CQC flags concern over GP access despite 2m face-to-face appointments last week

The CQC plans to 'follow up' concerns about access to face-to-face GP services, warning that remote care 'does not meet the needs' of all patients - despite practices in England delivering 2m appointments in person over the past week alone.

CQC chief inspector of primary care Dr Rosie Benneyworth (Photo: Pete Hill)
CQC chief inspector of primary care Dr Rosie Benneyworth (Photo: Pete Hill)

Launching the watchdog's annual State of Care report, chief inspector of primary care Dr Rosie Benneyworth said it wanted to ensure that all practices are delivering 'appropriate access' for patients.

She said: 'For some people, digital access is brilliant - an online consultation or phone call can be much more convenient. But that does not meet the needs of all of the people using services so 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.'

The comments are likely to infuriate GPs at a time when RCGP data show that - despite the ongoing COVID-19 pandemic - GP practices across England delivered more than 2m consultations face-to-face in the past week alone.

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How have GP practices fared under CQC inspections?

Dr Benneyworth's remarks come just weeks after NHS England's primary care medical director apologised for an 'insulting' letter to GP practices warning that failure to offer face-to-face consultations when appropriate could constitute a breach of contract.

The letter triggered negative media coverage that BMA leaders have said brought a 'wave of abuse' for GPs and practice staff working hard to keep services going amid a growing second wave of the pandemic.

Responding to the comments from the CQC's chief inspector of primary care, RCGP chair Professor Martin Marshall said the COVID-19 pandemic had been the biggest challenge the NHS had ever faced.

He added: '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. College data shows that routine GP appointments are currently higher than pre-pandemic levels, following a slump around the peak of the pandemic.

COVID-19 pandemic

'Where face-to-face appointments are necessary, they are being facilitated and college data shows that more than 400,000 face-to-face consultations are being delivered in general practice every day. 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.'

The CQC report shows that almost nine in 10 GP practices in England are rated 'good', with a further 5% 'outstanding' in the year to 31 March 2020.

Just 4% of practices were rated 'requires improvement' and 1% 'inadequate', but the CQC said the headline figures 'masked a more volatile picture' - because 192 GP practices improved their rating to 'good' during the year while 173 dropped from 'good' to 'requires improvement'.

Dr Benneyworth also said that infection prevention and control procedures would be looked at during every on-site GP practice inspection in the coming months as part of the regulator's 'new methodology'.

Digital divide

The watchdog's report this year focuses on the impact the pandemic has had on the health service, acknowledging that GP practices were 'quick to rise to the challenge' of COVID-19 and had rapidly adopted remote consultation 'to continue to support the needs of their communities'.

However the CQC said that it was concerned that people may not have been seeking help when they needed 'because they did not have access to online or telephone care, were worried about catching COVID-19, or did not want to bother their GP at the time of a pandemic'.

It said that this had resulted in a 'substantial drop' in urgent cancer referrals and new referrals to treatment. 'Primary care services need to make sure that people and patients are given the confidence to interact with them early, provide a range of different ways for people to access the care they need, and make it easy for them to do so,' it added.

The CQC also said that surveys it had carried out with patients suggested that they were  positive about the changes adopted by general practice during the pandemic. 'Most of those who responded to us wanted the access routes available during the pandemic, such as online appointments and telephone and video consultations, to remain available in the future,' the report said.

Primary care advice

The report also highlighted that practices had to contend with 'information overload' during the pandemic. In particular practices struggled with 'guidance from different sources that was changing or conflicting' - warning that guidance on infection control was 'inconsistent and confusing', particularly in the early stages of the pandemic.

Based on conversations with 43 practices as part of its assessment of infection control across the NHS, the CQC said GP surgeries 'generally had good PPE and cleaning procedures, procedures for social distancing and audits for infection prevention and control'.

The report highlighted numerous examples of how general practice had helped support patients and care homes in particular by adapting how they worked. However, it also said that some care homes had found it 'difficult to get GP access'.

Overall the report noted that the pandemic had magnified health inequalities and that this risked 'turning fault lines into chasms'.

Waiting lists

It concluded: 'The increased waiting lists and backlog of urgent and elective care need to be addressed – services need to assess and prioritise patients so that they are treated according to clinical need and that people waiting for long periods for treatment are kept safe.

'Going forward, hospitals and other healthcare services need to finely balance the capacity to provide COVID and non-COVID care, and make sure that people have the confidence to come forward for the care and treatment they need.'

Professor Marshall added: 'We certainly do not want patients to avoid seeking medical assistance if they are concerned about their health, as we suspect happened around the peak of the pandemic, especially if they have signs or symptoms that could indicate serious conditions, such as cancer.

'General practice is open for patients with conditions both related and unrelated to COVID-19 - we will continue to make the vast majority of patient contacts in the NHS, alongside delivering the largest flu vaccination programme in NHS history and preparing for what is set to be a very difficult winter.'

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