Special measures: GP practices

Responding to services rated as inadequate

We want to ensure that services found to be providing inadequate care do not continue to do so. We have therefore introduced special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care, and, working with other organisations, ensure that services make improvements and are aware of the support available.
• Provide a clear timeframe within which providers must improve the quality of care. If they do not, we will take action to cancel their registration.

Services rated as inadequate overall will be placed straight into special measures.

Services that are rated as inadequate for a key question will be re-inspected within six months. If there is still a rating of inadequate for any key question after six months, the service will be placed into special measures.

Once a service is placed in special measures we will re-inspect within six months to check that it has made sufficient progress to improve. After this inspection, if we feel the service has made sufficient progress, we will remove it from special measures.

If sufficient progress has not been made when we re-inspect, and we give a rating of inadequate for any key question, or overall, we will take further action to prevent the service from operating, either by proposing to cancel its registration or vary the terms of its registration. There will then be a further inspection, normally within six months. If sufficient progress has still not been made, and there is a rating of inadequate for any key question, or overall, we are likely to proceed to cancel the registration or to vary the terms of registration. This will mean that the provider’s registration will be cancelled.

Special measures does not replace CQC’s existing enforcement powers: we are likely to take enforcement action at the same time as placing a provider into special measures. In some cases, we may need to take urgent action to protect people who use the service or to bring about improvement, in accordance with our enforcement policy.

Read our detailed guidance about our approach to special measures for these services.

Services rated as requires improvement

Where services are rated as requires improvement on more than one consecutive inspection, it shows that they cannot demonstrate the necessary leadership or governance processes to assure and improve quality. In these cases, we will consider whether this may represent a breach of Regulation 17 (good governance). We may also ask the provider for a written report to set out how it will assess, monitor and improve the quality and safety of its services. This improvement action plan needs to be agreed with the provider’s commissioners.

If we rate a service as requires improvement for a third time, we will hold a formal management review meeting (MRM) to consider the next steps and the potential use of our enforcement powers.

Where we register larger primary care providers, we will monitor quality across all their services. Where there are concerns across the group, we may consider taking action to hold the provider to account, for example by using our enforcement powers.