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Practices rated ‘inadequate’ by CQC have underlying recruitment problems

Exclusive GP practices given poor CQC ratings have underlying problems with recruiting GPs and staff, including a practice where on occasions one GP was forced to cater for over 8,000 patients.

Six of the seven GP practices to have been rated ‘inadequate’ under the new Ofsted-style CQC inspection regime had problems with GP recruitment, high staff turnover and trouble recruiting nurses because they either could not find or not afford them.

Staff at the seventh were being stretched across two sites after taking over another practice, a Pulse analysis of their CQC reports have shown.

GPC said these underlying isses are as likely to reflect the lack of investment in these practices as they are overall quality.

It comes as GP recruitment is facing a crisis with GP leaders warning that the lack of new doctors entering the profession is threatening patient care. Last week, the RCGP warned some areas of England need more than a 50% boost to GP numbers to be able to meet demand over the next five years.

Examples of pressures described in the CQC reports includes:

  • Priory Avenue Surgery in Berkshire had doctor shortages so bad that on occasions only one GP was forced to cater to 8,050 patients. The practice had recently been hit by a series of resignations, long-term sick leave and trouble recruiting administrative staff.
  • Woodside Group Practice in south east London was left with just one practice nurse for a list of 13,000 patients to provide core and enhanced services after failing to recruit replacements for departing nurses as well as GPs.
  • Dr Srinivas Dharmana’s surgery in Liverpool saw patients speaking highly of the lead GP but they had been away from clinical practice for around a year at the time of inspection and another ‘key staff member’ was also on a long-term absence.
  • Dr Wayne Sefton Davis’ practice in Manchester, the lead GP had been absent for several months and financial pressures had left it unable to employ a practice nurse.
  • Dr Sunil Srivastava’s practice in Leeds had a lack of administration staff which led to difficulties for patients getting appointment and gaps in the practice’s audit trail
  • The CQC criticised Dr Michael Florin’s surgery in Cheshire because staff holidays and sickness had prevented practice meetings from taking place and minutes from being kept.

There were also direct references to low staff morale in the CQC reports for three of the seven practices. All seven were hit with complaints over a lack of evidence and appropriate paper trails.

Although there were also other reasons behind the CQC’s judgement on the practices, the GPC warned that rating them ‘inadequate’ failed to take into account underlying factors such as funding and trouble recruiting.

The report summary for Priory Avenue Surgery, which the CQC has now placed in ‘special measures’, said: ‘The practice was going through a significant staffing crisis and there had been severe staff disruption in recent months. The practice was working closely with the NHS England area team to ensure they took immediate corrective action, which would enable them to fulfil their basic functions safely. The North and West Reading Clinical Commissioning Group were also monitoring the concerns and issues within the practice.’

Meanwhile the CQC wrote about Woodside Group Practice: ‘There was a high turnover of clinical staff with two GPs and practice nurses having left in the last few months. The practice had been unable to fiund suitable replacements.’

Dr Robert Morley, GPC contracts and regulations lead and a GP in Birmingham, said: ‘I would say these are issues which are as likely, if not more likely, to reflect the lack of investment in, lack of support for and the deliberately destructive policies towards general practice by politicians, PCTs and NHS England over the last decade as they are to reflect the quality of care that practices strive to provide.

‘It would be interesting to look at judgements made by CQC in the context of the funding and working conditions of these practices compared to those that CQC has been less critical of, but CQC judgements and ratings appear devoid of such context.’

GPC deputy chair Dr Richard Vautrey said: ‘This is yet another sign of the huge pressure practices are under and the impact this is having on GPs’ health. Both CQC and NHS England have to work to address these issues and support practices rather than condemning them.’