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CQC downgrades GP practices over ‘lack of capacity to meet demand’

CQC downgrades GP practices over ‘lack of capacity to meet demand’

The CQC has quoted lack of capacity to meet patient demand among the reasons for placing a group of GP practices in special measures.

The regulator rated Modality Mid Sussex – which runs Crawley Down Health Centre, Judges Close Surgery, Park View Health Partnership and Ship Street Surgery – inadequate and placed it in special measures following an inspection in May and June.

Lack of access was not the only point on which the practice failed to meet CQC expectations however it was stated as a contributing factor.

The CQC inspection was carried out because this was a newly registered service following the merger of four established practices, but also in response to ‘concerns reported to CQC, including people’s access to the service’. 

The inspection report said: ‘We rated the practice as inadequate for providing responsive services because… patients were unable to access services in a timely way.’

Neil Cox, the CQC’s deputy director of operations in the South, said that when the regulator inspected Modality Mid Sussex inspectors ‘were disappointed to find that the practice didn’t have enough capacity to meet people’s demand for appointments’.

Following the inspection, the practice was rated inadequate overall; and inadequate at being safe, responsive, and well-led.

Mr Cox said: ‘On-the-day appointments were often filled by mid-morning and reception staff were then asked to redirect people to local accident and emergency departments, community pharmacies and the local walk-in minor injuries unit or contact NHS111.

‘The lack of access to appointments also impacted the care of people using the services.

‘The practice did try to manage this risk by asking staff to work extra hours and employing locum GPs, but the unmanageable additional workload left staff morale low.’

The CQC also downgraded the practice on the basis of failings including medicines monitoring, patient follow-up and a lack of effective systems for risk management.

Under the 2023/24 GP contract, practices are contractually obliged to offer an ‘appropriate response’ to patients the first time they get in contact, and subsequent NHS England guidance said that they can only divert patients to 111 in ‘exceptional circumstances’.

Following the publication of this guidance, the BMA said GPs should redirect workload after 25 contacts in a single day.

However, in an interview with Pulse last month, national primary care director Dr Amanda Doyle said NHS England finds BMA’s 25 contact limit ‘arbitrary’ and does not accept routine diversion to 111.

She said NHSE does accept staff sickness or unusual levels of demand as ‘exceptional’ incidences but expects GPs to inform their ICB before redirecting patients to 111.

Dr Richard Vautrey, RCGP president and assistant medical secretary at Leeds LMC, told Pulse: ‘I cannot comment on the specific practice as I don’t know the details of their staffing arrangements.

‘However following years of underinvestment in to general practice and falling recruitment and retention of GPs at the same time as rapidly rising demand from patients and long waiting times for secondary care services, many practices are struggling to match capacity with demand. 

‘This is despite practice staff working as hard as they possibly can and practices providing more consultations than ever before.

‘Adverse CQC ratings can make it even harder to recruit and retain staff, and so can make the problems facing a practice worse not better. 

‘Therefore, to support improvement CQC needs to take information about practice pressures and use that to highlight to government the urgent need to invest in general practice and to support our workforce.’

Dr Dean Eggitt, chief executive of Doncaster LMC, said: ‘The CQC knew this was going to be an issue a couple of years ago.

‘Practices are starved for resources and not able to meet the needs of patients, and are doing what they can with the resources they have.

‘I worry that this could set a precedent and the CQC has seen this coming, and should have put processes in place.

‘It doesn’t feel right, and I think there should be a different category in CQC inspections for practices that have failed due to national or local circumstances.’ 

Amy Galea, chief primary care officer at NHS Sussex, said: ‘Improving access to primary care across Sussex is one of our key priorities for this year.

‘Aligned to that, we have been working with the team at Modality Mid Sussex for several months to understand the areas of improvement that were raised by patients earlier this year and to support the measures the practice team identified to address them.

‘An action plan was developed, and this now takes into consideration the actions outlined in the CQC report.’

