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.’