GP practices that persistently provide inadequate services will face closure if they fail to improve within a year, the Care Quality Commission has announced.

The CQC today unveiled its special measures regime for general practice, which will be introduced in October, at the same time as its new style inspection process and ratings of individual practices will begin.

The chief inspector of general practice Steve Field told HSJ that while the “vast majority” of practices “are providing care which patients would want to see” a “very tiny percentage are letting the rest of them down”.

“Many of those people have known about for years, but unfortunately the concerns haven’t been addressed consistently across England,” he said.

Under the new regime, if a practice that is deemed to be ‘inadequate’ does not improve within six months, it will be placed into special measures.

If the practice was still found to be inadequate after a further six months, the CQC may cancel its registration and/or NHS England terminate its contract.

However, the CQC may place a practice in special measures immediately if it is “really worrying”, Professor Field said. Out of the practices that have been inspected since April, when the CQC began piloting its new-style inspections, the number of practices that would fall into the category is in “single figures”, he revealed to HSJ.  

He said “what you tend to find” at the worst performing practices “is a practice that’s failing generally on a number of areas, without good leadership”.

GP representative bodies have expressed concerns that practices may fall foul to regulators due to workload pressures or inadequate premises rather than their own failings.

Royal College of GPs chair Maureen Baker warned that “a small number of practices… are struggling to meet quality standards, often due to factors beyond their control”.

“If this is the case, the solution is not to ‘label’ them but to look at what support they need to bring them up to scratch.”

Professor Field stressed the CQC’s responsibility was for “diagnosis”. “We are not the improvement body. Our job is to encourage improvement.”

“In some cases it might be that the premises are owned by somebody else and the doctors are having to work in inadequate circumstances. We will not be scared to say that. If the practice tells us that it’s difficult to recruit, we will report that.”

Professor Field said the “ultimate responsibility” for improvement would be with the practice, as an independent contractor. However, NHS England and the Royal College of GPs will pilot a programme to support practices placed on special measures. The CQC intends to inspect every practice at least once by April 2016.