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Independents' Day

Practice ratings 'not linked' to lack of funding, claims CQC

Practice CQC ratings are not clearly linked to the variations in funding across practices, or underinvestment by the Government, the CQC has claimed.

The CQC’s State of Care in General Practice, 2014-2017 report on the first round of inspections of all practices in England highlights that 90% of practices were rated 'good' or 'outstanding' - as first revealed by Pulse.

The report says the CQC has 'not found any causal relationship between the funding that practices receive from the NHS and our ratings', adding it is 'a complex area that may benefit from further work'.

In an interview with Pulse, CQC chief inspector Professor Steve Field reiterated that the regulator could not ‘draw strong correlations with the funding of practices and whether they’re “outstanding” or they’re “inadequate”'.

This was despite a BMA study of nearly 3,000 practices last year finding practices that received an ‘outstanding’ rating received on average 37% more per patient than those rated ‘inadequate’.

The report details the lessons CQC has learned about what makes a practice ‘outstanding’ or ‘inadequate’ from this first inspection round, and found:

  • A poor rating can exacerbate recruitment problems, as it ‘limited practices from improving because of a perceived poor reputation';
  • More work is needed on understanding what impacts ratings, as there is little correlation between funding or geography and ratings;
  • Patient safety ‘continues to be the poorest’ of the five inspection domains, with 33% of practices rated inadequate or needing improvement on first inspection;
  • In the future, remote monitoring of practices will be much more important than annual inspection [as revealed by Pulse earlier this year].

Chief inspector Professor Steve Field told Pulse the report was ‘a really good news story for general practice’ and said he had told health secretary Jeremy Hunt this directly when handing him a copy on Tuesday.

He also said that the GP Forward View commitments were vital to address the ‘substantial’ workload increase, which the report says ‘has not been matched by growth in either funding or workforce’.

But when asked if the Government should shoulder some responsibility for underinvestment in general practice and creating the pressures that may impact a practice's rating, he said: ‘I don’t think we can draw strong correlations.

‘The problem with “inadequate” practices is largely about lack of leadership, lack of vision. The main thing I would put my finger on is professional isolation.’

Dr Richard Vautrey, chair of the BMA’s GP Committee, said: ‘This report shows that general practice consistently receives the highest ratings for the quality, despite the unprecedented and growing pressures.

‘The CQC process itself remains overly bureaucratic and continues to result in GPs spending time filling in paperwork when they should be treating patients. In this climate, it is important that any GP practices deemed to be struggling are given the necessary support so that any issues can be addressed.’

The first wave of inspections cost £110m in total and got off to a rocky start.

Professor Field pledged that inspections wouldn't be a 'witch hunt' when the regime was announced in 2013, but then caused an immediate outcry when the launch press conference was dominated by one case of maggots found in a treatment room.

However, the practice involved disputed this, saying a small number of larvae were found in a back corridor and had come in from outside the building.


Readers' comments (14)

  • well steve if you want me to present you with some facts that clearly prove this to be untrue (at least in this area),then the offer to meet is still open.
    otherwise keep destroying in the name of improvement.
    But spare us the spin. you are fooling nobody and making yourself look silly.

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  • Professor Field refuses to acknowledge the truth about practice funding..but he MUST remember that he has a duty of candour to be honest even if his government employers aren't happy...saying the full story is the only option....the truth always comes out in the end...remember that.

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    Hope Prof Field has sorted his own practices shortcomings .. How embarrassing

    The beatings will continue
    until morale improves

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  • Mr Field
    You are no longer a doctor in any meaningful sense of the word. But I think you do great as a politician, well at home in the company of Jeremy, Boris (Trump?) and the likes.

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  • I spoke with a CQC inspector during a meeting that had nothing to do with CQC about this. She was absolutely clear that well funded practices scored better than poorly funded practices and in her view, this was all CQC were proving...which is proving the bleeding obvious.

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  • These findings will do very little to reverse the gross underfunding and workforce crisis in General Practice! Leadership issues are part of the problem But it is far more deep rooted! Until there is a step change in resources the General Practice component of NHS will continue to wither! Real Political Leadership is Urgently Required. Steve Fields is not up to the task!

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  • Any Doctor has a candour of duty-they must tell the truth or they are putting their registration at risk-and this applies to everybody on the GMC register, no matter how high and mighty they are.

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  • From the article below on the Pulse homepage:
    "Trust-led practice rated 'inadequate' as GP shortage left no doctors on site"

    I suspect if partners there were earning at the top end of the scale (200k/ year) then there would not have been a shortage of GPs.

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  • Vinci Ho

    Very easily answering this:
    Rating is not correlated to level of funding . This is because we are talking unresourcing , not just underfunding , in general practice.
    And what are resources, Professor?
    Money , Manpower , Expertise and Time . One for all , all for one . Please clarify this concept clearly before making a conclusion to the health secretary to whom you are so abiding.

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  • This isn't true. When you look at the data on their map, a lot of the poorer areas are shaded in deep purple like the southeast coast, the poorer parts of London, Northeast Lincolnshire and so on. The connection with deprivation is really quite marked.

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  • dear professor,

    using your logic, as quality is not linked to funding, how about cutting your budget by half?

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  • The CQC is actually part of the problem. Maybe it was designed like this but for many they are the final straw.

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  • Simon Sherwood - that is a stunning response and should be put to the Prof. Dear Ed, can you please put this to Dr/Mr /Prof Field....before he jumps to crapita or another provider..... he's just another stooge for the establishment, where the main business is protecting the private providers profits.....

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  • Not linked to funding but absolutely linked to practice size. Right.
    Does anyone have any doubt any longer that the CQC is dancing to the tune of HMG? And Steve is headed for a gong, no doubt about that either. Well done, mate. Your mother would be proud of you.

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