GPs told: get better or face closure

GPs told: get better or face closure NHS's first chief inspector of primary care says sanctions will be used to drive improvements in general practice.

GP surgeries that offer inadequate care and do not open for long enough, or pose a safety risk to patients, are at risk of being closed down under a beefed-up inspection regime planned by the profession's new policeman, who also wants local doctors to offer seven-day services.

In his first interview since being appointed as the NHS's first chief inspector of primary care, Professor Steve Field told the Guardian that he would not shy away from using sanctions, including fines and suspensions of surgeries' licences, to drive through major improvements to poorly performing GP practices.

"I will not hesitate at all to order the closure of GP practices that we find to be unsafe, or providing poor access, or which do not care for patients properly or treat them with dignity," said Field, who starts work on Tuesday.

The former chair of the Royal College of GPs (RCGP) is the first occupant of a key role that the Care Quality Commission, the NHS watchdog, has created as it aims to get tough on NHS care providers in the wake of the Mid Staffs hospital scandal.

"While we've got some of the best general practice in the world, it's let down by a small percentage of practices which aren't providing appropriate access or quality of care," said Field, who estimates that 10% of the 7,607 GP surgeries in England which he will start overseeing from next week need to make major improvements. Too many surgeries are not responsive enough to patients' needs, especially over when GPs are available and the difficulty of getting same-day appointments, added Field, who is himself a GP in Birmingham.

A surgery in South Woodham Ferrers in Essex was recently closed down after CQC inspectors decided the premises put patients at risk and were denying patients their privacy, dignity and confidentiality because the consulting rooms had no doors and conversations with the GPs were easily audible to others.

Another surgery in Sale, Cheshire, is also facing penalties, including having its registration cancelled, unless it makes major improvements by next Tuesday to a host of problems CQC inspectors found. They included patients with emergency medical problems being given out-of-date medicines, confidential patients' medical records being left unattended and vaccines in the fridge that were six months out of date. The single-doctor practice, run by Dr Michael Florin, is the first to be named and shamed by the CQC after it failed to implement improvements in 13 areas of both quality and safety the regulator ordered to be done by April.

The incoming regulator, who will introduce Ofsted-style ratings for GP practices, also wants the public to be able to see a GP seven days a week. "Access should be brilliant, but currently it's patchy. A lot of patients are dissatisfied with current access and think it's inadequate. It seems to be a huge source of frustration," said Field. Working people in particular faced difficulties getting an appointment with their GP easily, he said. "I think we should move to seven-day services in general practice, where patients should be able to access a GP for advice at the weekend."

That would not need to be their own family doctor but could instead be any GP from a newly formed federation of nearby surgeries, which would take it in turn to see patients on Saturdays and Sundays, in order to make the extra workload bearable for GPs. Compliance with his demand for a dramatic expansion of access to GPs would now be a key issue that CQC inspection teams assessed surgeries on, he pledged.

A small but growing number of GP practices are now starting to move to offer seven-day access, as well as appointments earlier in the day and into the evenings, as a result of pressure and cash incentives from NHS clinical commissioning groups and NHS England. This should ultimately become the norm, Field said.

Dr Clare Gerada, chair of the RCGP, signalled a hostile reception from the profession to Field's plans, which she criticised as unrealistic. "I would love there to be seven-day a week access to GPs. But that's not possible when we need 10,000 more GPs to cope with our growing workload, and when GPs are getting their smallest share of the NHS budget for a decade," she said. "We need those in power and authority to understand that and not constantly berate GPs and get the stick out."

Field's first act as chief inspector will be a crackdown on England's 48 providers of out-of-hours NHS care, following scandals that have seen several patients die and serious concerns raised about the quality of care provided by private firms such as Serco and Harmoni. "Out-of-hours care has been a concern of mine for years," he said.

Risks to patients included out-of-hours GPs' lack of access to their medical records, the poor quality of some doing overnight and weekend shifts, doctors' unfamiliarity with patients, and medication errors. "The link between the patient and their GP and GP practice is much weaker than in office hours. That's one of the reasons why there's a greater risk of poorer outcomes in out-of-hours and a key reason why my new inspections will start with these services," said Field. The Guardian