Dr Sharon Pruden, senior partner at Modality Mid Sussex, said: ‘We take the findings of the CQC report very seriously and have been working with our team, addressing each of the recommendations, to make improvements and provide patients with good quality care.

‘We have an improvement plan in place, and we are already making progress in key areas such as numbers of appointments offered and recruitment. 

‘We are encouraged however, that following the inspection, the CQC acknowledged the positive way in which our staff communicate with patients and a culture to drive improvement.

‘We hope that this will offer some assurance to our patients of our commitment to provide them with safe, effective, responsive, well-led and caring services.’  



Please note, only GPs are permitted to add comments to articles

Not on your Nelly 27 September, 2023 5:07 pm

So this is the new rating for EVERY SINGLE PRACTICE in the while country. Jeez

Turn out The Lights 27 September, 2023 5:39 pm

Disband the CQC and label everything in the NHS as Inadequate, save the money. Time for the CQC to insepct NHSE central andrate their performance eh.Abusive blame the victim dont hold the abusers to account.Does this mean we can prune and close our lists?Thought not.ABUSIVE RELATIONSHIP.

Sam Macphie 27 September, 2023 5:54 pm

Why is there not an equivalent GP or BMA 0rganisation, Commission set up to award unCaring Quality points applied
monthly to counter Sanuk’s government, Mandy Preachhard’s NHSE and local Managers. For one thing, ‘lack of capacity to meet demand’ is ultimately their responsibility and scoring low points for 13 years; and more money needed to invest in GPs directly and evenly, without silly strings attached. Hospitals always seem to get money as too big a proportion of budgets cf GP practices
Award Sanuk’s cabinet unCaring Quality points monthly and to be delivered to Sanuk’s door at no. 10, in full glare of the media: set this up, some good GP.

Jonathan Pryse 27 September, 2023 6:01 pm

Completely agree with Comment 1 from “Not on your Nelly”. They cite that ” On-the-day appointments were often filled by mid-morning ” – well wake up, that is the same for us all! Amanda Doyle’s comments were very worrying/arrogant too. This will push a lot of people like me, in their 50’s to retire at the next CQC visit. Well done CQC..

David Church 27 September, 2023 8:16 pm

We do need to be honest, but then also honest that the cause of the falling service levels is due to government interference and insufficient funding, aiming at privatising everything like in America, so that the poor will get nothing, and the multinationals richer.
And, yes, if the same-day appointments were not filled by mid-morning, there would be a lot of unproductive doctor time due to unfilled appointments, just the same as for plumbers, electricians, gas engineers, solicitors, etc, but nobody mentions that?

David jenkins 27 September, 2023 10:22 pm

– retire !

or resign !

doesn’t mean you have to stop work – just makes sure that they realise they don’t hold all the cards !

if enough do it, they WILL wake up !

google “prestatyn surgery” if you want to see what happens.

admittedly this is wales, but the principle is the same.

C B 27 September, 2023 10:52 pm

I think its time for us to
a) Retire
b) Go on strike and provide emergency cover only
c) Resign from the NHS and do a dentist

John Glasspool 28 September, 2023 8:09 am

Dear CB,
People have been saying this for 25 years, and doing—- nothing.

Turn out The Lights 28 September, 2023 8:10 am

Personally roll on April ,Yay.

Simon Gilbert 28 September, 2023 8:39 am

This is the logical end point of a Soviet style command and control system of Healthcare.

Contractual discussions and the need to increase associated payments become meaningless if you can expand the primary care workload by a combination of regulatory organisational jeopardy (CQC), personal professional risk (GMC), civil risk (being sued), criminal sanction (prosecutions for poor outcomes), anonymous commissioning failure (e.g. eating disorders, gender dysphoria), coronal forensic analysis of a 10 minute interaction, and public scorn (Daily Mail printing a picture of your house and its value).

The proposed traffic light self reporting systems for primary care will all flash green as no one wants the email that states ‘We’re from the commissioners and we’re here to help”, further enabling NHS management and government to state that problems in primary care are overstated.

