Larger practices and those in federations score highest CQC ratings

Practices with larger list sizes 'tend to be rated better' in CQC inspections, according to a comprehensive report on ratings from the regulator, which also warns of an impending collapse in adult social care.

The CQC’s State of Care report, its annual assessment of health and adult social care in England, shows that 83% of practices have been rated good, with 4% outstanding. One in 10 (10%) are requires improvement, while 3% are inadequate.

Chief executive David Behan said the results showed the majority of practices were providing good quality care, adding that ‘success of the health system relies on a strong general practice’.

But analysis of ratings in the report shows that practices with larger list sizes and those working collaboratively with others may be more likely to receive higher ratings.

It also shows that practices are more likely to fall down on the CQC's 'safety' domain during inspections, and that adult social care is nearing a 'tipping point' that could lead to collapse – and impact on general practice.

Map: GP CQC ratings

The regulator found a correlation between the average list size of practices with different ratings – with the average inadequate practice having a list size of 4,755, requires improvement 6,311, good 7,682 and outstanding 9,598.

The report added that although many small practices have performed well in inspections, those that work in isolation ‘have often struggled’.

Mr Behan said it was ‘too early’ to tell whether practices in federations are more likely to perform better in inspections, but the report says inspectors have seen 'good results' where independent practices work together.

He told GPonline: ‘I think what we’re seeing is federations coming together and collaborating to do things like continuing professional development, or to ensure GPs have access to training.

‘That’s a welcome development, as those economies at scale are developed by practices coming together as federations. And that’s a driver for improvement in general practice.’

GP safety rating

The report also shows that the CQC has ‘concerns about safety’ regarding general practice, revealing that this is the area GP practices are most likely to trip up on during inspections.

A quarter (26%) of practices rated so far have received a score less than ‘good’ for being safe, over twice as many as in any of the CQC’s other 'key lines of enquiry' – categories looking at how effective, caring, responsive and well-led practices are, that feed into their overall rating.

This compares to just 4% failing to secure a good rating for caring, practices’ highest performing area, and the 13% who fell short of a good or outstanding rating overall.

According to the CQC, its safety domain refers to whether practices can demonstrate that staff are aware of their responsibilities to raise concerns and that they learn and improve after mistakes are made.

Common areas where practices have fallen down on this include not regularly recording health and safety incidents, inadequate equipment and training for medical emergencies and not conducting checks on storage conditions and expiry dates of medicines, it added.

Adult social care crisis

Mr Behan also warned of a looming crisis in adult social care services that could impact general practice and other NHS services.

Rising pressures on demand, access and cost means adult social care services may not remain sustainable for long, despite 72% being rated good or outstanding so far, the regulator said.

The CQC is ‘calling for greater collaboration’ between these services and GP practices to help alleviate this ‘urgent situation’, he said.

'What distinguishes many of the good and outstanding services is the way they work with others – hospitals working with GPs; GPs working with social care and all providers working with people who use services.

'Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more people whose needs aren’t met, less improvement and more deterioration.'

Commenting on the report, GPC deputy chairman Dr Richard Vautrey said: ‘Given the incredible pressure on general practice it is a remarkable level of achievement that close to nine in 10 practices are rated as good or outstanding.

‘No practice that delivers care in an unfit manner would be allowed to remain open. Instead of demonising those practices that are struggling, we do need to ensure that every local GP service is given enough resources and staff so it can meet public demand.’

Photo: iStock

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