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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.