Make sure not to give ‘inadvertent’ message practice is closed, CQC tells GPs

GPs should make sure not to give the ‘inadvertent’ message that their practice is closed, the CQC has said.

It added that practices must ensure ‘appropriate’ access and ‘timely’ care is given to patients.

It comes as the CQC today released its annual state of care report, which showed that the vast majority of practices (94%) are still rated good or outstanding.

It also found that most practices have ‘good’ infection prevention and control measures in place such as PPE and cleaning and social distancing procedures.

But the CQC said that in light of the pandemic, GPs should now chase up on patients who may be missing out on care.

In a media briefing, CQC chief executive Ian Trenholm said GPs should make ‘an active effort’ to look for those who ‘maybe are sitting quietly at home [and] have got a lump and a bump and haven’t gone to see their GP’.

He added: ‘It’s absolutely right that GPs will want to go back through their patient list and look at who they’ve been supporting who they haven’t seen in a while but we at CQC are absolutely supportive of the work that NHS England is doing on the national campaign to encourage people [that] the NHS is open.

‘We just want to make sure that there aren’t inadvertent signals being given when people put signs on doors or they talk about services being restricted because of Covid.’

This is sometimes done ‘with the best of intentions’ but can ‘dissuade’ people from seeking care, he said.

The annual report added: ‘Primary care services similarly need to make sure that people are given the confidence to interact with them early, provide a range of ways for them to access the care they need and make it easy for them to do so.’

Mr Trenholm also said GPs should ‘make sure no one is left behind’ as a result of the NHS being effectively a ‘Covid-only’ service during the pandemic.

He said: ‘Although there is an increasing number of GP appointments available and GPs are working incredibly hard to get that number up to pre-Covid levels, the reality is it’s probably not there yet.’

And CQC chief inspector of primary medical services Dr Rosie Benneyworth added that the CQC is ‘working very closely’ with practices to make sure ‘the appropriate access is given to patients’.

She said: ‘We need to make sure that if people need a face-to-face appointment, they can access one and people get the appropriate care in a timely way to meet their needs.

‘It’s really important that all the needs of the people who use services are met, not just the people with Covid [and] all conditions are treated appropriately.’

Responding to the comments, RCGP chair Professor Martin Marshall said ‘general practice is open for patients with conditions both related and unrelated to Covid-19’.

He said: ‘General practice has been open throughout the pandemic, although care is currently being delivered differently to usual, in line with official guidance, with most consultations being delivered remotely.’

Face-to-face appointments are being delivered where ‘necessary’ and the RCGP ‘certainly does not want patients to avoid seeking medical assistance’ if they are concerned about symptoms, especially if they could indicate serious conditions such as cancer, he added.

He said: ‘We understand that some patients prefer to see their GP face to face – and many GPs prefer this as well – but we are in the middle of a pandemic, infection rates are rising, and we must consider infection control when delivering care in order to keep patients and staff safe and help stop the spread of the virus.’

BMA GP Committee chair Dr Richard Vautrey added that practices were following what the ‘Government instructed’ by increasing remote access and triage to keep staff and patients safe.

He said: ‘Of course, remote consultations are not suitable for everyone and will never be a complete replacement for in-person care.

‘[But] practices have been working incredibly hard, remaining open for patients throughout this time to ensure everyone has access to the right professional, and the latest data has shown a significant rise in face-to-face appointments in recent weeks.’

It follows much controversy over whether or not GP practices are open to the public, with a health minister recently suggesting GPs can ‘recommence’ face-to-face care safely using PPE.

The state of care report, which covers the period before and after the pandemic took hold, also said:

• Practice ratings remained ‘almost unchanged’  with 89% rated good and 5% rated outstanding at 31 March 2020, compared with 90% rated good and 5% outstanding last year.
• However, practice ratings were ‘volatile’, with 192 improving their rating to good on re-inspection and 173 declining from a rating of good in the year to 31 March 2020.
• There was a ‘long-term decline’ in patients saying it was easy to get through to their practice on the phone, from 81% in 2012 to 65% in 2020 and ‘difficulties’ for some people with mental health or substance misuse issues registering with a GP.
• Relying on telephone and online appointments raised concerns over GPs ‘potentially missing diagnoses or not referring patients in a timely way’.
• Views ‘varied’ over the effectiveness of joint working ‘particularly between care homes and GP practices’ and in some cases death verification arrangement had caused a ‘rift’ between care homes and practices.
• Practices have received  ‘good support and engagement’ to help them manage Covid, including from CCGs and PCNs, but faced ‘information overload’ with ‘changing or conflicting’ guidance. 

It comes as GP practices have been asked to welcome CQC inspectors again from 19 October, as the regulator has set the start date for its ‘transitional’ regulatory approach.

Earlier in the summer, the CQC announced it was piloting a new model of checking up on practices ‘without crossing the threshold’.