CQC – Further Scrutiny for Your Practice

Are you sitting comfortably?

A GP practice will have a contract for the provision of medical services with NHS England. The Contract sets out contractual obligations for ensuring that the premises are suitable for the delivery of services and sufficient to meet the reasonable needs of patients and requires GPs to have appropriate policies and procedures in place for compliance with legislation and guidance including for example clinical governance, prescribing and infection control. Breaches of the Contract may result in NHS England issuing remedial notices or breach notices which if not complied with may result in termination of the Contract and the closure of the Practice.

A medical practitioner will also be subject to professional obligations to the GMC. Failure to comply with the professional obligations may result in the GMC taking action on a GPs registration, which in the most serious cases may include suspension or complete erasure from the medical register.

CQC Obligations and inspections

A further level of scrutiny and potential source of action is the CQC,  an independent regulator of health and social services in England with a responsibility to monitor, inspect and regulate GP services to ensure practices meet fundamental standards of quality and safety.

Since April 2013 GP providers have been required to register with the CQC in accordance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in order to continue to provide medical services to patients. Failure to register with the CQC is a criminal offence and may result in prosecution and a hefty fine. One unregistered provider prosecuted by the CQC was fined £40,000 and costs of £22,548.

As part of its regulatory functions the CQC undertake inspections of GP practices undertaking regulated activities. These can be routine scheduled or themed inspections on 48 hours notice or responsive inspections which are unannounced inspections where the CQC has received a reported concern about the practice.

Five Key themes when inspecting practices are: are they safe, effective, caring, well led and responsive to peoples needs.

At present, during a routine inspection the CQC will consider whether the practice meets the standards set by the CQC using its Judgement Framework. If a practice does not meet the standards the CQC will consider the impact on the service to patients and whether this has a minor, moderate or major impact.

What happens when a GP practice fails an inspection?

The CQC have published their Enforcement Policy which details the decision making process it will follow when determining what sanctions to impose if a provider fails to meet the requirements.

Minor failings or moderate failings on the first occasion usually result in a Compliance Action, where the provider must provide a report within 7-28 days. This should document who will take the necessary compliance action and when and how it intends to monitor progress and notify the CQC when it has been completed.

More serious failures such as a major impact failure or a failure to comply with a compliance report will result in Enforcement Action. This may include imposing a formal Warning to the provider and a requirement to produce an Action Plan to address the failings within a period specified by the CQC. The CQC will re-inspect the practice to ensure that the failure has been adequately addressed. Failure to comply within the time period will result in the CQC escalating its enforcement powers which may lead to suspension or cancellation of registration and in serious cases may result in prosecution. The CQC has considerable powers of enforcement and inspections should not be taken lightly.

There is a right of appeal and challenge against some CQC decisions and an opportunity to make representations in respect of decisions such as a proposed issue of a Warning Notice. However these challenges may be costly and time consuming. A GPs efforts and money would be better spent ensuring that they are proactive and have put in place robust and effective practices and systems which meet the CQC standards and can be demonstrated to the inspectors’ satisfaction at the time of inspection.

Failure to meet with the standards may also amount to a breach of the Contract with NHS England and could lead to termination of the Contract. Depending on the circumstances of the failure if it involves breaches of the GMC Guidance in Good Medical Practice, it may also result in referral of the medical practitioner to the GMC for investigation under its Fitness to Practise procedures

CQC Developments for GP Practices

The CQC has recently published details of its new approach to inspection and regulation of GP practices and has appointed a Chief Inspector of GP Practices.

  • The inspections will be expert led with clinical input from GPs. The Inspection Team will include an Inspector, a GP, a nurse and/or a practice manager and a GP registrar and an expert user of GP services.
  • From April 2014 each CCG area will be visited every 6 months and the CQC intends to have completed inspections of all GP practices by April 2016 and will review inspection frequencies thereafter.
  • The CQC is expected to publish further Guidance in coming weeks on how it will inspect GP practices going forwards.
  • In the summer of 2014 the CQC will publish further guidance and issue new standards for inspection and regulation of GP practices focusing on the five key themes.
  • From October 2014 new regulations will be introduced, the CQC will publish its ratings for GP practices inspected and rate them as; Outstanding, Good, Requires Improvement or Inadequate to help drive improvement and support peoples choice of surgery.

The CQC will continue to develop its relationship with CCGs and NHS England to ensure that robust action is taken against failing practices without duplicating activity. Clearly practices are going to be put under more detailed scrutiny going forwards and the message is to rout out unacceptable care.

Summaries of Inspection Reports are published on the CQC website. GPs and practice managers should keep a look out for CQC developments which will impact on the practice and may benefit from reviewing the CQC publications on its website.

Hempsons has a team of Primary Care, Real Estate, Corporate and Commercial lawyers who can assist your practice to ensure compliance with CQC standards, minimise risk of failure, and offer support and advice on how practices can achieve the best rating possible and reduce the risks of an adverse inspection.