‘Significant’ general practice investment required, finds CQC review
The Government needs to invest significantly in community services, including general practice, or its aim to move more care away from hospitals risks failing, the CQC has warned.
In a new report on the state of care in England, the watchdog said that community services ‘need significant investment’ to deliver the transformation in people’s care set out in the 10-year plan for health.
The plan pledged to move ‘the majority of outpatient care’ outside of hospitals and into the community by 2035.
But the CQC said that without more support to help community services deliver the vision of the plan, ‘there is real risk of erosion in care quality’, with people struggling to get the care they need and the most vulnerable groups ‘likely to be hit hardest’ through longer waits, reduced access and poorer outcomes.
It also highlighted that people living in deprived areas are more likely to struggle to access their GP, and warned that a ‘lack of investment’ in community services ‘threatens the shift towards care outside hospital’.
The report said: ‘Most progress in shifting care into the community is described as moving hospital-based expertise, diagnostics and screening into community settings.
‘But there are reported barriers to moving care closer to home, with insufficient funding being the most frequently cited issue.
‘There were also significant disagreements within systems about how to shift resources to prioritise community services.’
The CQC found that although the number of trainee GPs has risen per head of population this year, the number of fully qualified GPs per head of population has fallen and ‘demand continues to grow’.
It said: ‘Based on the information and insight from our regulatory work, as well from the GP Patient Survey 2025, access to GP appointments remains a challenge, with evidence that some groups find it harder than others.
‘This includes those living in the most deprived areas, autistic people and people with a learning disability, and people with a mental health condition.’
When people can’t get help from their GP, it may mean they go to a service ‘not designed to meet their needs’, creating pressures elsewhere in the NHS, the report added.
It also found that when people ‘couldn’t contact their GP or didn’t know what the next step would be’, one in 15 went to A&E.
The CQC added: ‘We are calling for more focus on community care and the necessary investment to make the shift away from hospital care successful – with particular attention to neighbourhoods in deprived areas – to avoid worsening existing inequalities.’
RCGP chair Professor Kamila Hawthorne agreed with the report’s findings, and said that the ongoing review of the Carr-Hill formula for GP funding will be ‘a good start’ in helping to funnel investment into the communities ‘that need it most’.
She said: ‘If the Government is going to realise its aspiration to deliver more care outside of hospitals, we need to see a major shift in investment into community services, including into general practice, to facilitate this.
‘While by many metrics we’ve seen patient satisfaction with GP access rise over the last year, today’s report highlights that too many patients are still struggling to access the care they need, and that some – often our most vulnerable – are struggling more than others.
‘It makes clear that those living in areas of higher deprivation, as well as patients living with autism, learning disabilities, mental health problems and other long term health conditions are more likely to report issues with GP access.
‘These are not standalone issues; we know that health inequalities are entrenched across the NHS and across the country, and we must do more to address this.’
The King’s Fund chief executive Sarah Woolnough said: ‘The Government is absolutely right to want to shift the focus of the NHS from hospital to community, but that ambition is not new.
‘Despite multiple attempts to move more care into the community, the focus of government remains on hospital care and waiting times targets.
‘For the shift to happen successfully, the Government must be clear that there will need to be trade-offs, with both more focus and more investment in primary and community services so that people can get the care they need to keep them living well wherever they live.’
A Department of Health and Social Care spokesperson said: ‘This report lays bare the scale of the challenge we inherited after years of neglect and underfunding.
‘This Government is getting the NHS back on its feet, and we’ve made significant progress in just a year. Patient satisfaction with GPs is on the up – we have cut waiting lists by 206,000 in a year, recruited over 2,500 more GPs and taken action to end the 8am scramble.’
The GP funding formula is undergoing a six-month review and health secretary Wes Streeting previously pledged it would result in ‘working-class areas’ receiving their ‘fair share of resources’.
Citing Pulse’s award-winning investigation into practice closures, the Government said that data shows that on average the GP practices that close for good are in areas with areas of higher deprivation.
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READERS' COMMENTS [5]
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CQC opening their eyes finally…. I look forward to their next headline report …. CQC says unfettered online access worsening health inequalities as care shifts towards the worried well… the inverse care law.
