be restricted. There will be warnings saying: "Unless things improve there's a risk of closure."'
There will also be an assessment of commissioning, although the performance of PCTs will continue to be managed by strategic health authorities.