Smaller GP practices have fared worse under the Care Quality Commission’s inspections so far because of the “splendid isolation” in which some are operating, the chief inspector of general practice has said.

Professor Steve Field said inspectors had found “some extraordinarily brilliant small practices”, which shared data and services with others but that others struggled “because they’re isolated not because they’re small.”

Steve Field

Steve Field said the CQC would prioritise smaller practices for inspection because of the patterns it had found

“We have a statistically significant correlation between the size of practice and the likelihood they will fail [in inspections].”

Professor Field was speaking on Wednesday at an event organised by the Cambridge Health Network.

He added that some small practices were poorly led with a small number employing no nurses or management support and some “work in splendid isolation”.

Professor Field said the CQC would continue to prioritise smaller practices for inspection because of the patterns it had found.

The regulator is due to publish its first GP practice ratings in the coming days, following the full introduction of its new inspection system on 1 October, since when it has inspected more than 300 practices.

Professor Field said it had discovered some “wonderful” practices including one example which, cared for many “very vulnerable” patients, and had established a charity to help those which were homeless, and took one terminally ill patient on a trip to the seaside.

He said inspections found many practices were “jolly good” and that it was due to publish two “outstanding” ratings.

However, the CQC had also found a number that were “inadequate” and two that would potentially be put into “special measures”, which “takes longer” to put in place, he said.

NHS England commissioning strategy director Ian Dodge, also speaking at the event, said problems for primary care included a “reduction in relative investment compared to other services” over a decade, inequality in provision, lack of workforce and poor premises.

He said his organisation was working to address these issues and to develop new service models involving primary care.

NHS England wanted to “facilitate faster change by being able to… act as a kind of Dyno-Rod, unblocking barriers and constructing solutions for people” but “not imposing change across the system”.

He gave the example that it would “not [be] saying we’re going to scrap for example GMS [GP contracts], but creating easy alternatives”.

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