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The Royal College of General Practitioners (RCGP) is working in partnership with the Department of Health and NHS England in a pilot programme to support practices which have been placed in special measures following a Care Quality Commission (CQC) inspection.1Although it is too early to evaluate the pilot, our early experience of working with practices in special measures has uncovered some unintended consequences of being placed in special measures, which could impact negatively on the quality of care received by patients.Blake, Sparrow, and Field outlined the new methodology for CQC inspections focusing on quality and highlighted the five key questions introduced in April 2104.2 Since 1 October 2014, CQC reports have rated practices on a 4-point scale: ‘outstanding’, ‘good’, ‘requires improvement’, and ‘inadequate’. This January the CQC announced that all practices rated as inadequate would enter special measures, acknowledging that previously there had been a lack of clarity over which inadequate practices would enter special measures.3By the end of May 2015, of the 1164 general practices inspected, 33 (2.8%) have been rated inadequate and placed in special measures. To set this in context, 29 (2.4%) have been rated outstanding, 656 (56%) rated as good, and 106 (9.1%) rated as requires improvement, the remainder not being rated for a variety of reasons. Currently there are 9325 providers of general medical services registered with the CQC. The experiences detailed below are derived from a mix of practices in disparate parts of England, all sharing the common characteristic of being rated as inadequate following a CQC inspection.### Difficulty with recruitment and consequent staffing costsCommon themes within practices in difficulty include inadequate clinical staffing and lack of effective leadership or practice management. Attempts to rectify these issues may be hampered by placing the practice in special measures. We have experienced staff recruited prior to …

CQC inspections: unintended consequences of being placed in special measures