Exclusive: Poor CQC ratings linked to underfunding of GP practices

Practices rated 'inadequate' or 'requires improvement' by the CQC receive about £50,000 a year below national average funding, a GP investigation has revealed.

Average funding per weighted patient at 47 practices rated in the bottom two categories is £7 below the national average rate of £136 per patient. For an average-sized practice with a list of 7,000 patients, this is equivalent to £49,000 a year.

Poll: Should the CQC factor funding into GP ratings?

The findings suggest a strong correlation between underfunding of GP practices and poor performance in CQC inspections.

The GPC said the findings highlight the unfairness of the CQC ratings system, which fails to take account of how resource pressures affect practices’ ability to provide the best quality services.

GPC chairman Dr Chaand Nagpaul said there was ‘no doubt’ the quality of care practices can provide is in part determined by resource constraints.

‘There is a concern practices labelled as needing improvement are trying to operate with inadequate resources improvement when in many cases, they are trying to operate with inadequate levels of resources,’ he said.

Many practices would be able to provide ‘far greater and improved levels of care’ if given the resources to do so, he added.

Dr Nagpaul called for CQC inspections to stop labelling practices and instead highlight the constraints GPs face on providing optimum patient care.

Executive partner at Firsway Health Centre in Cheshire Dr Kath Sutton said she believes the practice’s ‘requires improvement’ rating was related to significantly below average funding.

‘We provide excellent care to patients,’ she said, ‘but our ability to recruit has been impacted by our underfunding.’

One senior GP, however, said low resourcing could in some cases be a symptom of ineffective practice leadership failing to attract funding.

The relationship between funding and CQC rating was not necessarily cause and effect, the top GP warned.

CQC inspection bosses have said practice leadership is a key factor affecting patient care quality.

Writing in last month’s BJGP, the chief inspector of general practice, Professor Steve Field, and senior national GP adviser Dr Nigel Sparrow said that while quality varies substantially, well led practices are more likely to offer better care.

Safety culture

Among the most common areas which inspectors found requiring improvement, safety culture is top, with recruitment and staff management second. Other common areas requiring improvement include staff training, leadership and premises.

Using CQC reports and Health and Social Care Information Centre (HSCIC) practice income data, GP calculated the average per patient funding for inspected practices.

The 15 inadequate practices received an average £126.30 per weighted patient, £10 below the £136 average according to HSCIC data.

Two-thirds receive below average funding, with the lowest funded on just £83.60. The 32 practices with a ‘requires improvement’ rating average £129.50 per patient.

GP’s analysis also found that inadequate practices are far more likely to be single-handed. Sixty per cent of those given the lowest rating by the CQC have just one GP, while across England, according to 2014 HSCIC figures, about 17% of practices are single-handed.

A CQC spokesman said: ‘Everyone who uses GP services has a right to expect those services to be safe, effective, caring, responsive to people’s needs and well-led. CQC inspections are carried out to establish if they are.

‘The ratings tell the public how  CQC views the practice. The law requires practices to meet fundamental standards; if they do not meet them, CQC takes appropriate action to promote improvement. Questions about funding are a matter for NHS England.’

NHS England was unavailable to comment as GP went to press.

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