GP practices remain highly rated by CQC despite sustained workload pressures

General practice remains the highest-rated NHS service covered by the CQC despite huge workload pressures on surgeries over the past year, the watchdog's annual State of Care report reveals.

A total of 90% of GP practices were rated 'good' by the CQC in July 2021, while 5% were awarded an 'oustanding' rating by the watchdog. In comparison, 67% of NHS acute core services were rated as 'good', while 8% were 'outstanding'.

Just 4% of the 6,429 surgeries were rated 'requires improvement, while around 0.5% were deemed 'inadequate' by the CQC. This comes at a time when GP practices are dealing with record numbers of consultations and levels of admin work.

The report highlighted the efforts of GPs delivering the COVID-19 vaccination campaign, praising GP practices - working across PCNs - for being 'at the forefront of this critical task'. It also recognised GP work to move 'rapidly' to remote consultations to respond to the pandemic.

Patient access

It said patients, at times, found triage systems 'cumbersome' - and they had difficultly figuring out the ‘best or correct’ way to contact practices. Report authors also said that people complained about being put on hold 'often', or being stuck in a queue for ‘a long time’.

The CQC backed calls from the RCGP to carry out a comprehensive review of total triage and remote consultations - insisting that the profession must work with patients to ensure that health inequalities are not exacerbated by new ways of working.

Figures from this year's GP patient survey quoted in the report showed that a high proportion of people (83%) continued to say that they had a good experience of their GP practice, similar to the results across the previous three years. Satisfaction rates for appointment times also rose to 67% this year, up from 63% in 2020.

But issues were reported around access, while some patients reported issues with chasing up referral requests, prescription requests or having to discuss with a receptionist why they needed an appointment.

Patient experience

Despite the watchdog admitting that the pandemic had been a ‘steep learning curve’ for some practices around remote access, it said that improvements should not be lost during the recovery - but ‘strengthened and embedded’.

It said: ‘We support the RCGP’s call for an evaluation of what ‘good’ looks like for digital triage systems, co-designed with patients and clinicians, to ensure that they do not exacerbate health inequalities.’

NHS England guidance earlier this year said NHS organisations should 'continue to support practices to increase significantly the use of online consultations, as part of embedding total triage', and suggested embedding total triage into the health service could be an 'enduring legacy of the pandemic'.

The RCGP has made clear that remote consultations 'will remain an important way of delivering general practice services in future', although face-to-face consultations will 'always remain a major element of general practice'. College chair Professor Martin Marshall has said that although the right balance will vary between practices and regions, he believes that the current 60% of appointments delivered face-to-face is 'about right'.

Remote consultation benefit

The report found that greater use of remote or digital care had been beneficial for many people, including those would would struggle to attend in-person appointments and people who are anxious about attending surgeries - adding some patients appreciate the 'flexibility' it offers.

'This included people with learning disabilities and people receiving cancer treatment. It said: 'We heard that remote consultations were more accessible for some people with a learning disability and their families and carers, as they removed the barriers imposed by travelling to appointments, particularly cost and time'.

Data around the total number of full-time equivalent GPs was also described as a 'concern' by the watchdog, which stressed that the profession would need the workforce to cope with the potential backlog of patients following disruption to services during the pandemic.

It advised that practices should use the Additional Roles Reimbursement Scheme (ARRS) to create 'bespoke multidisciplinary' teams, but insisted surgeries needed the capacity to supervise and support these new roles to 'meet the ambitions of the scheme.

Primary care leaders have repeatedly called on NHS England to provide additional funding to cover the cost of senior primary care staff taking time to train new recruits brought in by PCNs, as well as increased flexibile to hire a wider range of staff.

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