Findings presented by CQC chief inspector of general practice Professor Steve Field at the Health+Care conference in London have revealed that a range of factors are linked to high performance during inspections.
After analysing inspections carried out so far, the CQC identified GP patient survey results, the number of GPs working at the practice and total NHS payments made to the practice as having a ‘strong’ positive association with CQC rating.
Practices that remain open for longer, that provide palliative care case review meetings and those that double up as a dispensing practice are more likely to be found ‘outstanding’ by inspectors, the results also show.
Other findings corroborated research conducted by GPonline, showing that APMS and PMS practices tend to outperform those with GMS contracts, and practices receiving more in total NHS payments also being ‘strongly’ associated with higher ratings.
Geography also had an impact on performance, Professor Field said, singling out London in particular as ‘a real problem’. Analysis by GPonline has previously showed that practices in the capital are over twice as likely to receive poor ratings than those in the north.
Professor Field added that ‘pockets of poor practice’ had also been identified in south Reading, Essex and Birmingham. Other areas – most notably Devon and the south west – have particularly high CQC performance.
Regarding the GP patient survey, practices that scored highly on questions asking whether they would recommend the practice, whether they thought their GP showed care and concern, whether their GP involved them in decisions and the overall patient survey rating were linked to better CQC results.
Looking across inspections as a whole, Professor Field said – in his experience – it was poor or non-existent leadership that was the single biggest contributor to poor CQC ratings.
Strong leadership likely has a knock-on effect with other contributors to high ratings, he added, as ‘they tend to get more funding as they are more entrepreneurial’.
Singlehanded GPs are more likely to receive poor ratings, according to the results. He said: ‘There is a statistic correlation between single-handers and poor ratings. It’s not in every case, but they often get isolated from other doctors and so they’re less likely to share learning, etc.
‘The other thing we find in some is they're not serving the population’s needs in their area. Half of people living in most areas are women, but we're finding many don't have access to a female doctor or nurse when they want one. If you're working on your own and there is nowhere else nearby with an open list, patients get disenfranchised.’
He praised well-performing practices, but warned that – with 15% of practices rated inadequate or requires improvement so far at the halfway point – up to a third of patients could be at risk from poor care from their GP practice.
‘General practice is the jewel in the NHS where it's working – but unfortunately, it’s not working everywhere. We have allowed that to go on for too long. We’re still finding the same proportion of bad practices as we were when we started.’