Heavy workload key factor behind poor GP ratings, warns CQC report

Problems triggered by heavy workload and staff vacancies are often to blame for poor practice, according to a report by the watchdog on 10 GP surgeries that secured dramatic improvements in their CQC rating.

A CQC report based on interviews with staff at 10 practices across England that received poor ratings found that in many cases 'hard-working GPs – sometimes in surgeries affected by vacancies – have not been able to find time to effectively manage the practice on top of their clinical responsibilities'.

The report adds: 'Couple this with the absence of a practice manager, or a practice manager who doesn’t have the appropriate skills or experience to lead the practice team, and failure beckons.'

Problems with staffing were a feature of many practices that received poor iniital ratings, the CQC says, with many facing staff shortages, and others problems with a lack of clarity over roles, a lack of training and appraisal, and poor recruitment processes.

CQC ratings

Nine of the 10 practices featured in the CQC report were initially rated ‘inadequate’ and placed into special measures, but improved to ‘good’ on their last inspection, while a 10th practice in Norfolk went from ‘requires improvement’ to ‘outstanding’.

All 10 improved their ratings in under two years and two achieved ‘good’ status in just eight months, the CQC report shows.

Many of the problems faced by these practices were less about clinical care and more to do with the operational and business foundations on which they were based, the watchdog found.

Litcham Health Centre GP Dr Julian Brown, whose practice improved to 'outstanding' from 'requires improvement', said: ‘We were pretty good on outcomes for patients, but the report did highlight flaws in our processes and identified some failings, so we did a deep dive… and realised we needed to strengthen our management.'

Small practice

The Norfolk GP added: 'The problem with a small surgery like this, with someone like me who focuses on the clinical side, you need to have someone who focuses on the blind spots. And we’ve now got that. Maybe I had focused too much on front line and left holes in the overall management of practice.'

The practice sought initial support from an adviser, and has now brought in new practice managers, who have overhauled governance processes and training.

Key factors identified by the CQC that contributed to improvement across the 10 practices included:

  • Ensuring practices had strong leadership from a practice manager.
  • Addressing staffing and training issues.
  • Ensuring that every member of the practice team understood their role, and involving the whole team in the running of the practice.
  • Realising the benefit of involving patients and the local community.
  • Accessing external support, locally or nationally.

CQC chief inspector of general practice Professor Steve Field said: ‘This report is a celebration of excellent general medical practice, commitment to patient care and a testament to the hard work carried out every day by practice teams across England.

Quality of care

‘As general practice is the first port of call for most patients, it is vital that we listen to what practices have to say and similarly, it is vital that they engage with the wider system and resist the professional isolation that can lead to poorer care.’

Health and social care secretary Jeremy Hunt described the improvements made by the 10 practices as ‘a big achievement’.

‘The hard working GPs and staff at these practices which have shown remarkable improvements in quality and safety deserve huge credit,’ he said.

‘Reaching a good or outstanding rating demonstrates sheer hard work and a real commitment to patient care.’

Professor Field concluded: ‘I am incredibly grateful to all of the practice teams who worked with us in pulling this report together. The lessons from these conversations can help other practices as they face the very real pressures of modern general practice at a time of growing patient demand and workload.’

Inspections of every GP practice in England carried out by the CQC found that nine out of 10 were good or outstanding - a far higher proportion than for any other type of NHS provider organisation.

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