But the CQC is not fit for purpose, said a government spokesperson
today from Roy Lilley
another thing that requires change
spot on
I think it was Napoleon who said he didn’t care too much about the qualifications of his generals… he just wanted them to be lucky.
Luck or talent? What do we want? It’s a close call.
The news that junior doctors are to go on strike this November, when we were led to believe Streeting was negotiating with them, bringing an end to their industrial dispute, begs the question…
Is he unlucky? For sure, there’s no sign of talent.
On his watch we have:
an unfunded, unplanned ten-year-plan, with no impact analysis, or implementation plan;
the chaos of an unheralded closure and merger of NHSE and DH+;
swingeing workforce cuts and unfunded redundancies;
no parliamentary time to introduce the legislation needed to close NHSE and legislate for the successor organisation;
a bewildered duopoly of committees and boards trying to run what is essentially a single organisation;
waiting lists, at best static;
morale through the floor;
social care hanging by a thread;
Covid numbers skyrocketing and cuts to vaccinations;
productivity grinding to a halt;
primary care close to rioting;
rows about physician associates and workforce planning;
a looming barney with the pharmaceutical industry;
and an unpaid bill of about £300m from the last round of strikes…
… it’s hard to think this is all as bad luck.
It’s a man-made mess, made by a very silly-boy.
The strike represents a direct challenge to Streeting’s authority over pay, workforce policy and industrial relations.
A walkout casts doubt on his ability to manage one of the service’s most critical workforce groups, without provoking them.
Already, during earlier strike rounds, Streeting has framed the dispute as a confrontation… he warned that doctors would ‘lose a war with this government.’ Really…
These unwanted and crippling November strikes escalate that confrontation.
Streeting will be judged on how well he handles his self induced crisis…
… both on optics; can services continue, are patients protected…
… and substance; can he strike a deal without destabilising finances or alienating other NHS staff?
Any missteps will be magnified, especially given rising public anxiety over NHS waiting lists and access to services.
Streeting has said there is ‘no more room for manoeuvre’ on pay. He has offered non-pay concessions on conditions and training reforms… but even with that leverage he has achieved nothing.
His combative nature will push him into trying to mobilise public opinion and prevail on the non-striking NHS to once more bust-a-gut to keep services flowing.
I imagine a lot will think carefully about donating their discretionary effort, to dig Streeting out of a hole he’s dug for himself.
There is also the no little-matter of the potential reputational damage within the Labour Party.
The NHS is a core issue for Labour. Many supporters will expect Streeting to defend and strengthen it…
… actually, he’s attacked it with his ‘broken’ message and weakened it with chaotic reforms.
If strikes are viewed as symptomatic of Labour’s mis-management or failure to deliver, that could erode support or provide fodder to critics.
Streeting has already warned that extended strikes could become ‘a gift to Nigel Farage’.
Given his temperament I wouldn’t be surprised if Streeting’s considering legal, regulatory or contractual levers to limit or constrain strikes.
This would be politically fraught and might escalate confrontation, union backlash, court challenges, or political backlash.
Public opinion? It’s unlikely the doctors will carry public support…
… but they know that and they don’t care. These doctors aren’t from the Dr Findlay era.
They calculate, given the unpopularity of HMG and recent missteps, it’s likely attention will turn on the competence of the government.
Can Streeting project a government in control, credible, responsive. I doubt it. It looks to me reactive and cornered.
The narrative will be critical.
Talking tough is stupid. Talking-up improvements in conditions, demonstrating they’re in place and being clear about reasons for resisting further pay demands…
… would demand a maturity we don’t see in Streeting.
During the last action NHSE tried to downplay strikes and project a ‘business as usual’ image. Bushing off the impact. I’m not sure that will hold as winter draws-in.
Streeting’s leadership, judgment and ability to finesse industrial, financial and public pressures will all be under the microscope.
For the NHS, it’s another escalation in a destructive cycle brought about by an inexperienced health secretary, advised by people who want us to make the same mistakes they made 20 years ago.
It’s time for a change.
Excellent commentary DC.
This is a wonderful analysis, this is a crisis made by the Tories and worsened significantly by Streeting. Please put it in a column Pulse!