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Independents' Day

CQC says mergers partly to blame for GP practice ratings deteriorating

Exclusive GP practices merging is leading to lower CQC ratings, the regulator’s most senior inspector of primary care services has said.

In an interview with Pulse, Dr Rosie Benneyworth, CQC chief inspector of primary medical services, said the CQC was working with larger practices taking over struggling practices to understand the reasons behind the issues.

She said the process of combining two surgeries ‘can have an impact on the quality of care’ and that it was important to realise the difficulties in merging the working cultures of two different practices.

It comes at a time when NHS England are encouraging practices to form larger groupings

Earlier this year the CQC reported 17% of practices rated ‘good’ last year had deteriorated to either ‘requires improvement’ or ‘inadequate’ in 2018/19.

Dr Benneyworth told Pulse the reason for the deterioration was down to several factors, such as practices merging, the increase in demand for practices or a change in leadership at a surgery.

She said: ‘We’re seeing “inadequate” and “requires improvement” practices improving but we are seeing some deterioration in the “good” and “outstanding” practices.

Dr Benneyworth said this was due to several factors including an increase in demand on practices - from patients and other parts of the health system

She said: ‘I think very often some of the changes we see in practices are due to change in leadership, so sometimes we find that the deterioration in the practice can be due to a change in practice manager, a change in GPs and the effect that that can have.

She added: 'Sometimes we also see that there’s an interesting issue with some of the primary care at-scale providers. It’s really important that the practices who are merging or taking over other practices really understand the impact of that and the importance of continuing to focus on quality while going through that change so it doesn’t have any difficulties.

'Of course, we are seeing some of the primary care at-scale providers take over the practices that are struggling, and we are working with some of the larger primary care at-scale providers to really understand that in more detail.

‘I think some people think, “Oh, just bring two practices together and it will all work,” and actually it’s [about understanding] that process [of] bringing two different cultures together - we can’t underestimate how difficult that sometimes can be, and the... impact on the quality of care that practice is able to deliver.’

Somerset GP Dr Benneyworth joined the CQC in March, following the departure of Professor Steve Field, who was the first chief inspector of general practice when he entered the post in October 2013.

In the CQC’s 2018/19 report it was revealed the regulator had increased the overall number of enforcement actions it took last year in an effort to ‘protect’ the public.

Its annual State of Care report, published this month, the CQC acknowledged that workforce and demand pressures had contributed to GP practices receiving lower ratings in the past year.

Readers' comments (16)

  • So much for big is good. The PCNs are another silly step.

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  • Vinci Ho

    ‘The bigger the better’( same as merging CCGs?)
    Working by scale
    Sacrificing continuity of care ( COC)
    Ultimately, survival is ‘victory’ .
    Caveat with a lower CQC rating ( well , is that really important as overcompensating always comes with a price?)
    Question is : why ?
    Austerity is really finished ? What about its aftermaths , hence , post apocalypse?
    Again , what was the intention of NHS England at the time ? Remember what Dr Madan’s infamous saying about small practices?
    Incompetence or malevolence?
    The next government after this historic Christmas general election has a big decision to make on these issues ......

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  • mid sized practices have evolved to be the most efficient and friendly. Why are we being forced into larger PCN groups which act as a time consuming distraction when all the effort and funding needs to go directly into the practices themselves?
    The lack of new full timers is also a major adverse influence. you cannot run a practice easily with part timers. When will this truth be acknowledged ?

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  • 'weighing the pig doesnt make if fatter'...... CQC can record the decline but can't really stop it..... so what is the point?

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  • When it is way too late Johnathan.

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  • when the regulators don't understand the "Issues" then what hope do we have and what's the point of CQC?

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  • Hold on a minute. We are assuming the CQC ratings are valid. In reality they are an incoherent amateur mess of a quango who ratings bear no correlation with quality. It is a bit random.

    They are best ignored as much as possible

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  • ‘I think some people think, “Oh, just bring two practices together and it will all work,”...

    Really? Do you really think merging practices think that? How stupid do you think your colleagues are?

    Merging happens because government lead pressures make it impossible to survive without doing so. So is the CQC going to be brave enough to say "government to blame"?

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  • 100% agree with above comments.

    Hardly surprising comments from them but their mentality appears to be we’re more shit than last time so we must inspect more to root out the the really shit.

    Forgets the point that they and the other reasons they have contributed towards the crap work space.

    Assume annual fees will be increasing again to justify themselves!

    GP Spa’s must be well paid with regular annual increases.

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  • How about shit government policies and regulations being the main reason?

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  • Steve Field was on a salary of £1,153593.00 ( in Sept 2018. I suppose that one can sell one’s soul for that kind of salary? Rosie will presumably be receiving a similar paltry stipend to sell her colleagues out? (do these people have souls?)

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  • From someone who is currently a part of a super partnership, this amounts to one of the worst career moves I have ever made in my life!! Bigger is definitely NOT better. I have seen a deterioration in the quality of the service we are able to offer since merger and the double whammy is you haven’t got the autonomy to improve things for yourself and resources are not necessarily distributed in an equitable fashion. My advice to my younger self would have been... ‘Don’t act in fear!!’ Don’t do it!

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  • to Decorum est- wow- I thought I would apply for Prof Fields old post for that salary, but (un)fortunately you are looking at the wrong column - that figure refers to the staff cost for his department, he was on between 175 and 180k, not worth losing sleep over

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  • If large practices were so marvellous why do you think they didn't evolve in the past? Large merged practices are a scar reaction to underfunding and are doomed to individual loss of autonomy and eventual slave culture.
    Hold out against them. The optimum size is probably somewhere between 8000-14,000 patients.

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  • @ Cedric | Locum GP30 Oct 2019 2:33pm

    Dear Cedric, I stand corrected. Thank You.
    (p.s. I still wonder if they have souls?)

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  • It is obvious to any GP with half a brain cell. Economies of scale do NOT work within GP practices. Autonomy lost, continuity of care lost, incentives to go the extra mile lost, close knit team with support from colleagues lost. The only gain is a duty system which would put any sane person in a mental institute after battling with it for a few years. We need to resist the autocrats in Whitehall from reshaping primary care into a monster which will destroy us all. More research needed on patient and staff satisfaction in super practices. Where I work the feedback is dire from nearby practices who have gone down this route. And can they ever go back? Almost impossible to imagine how.

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