Andrew Schapira 28 September, 2023 9:56 am

Only a few things to do now I guess but I think our leaders have no stomach for the action that is needed

Huge workload demand, LMC seem very good at passing resolutions BMA offered safe working guidelines all of which have been ignored, and to add insult QOF points to look after our own well being

I think this may be a tipping point

Cameron Wilson 28 September, 2023 10:25 am

Leaving aside the fact that reports often say more about the person/organisation writing it,rather than the recipient, at least it leaves little doubt what we are up against!
Complete and utter nonsense from this outfit that has done far more harm than good.
Sharon would have been better stating that she considered the report an irrelevance, and until the CQC starts by demanding that services get adequate staffing before judging them,then anything that they say will be treated with the appropriate contempt. Am sure she does think that, but the truth hurts and you can imagine what the usual villains,NHSE,GMC and HMG would do to her!
It’s just a game to that lot,we deserve better but unfortunately it’s every man for himself, the chickens have really settled down for this country!

Centreground Centreground 28 September, 2023 10:39 am

The CQC in my view is simply a group of very inadequately qualified, disconnected and disgruntled individuals with a chip on their shoulder who are responsible for the decline of the NHS via their ill thought out reports leading to low morale and the continue exodus of staff.
Hence, thereby causing increasing declines in the NHS service due to their complete lack of understanding of how it is to actually deliver a service rather than operate the basic desire to criticise while not working in the service you oversee or having left the NHS previously due to lack of ability or capability to cope with service delivery in the past and joining this pseudo quango as a result.

Turn out The Lights 28 September, 2023 11:22 am

CQC are enablers who work for abusers.

C B 28 September, 2023 12:03 pm

Dear John Glasspool I agree but I do think we may be reaching a tipping point now. The demands on access cannot be met. The hospital consultants, junior doctors and staff grades are now on strike, I think its time we joined them.

Truth Finder 28 September, 2023 2:50 pm

I think we need to strike. No surgery can ever meet the unlimited demands.

John Graham Munro 28 September, 2023 8:54 pm

G.Ps strike?——–”and the band played believe it if you like”

Dr No 28 September, 2023 10:09 pm

The CQC are government stooges tasked with punching down on failing practices (100% of us) by the Tories. And y’all know by now what I think of the Tories.

Dr No 28 September, 2023 10:39 pm

Actually I’m kinda looking forward to my next CQC inspection. 10 years of anger… if I’m pushed I’m gonna go full Krakatoa.

Paul Smith 29 September, 2023 1:14 pm

The CQC are a quango that is self serving. Their goal is to keep themselves in well paid employment so they need to justify their existence by fomenting discord. I am not convinced the assessments are accurate or reproducable.

However I think they are not helping the NHS. Take a step back and look at this organisation dispassionately. They cause a lot of harm and take an inordinate amount of staff away from patient care. They are not force for good are they ?

Scotland seems to do ok without a CQC.

Carrick Richards 29 September, 2023 4:18 pm

How can CQC punish a practice for something that is entirely public policy and not anything the practice can control?!? Section 21 of the Theft Act 1968 – Use of threat (including sanction under professional standards) to obtain goods and services to which there is no entitlement. This criminal behaviour appears to be policy, which makes it conspiracy (with a sentence guideline of up to 10 years prison).

Laurie Jacobs 30 September, 2023 10:55 am

There was an interesting and worrying statistic from the 1980’s/90’s (when we were all working 24/7), that if you retired at 65, your average life expectancy was about 1 year, but going at 60 gave you another 12 years. Perhaps the CQC are working closely with the Chancellor and the Pensions authorities to see if there is some way of reducing the NHS pension pot ! CQC has always been ridiculously knee jerk with practices swinging between needing special measures then excellent and vice versa. It’s a nice job, travelling around the country, no patient contacts to cause any of those troubling hassles and anxieties, well paid with travelling and hotels thrown in often, so what’s not to like !

Hank Beerstecher 2 October, 2023 9:37 am

David Jenkins, It is not the same in Wales, practices are systematically underfunded by ~12% compared to English practices.