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GPs go forth

Lower GP practice ratings due to workforce and demand issues, says CQC

Workforce challenges and rising patient demand have contributed to practices receiving lower CQC ratings, the watchdog has said.

In its latest report on the state of health and adult social care in England, the CQC revealed that a 'large group of GP practices' have deteriorated to a lower rating due to 'ongoing capacity pressures'. 

Pulse reported this summer that almost one in five practices rated 'good' had dropped rating to either 'requires improvement' or 'inadequate' this year, an increase from the previous year

CQC chief executive Ian Trenholm said an increasing number of good providers are now moving into 'requires improvement'.

Presenting the findings of the report, he revealed that practices are struggling to improve and sustain a good rating due to demand rising faster than the workforce. 

According to the report, 13% of GP practices went from 'good' to 'requires improvement' in the year to 31 July 2019, based on the previous and the most recent inspection. 

Meanwhile, more than a third of practices (35%) rated inadequate failed to improve after re-inspection. 

Mr Trenholm said: 'In primary medical services, GPs are doing a really good job, they’ve had a 95% good or outstanding [rating] for a number of years now. So the opportunity to improve and increase is hard.

'However, we are seeing movement in the sector, which could potentially cause some concerns.

'We’re seeing good providers moving to "requires improvement" and we’re seeing "requires improvement" providers increasing so although the net figures look ok now there’s more movement perhaps than there once was.'

He added: 'There’s a continuing challenge in accessing GP services but also GPs able to access other community services to refer people on when they need local help. And the reason is there’s insufficient integration across community and acute services. We know also that demand for GP services is increasing and that demand is increasing faster than the workforce available.'

The report said: 'Although overall ratings are similar to 2018, re-inspections show that some GP practices are moving down as well as up in ratings, and there are signs that improvement has become harder to achieve and to sustain. The change on re-inspection in 2019 shows that a large group of GP practices have failed to improve and move out of the lower ratings and more than a third of practices rated as inadequate have not improved on re-inspection.

'We have reported previously that some GP practices have not been able to improve or to sustain improvement because of issues with poor leadership and management, but ongoing capacity pressures on general practice as a whole may affect the ability to improve.'

The latest NHS Digital statistics show that the number of fully qualified full-time equivalent GPs in England has fallen by 576 over the past year, with 28,257 full-time equivalent GPs (excluding registrars) in June 2019 compared to 28,833 in June 2018.

Mr Trenholm also said that fewer newly qualified GPs are interested in joining a partnership, which is having an impact on the delivery of good patient care. 

He said: 'I’ve had conversations with GPs where they talked about the difficulty of interest in newly qualified GPs in partnership opportunities. People want a more flexible working environment in general practice and that’s mainly why the numbers of GP practices made remain stable.

'They have been increasingly challenged in keeping GPs, practice nurses and other practitioners in their practice able to deliver the services that they need and that’s a complicated factor in terms of delivering good frontline care.'

In January, the CQC announced new 'structured phone calls' with 10-15 practices, with the aim to cut the frequency of inspections for practices rated good or outstanding to as little as once every five years.

The BMA recently called for the CQC to review how they process compalints and inspections, which 'cause stress' and GP burnout

CORRECTION: The article previously said 65% of 'good' practices were rated 'inadequate' on second inspection. This was incorrect. The figure is 13%

Readers' comments (22)

  • Surely the CQC should be making conclusions within the context of the prevailing healthcare environment. What is the point in downgrading services for not having enough GPs when there aren't any?

    Any why is the CQC the most opaque and unaccountable organisation ever? Disagree with our rating, sir? No problem, we'll re-inspect you!

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  • The CQC should be disbanded. It is just a self serving quango.

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  • Abroad you get 30 to 40 min per patient with no QoF. Here, you get 10min and "best care" is expected. Ridiculous. CQC should be disbanded. There was no CQC in the past and care was better.
    An unhappy workforce will never deliver good care but in reality I doubt they want a good NHS. They want just a cheap one.

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  • And how much do the CQC consider they themselves have contributed to the loss of morale, the early retirements, the loss of autonomy and the general downgrading of the attractiveness of GP as a career.
    Because one thing is absolutely certain- there is no GP in the country, apart from those who have taken the CQC shilling, who welcome their random inquisitions.

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  • I wonder how much GP practices would improve if the anxiety and workload of a CQC inspection were lifted?

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  • The CQC causes rising health inequalities. It makes its profits by harming poor people. Primary care budgets are fixed on a capitation basis so if you spend more money on governance you spend less on front line care. We know that the practices that have run into problems are those in poorer and more remote coastal regions. This is a national scandal.

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  • 28 February 2019 HSJ
    £26m IT project at NHS Blood and Transplant may have wasted up to £17m
    Review criticises project’s former leaders, including the current boss of the CQC
    Second major IT project that Ian Trenholm (former police officer and now CEO of CQC) has overseen that failed to meet objectives or costs.
    It would seem that Mr Trenholm is particularly crap at fulfilling his duties, so it’s a case of ‘people in glasshouses........’

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  • David Banner

    -CQC downgrades a surgery because they cannot recruit.
    -New low grade guarantees that no GP will touch this surgery with a barge pole.
    -Partners scarper.
    -CQC closes down surgery.
    -Patients have no GP, and Last Man Standing goes bankrupt.
    Cheers CQC, a job well done.

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  • Despite the budget cuts Whorlton Hall received a good rating by the CQC... Clearly an emphatic and well warranted stamp of approval

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  • CQC should identify ALL issues in their report, i.e.
    1. This practice is significantly underfunded - this needs to be addressed with an immediate uplift of 30% to core funding.
    2. Patients in this practice do not get enough time with their clinical team members. All appointments should move to 20 minutes starting tomorrow.
    3. The practice medical team are working beyond safe capacity. No GP or nurse should have more than 26 patient contacts per day. Until extra capacity is found in the system, all patients who cannot get same day appointments for urgent care should attend A&E; and all patients who cannot get routine appointments should be enabled to self-refer directly to a specialist.
    4. Practice estates aren't fit for purpose. The NHS should buy out existing property-holding partners at a commercial value and immediately engage in an upgrade of all facilities to safe modern standards.
    5. Only when all of the above has taken place can we reasonably be expected to start to judge practices over issues such as 'is there a dog bowl for dogs to drink out of'.

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