The new chief inspector of general practice will use his role to reform primary care and develop integrated services, and to call for additional funding where it is needed, he has told HSJ.
Steve Field, speaking on his first day in post at the Care Quality Commission, said he was taking on a far-reaching role which stretches beyond checking basic quality standards.
As well as inspecting GP surgeries he said he would consider the quality and development of services across clinical commissioning group areas, and drive integration.
He said he would be an advocate for patients and the profession and would use his position to drive reform of primary care.
Professor Field, who joins from NHS England, where he was deputy medical director, told HSJ he believed he would be able to lead change in primary care more effectively in his new role than his old.
Asked why, he said: “Because I think there’s a fundamental thing about standards with teeth for patients… Unless you know what standards you’re expecting it is very difficult then to move on [to change services].”
He said in future the CQC would inspect a sample of GP practices in each CCG’s area at the same time, and ahead of this would hold a CCG-wide listening event for patients and the public.
Professor Field said he would consider links and interactions between GP practices and other services in their area, and insisted this was not going outside the CQC’s remit.
He said: “I’m an independent regulator, the chief inspector of general practice. If I find in an area when we talk to the providers there has been an issue regarding competition [for example], I will make a statement on that if it impacts on patient care.
“This isn’t just about looking at the provider, the GP practice or the dentist or out of hours, this is about looking at the system.”
He said this could also mean the CQC “might have issues with NHS England”, which contracts primary care. He gave the example of practices which deliver care to homeless and gypsy populations, which cost more to run. “If [practices] haven’t got enough resource we’ll say so,” he said.
The CQC is in the process of developing specific standards for the regulation of general practice under its five domains of service requirements: That they are safe, effective, caring, responsive and well led.
Professor Field said his work would consider information including the number of a practice’s patients who are diagnosed with cancer in accident and emergency departments, access to primary care, and variations in clinical practice.
He added: “Increasingly, over a geographical area one would expect patients should be able to access a GP with their patient record. That might be [at] a very big practice, it might be [through] a federation of GPs. There are different ways of doing it, but that is what patients want.”
The CQC began inspecting general practice in April, targeting practices which reported they were not compliant when they registered with the regulator for the first time last year. Professor Field said that, of the 287 practices visited so far this year, about 10 per cent had “issues that needed addressing”.
Under a revised inspection model, which is due to be piloted in out of hours services early next year, inspections will be carried out by a team including a CQC inspector, a patient, a GP, a trainee GP, and another relevant professional, such as a nurse or a practice manager.
Over the two years from April 2014 the CQC will inspect and rate every general practice in England. The subsequent frequency of inspections will depend on their initial rating, with details yet to be decided.