The Care and Quality Commission (CQC) says The Village Surgery in South Normanton has not improved sufficiently since it was placed in special measures in January.
The GP surgery has admitted ‘challenges remain’ but says patient safety is of ‘paramount importance to us’.
A spokesperson said: “The partners and staff at The Village Surgery welcome the feedback from the Care Quality Commission about how we can continue to improve the way we deliver care to our patients.
“The team have put in a significant amount of work over the past months to introduce more robust and effective processes, but we also recognise that challenges remain.
“We can assure patients that their safety is of paramount importance to us and that we will continue to build upon the improvements introduced since the previous inspection.
“More work is underway and we are clear on how we are aiming to meet the highest possible standards of care."
CQC inspectors visited the service on April 4 and ranked the care and leadership as inadequate.
The watchdog's report said the effectiveness of the practice requires improvement but the care and responsiveness was good.
It warned the surgery could be forced to close, or have its licence altered, if it does not improve over the next six months.
The report said: "Insufficient improvements have been made such that there remains a rating of inadequate for The Village Surgery.
"Therefore we are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service.
"This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve."
A spokesperson for NHS Derby and Derbyshire Clinical Commissioning Group said: "The new report provides a clear direction for the practice to continue to improve care for its patients, and CCG staff have been working closely with the practice team to achieve this.
"Improvements have already been made in a number of areas, but we also recognise that challenges remain.
“We will continue to work with the team at The Village Surgery, building upon the improvements introduced since the previous inspection."