GPonline analysis of the majority of practices in the country has unveiled a series of clear associations between CQC ratings and practice resources and circumstances. GPs have long warned that ratings simply punish underfunded practices rather than solely highlighting poor performance.
The GPonline findings results show a linear relationship between the number of GPs available per patient and eventual performance in CQC inspections, with better-staffed practices more likely to score higher ratings.
Practices rated outstanding have 0.68 full-time equivalent (FTE) GPs per 1,000 patients on average, the results suggest, compared to 0.56 at 'good' practices, 0.50 at 'requires improvement' practices and 0.46 at 'inadequate' practices.
This suggests outstanding practices have 50% more FTE GPs than those rated inadequate.
The average number of FTE GPs per 1,000 patients per practice in England is 0.56, according to the dataset – the same as the average for practices rated good.
Looking at the number of patients per FTE GP, a GP at the average outstanding practice cares for 1,812 patients, rising to 2,193 patients per GP at good practices, 2,442 at requires improvement practices and 2,897 for inadequate practices.
The analysis included NHS Digital data on FTE GPs, registered patients and CQC rating data from 5,545 practices. There are around 7,500 practices in England, but some CQC reports have yet to be released and data on number of GPs is not available for all practices.
Analysis shows the top-scoring practices tended to be larger, having close to double the number of patients of inadequate practices at 9,374 compared to 5,044.
They also had more FTE GPs – with outstanding practices having 5.8 on average, compared to 4.3 at the average good practice, 3.1 at requires improvement practices and just 2.6 at those rated inadequate.
Of the sample, 4% were rated outstanding, 86% good, 8% requires improvement and 2% inadequate.
The findings follow another recent analysis by GPonline that suggests practice funding is also linked to CQC performance – with those rated outstanding are paid 32% more per patient on average than those rated inadequate.
Outstanding practices are also more likely to have PMS contracts than practices with other ratings, GPonline has found, with two in five (42%) holding this contract.
This compares to 35% of good practices, 29% of those rated requires improvement and 34% of inadequate practices.
Some 4% of outstanding practices have APMS contracts, along with 2% of good, 2% of requires improvement and 3% of inadequate.
The watchdog has now inspected all practices that were registered as of October 2014 when it launched its four-point rating system.
In its recent State of Care report, released in March, the CQC acknowledged that it can be difficult for providers to drive improvements with limited resources, but added that ‘transformational change is possible’.
It said that it did not consider being ‘financially efficient’ and ‘providing high-quality care’ as mutually exclusive.
‘Some problems with the quality of care do require new resources, but many do not,’ the report said.