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GPs buried under trusts' workload dump

Almost one in five 'good' practices dropped rating this year, CQC reports

Almost a fifth of practices in England rated ‘good’ by the CQC have deteriorated to a lower rating, according to the regulator's annual report.

Published this week, the 2018/19 report found that three quarters (74%) of practices rated as ‘requires improvement’ improved their rating to ‘good’ upon re-inspection, up two percentage points from 2017/18.

However, 17% of practices previously rated ‘good’ had deteriorated to either ‘requires improvement’ or ‘inadequate’ in the last year.

This is an increase from last year’s annual report, in which 11% of those previously rated as ‘good’ deteriorated to a lower rating.

The annual report also showed: 

  • As of 31 March 2019, 95% of GP practices were rated 'good' or 'outstanding'
  • 90% (6,196) of all primary medical services in England were rated ‘good’, compared with 4% (264) of practices requiring improvement and 1% (86) providers being rated as inadequate
  • The number of ‘notices of proposal’, which are most often proposals to cancel registration of services where ‘the quality of care is not good enough' increased by over one quarter (27%) since last year

The regulator also acknowledged it needed to improve the public view of the CQC’s effectiveness to monitor public health services.

It follows calls from the BMA to review the CQC processes which 'cause stress' and GP burnout

BMA GP Committee deputy chair Dr Mark Sanford-Wood, said: 'Given the significant pressures many practices are facing, the fact that 95% of practices continue to be rated good or outstanding is indicative of the hard work and excellent care that is being delivered by GPs across the country.

'Notably, general practice remains the highest performing sector regulated by the CQC.

'While there is still work to be done to address the reasons some practice ratings have fallen on reinspection, the delivery of new funding as part of the GP contract and emerging primary care networks are important steps that will help practices maintain high standards of care and achieve improvements where necessary.'

CQC chief inspector of primary medical services and integrated care Rosie Benneyworth said: 'It is a testament to the hard work of GPs and practice teams in England that 95% of practices remain rated good or outstanding, despite the pressures around workforce and capacity that we know they face.

'When CQC finished the first inspection programme of general practice in England, we said that the system now faced the challenge of maintaining its focus on quality and supporting general practice to continue giving patients this same high standard of care. CQC also committed to continue to work with the profession to minimise the impact that regulation may have on providers’ workload.

'While we have seen improvements on reinspection and the overall number of practices rated good or outstanding has been consistent, there does appear to be some fluctuation in quality with practices moving down as well as up in ratings. It is important that the commitments made in the NHS long-term plan continue to be targeted and delivered appropriately to support general practice in delivering the high-quality care that people deserve.'

CQC chief executive Ian Trenholm said: 'At CQC we are ultimately accountable to people who use services. We want to make sure that we do all we can to protect people from poor care and encourage improvement, while offering value for money to providers, and being an efficient and effective regulator. In the past year we have made significant strides towards this, and we have a roadmap of activity to allow us to continue to improve.'

An independent review of gross negligent manslaughter and culpable homicide recently recommended the CQC should amend its processes to further scrutinise departments where doctors are being investigated to see if there are wider systematic failures.

Last year, a GP practice rated inadequate in Nottingham avoided CQC deregistration after appealing to a tribunal.

Readers' comments (10)

  • The government and their regulators are acting like some sadistic nurse from a 19th century mental asylum. The fact that GP premises are crumbling, the staff on their knees, with rock bottom morale from years of underfunding and lack of recruitment means nothing to them. They are only interested in cracking the whip and "ordering" providers to improve, to use their terminology. This is the very definition of tyranny and insanity.

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  • Don't worry PCNs will help. "Blue Sky thinking" "Outside the box thinking" and all those management BS.

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  • First inspection 60 person hours of inspection= Outstanding
    Second inspection 16 person hours of inspection = Good
    Mmmmmmm
    (Inspection only triggered because of taking on another Practice)

    They had the grace to come and see us when we protested but no way would they concede a thing including their failure to triangulate information they gleaned that at first sight might raise questions. They took it all at face value. I thought we were expected to weigh evidence and consider possibilities before acting. One law for Doctors and another for everything else?

    This is neither democratic nor just

    We have a solid track record of continuous improvement and if a practice is outstanding then they will have fewer adverse complaints. We cant magic them up from nowhere!

    I hope you notice that I am being very measured

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  • https://en.wikipedia.org/wiki/Regression_toward_the_mean

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  • Wish Boris would get rid of CQC etc. We all agree regulation and standards are needed but to the level now is affecting patient care in a negative way rather than positive

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  • Dear CQC, you may not have noticed but actually we all are drowning under the workload of trying to provide infinite care to a demanding and often ungrateful population. Sorry if we are putting patients before colour coded ring binders. Complete waste of time and for what? a gold star on your colouring book?

    Young ones, remember there is much truth behind all the cynicism you read on these pages. Emigrate and have a nice happy life or do anything but GP.

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  • can we refuse to be seen by non medics?

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  • Get over it. It really doesn’t matter what CQC say about you, no one is interested.

    CQC now totally discredited by their relationship with Carl Beech

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  • To the earlier reader who has stated:”We all agree regulation and standards are needed” can I say this:
    We do not all agree that the government has any business meddling in our affairs, least of all in “regulating” us. This is a folly and one for which you and all other doctors have paid a very heavy price. Just see what’s happening in the place where you work and in the comments here..this is what happens when you become bedfellows with the government. Your Liberty is taken from you and you start venting your anger on forums like this. Government should have zero business in “regulating” doctors. Doctors do not become doctors unless they are judged and scrutinised closely by their peers in competitive examinations. If a doctor is not up to scratch and makes mistakes in a free society not only would he or she fail to secure a livelihood very quickly, they would be publically and professionally ridiculed. It is common sense to assume that it is therefore in a doctors self interest to perform to a high standard. The final arbiter in cases of misconduct is the LAW and NOT some government agency. i.e. if a patient doesn’t like their doctor they can SUE the doctor in a court of law and not scurry away, playing the victim card to some MP or government agency.

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  • It is all self justifying nonsense of course. There is no reproducible validity to a CQC inspection.
    It is nothing to do with patient care. It is a quango trying to justify their existence. However politically they were set up to control primary care and is part of the privatisation agenda. It is much easier for a large private company to pass CQC than a small GP practice.

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