GPs maintaining high quality despite rising pressure, finds CQC analysis

GP practices have excelled in CQC inspections despite 'unprecedented challenges' facing the sector, according to the watchdog's most comprehensive analysis yet of data from inspecting all practices in England.

The state of care in general practice 2014 to 2017 report, which analyses the CQC's findings from inspecting and rating all practices registered since October 2014 is the 'most detailed analysis of the quality and safety' of general practice to date, the watchdog said.

In total, 7,365 practices have undergone the process, offering an ‘unprecedented detailed view of the quality of all GP practices’, according to the CQC.

Following conclusion of its inspection programme, 4% of practices were found outstanding, 86% good, 8% requires improvement and 2% inadequate.

Map: CQC ratings across England

In total, 299 practices were rated outstanding, 5,934 good, 528 requires improvement and 116 inadequate.

GPs have consistently achieved the highest ratings out of all sectors the CQC regulates.

The watchdog formally introduced its current regulatory regime for GPs in October 2014, when it introduced its key questions – are practices safe, effective, responsive, caring and well-led? – and its Ofsted-inspired four-point rating scale.

The CQC is scheduled to revamp this process again over the coming year, starting from next month.

Proactively identifying and effectively responding to local needs is one of the secrets to great and outstanding care, according to the report. Adopting ‘innovative approaches that deliver real impact’, sharing learning internally and externally and effective multidisciplinary working were also associated with highly performing practices.

Size link to ratings

However, the report acknowledges that other factors came into play, admitting there is a ‘link’ between size of practice and higher CQC ratings.

It suggested that this may be because it is easier to have staff with defined roles in a larger practice, and there is greater likelihood there will be well-functioning nursing teams where nurses focus on particular areas.

GPonline has previously revealed that the size of GP practices, geography and levels of funding are all associated with higher CQC ratings.

But the CQC's report said it did 'not [find] any causal relationship between the funding that practices receive from the NHS and our ratings'. It added: 'This is a complex area that may benefit from further work.'

Safety remains the most likely element of CQC checks that GP practices struggle with, with one in three initially rated as requires improvement or inadequate on this point.

Practices were likely to fall down on this area because of the way they managed serious incidents and what processes they had in place to ensure incidents do not happen again.

Clinical governance

It said that the main way practices make improvements is by acknowledging the problems, resolving governance issues, support from external bodies and improving leadership – particularly the leadership role provided by practice managers.

Professor Steve Field, CQC chief inspector of general practice, said: ‘This is the first time that we have such a detailed national view of the quality of general practice in England, made possible through CQC’s regulation.

‘Having inspected and rated 7,365 general practices across the country, we have found that the clear majority are safe and of a high quality. Where we identified concerns, most practices have taken action and improved. GPs, practice managers and other primary care staff should be commended for their efforts.

‘The challenge is for this focus on quality to be maintained and for general practice to be supported in continuing to give patients this same high standard of care in future while embracing and driving the changes elsewhere in the system.

‘The pressures on GPs are very real but we have found many practices are already delivering care in new and innovative ways to benefit their patients and the wider community.

‘The GP Forward View sets out the plan for sustainable and high-quality primary care in England. Nearly 18 months later, the commitments made must continue to be targeted and delivered appropriately to meet people’s local primary care needs.

‘Otherwise, improvements in the quality of care will come to a standstill. We want to encourage continual improvement in the quality of care in general practice so that patients, whoever they are and wherever they are in England, get the high standard of care they have come to expect and deserve.’

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