Practices with smaller list size perform worse in CQC inspections

The average practice rated 'inadequate' by the CQC has a list size just half the size of the average 'outstanding' practice, GPonline can reveal, as senior GPs warn that smaller practices are buckling under bureaucratic pressures.

A GPonline investigation compared CQC ratings data from over 1,700 practices to the most up-to-date practice list size data, revealing that ‘outstanding’ practices have – on average – a list size twice as large as the average ‘inadequate’ practice.

The average list size for ‘outstanding’ practices comes to almost 10,000, while the figure for 'inadequate' practices is just over 5,000, suggesting that smaller practices are being hit much harder by the CQC's intensive inspection regime.

The results are unveiled in the wake of a comprehensive CQC report on the State of Care in the UK, in which the watchdog criticised smaller practices – particularly single-handed practices – which it warned were more likely to work in ‘an environment that is not open and transparent’.

Single-handed GPs have a tendency to ‘work in professional isolation’, it said, which can result in ‘a lack of communication and engagement with staff and patients’.

Map: CQC GP ratings

The results show a clear correlation between list size and CQC performance, showing that 'outstanding' practices have an average list size of 9,901; 'good' practices of 8,088; 'requires improvement' practices of 6,897 and 'inadequate' practices of 5,328.

Just shy of a quarter of GP practices have been rated to date, with 83% achieving ‘good’ or ‘outstanding’ grades. One eighth have been rated ‘requires improvement’ and 4% ‘inadequate’.

The State of Care CQC report said small practices were 'struggling': ‘A relatively high proportion of the larger practices, with more GPs, have received good ratings, and some small practices have struggled, particularly those where the GPs are professionally isolated and lack local structures that enable them to connect with peers. It will be important to see how the market continues to develop.

GPC deputy chairman Dr Richard Vautrey said: ‘Most practices are struggling to cope with the rising bureaucracy that is part and parcel of general practice today, but this burden falls on fewer shoulders in smaller practices.

‘While 85% of practices are being rated by CQC as "good" or "outstanding" – something that should be celebrated more widely – there are a very small number of practices that need more support.

‘It's one of the reasons we are promoting the use of networks and federations so that practices can work together and share resources to enable them to cope with the bureaucratic expectations in a better way.’

GP federations

CQC also called for a push towards more smaller practices joining up and working together at scale rather than in isolated groups.

‘Over the last 10 years the number of single-handed GP practices has fallen dramatically. We are now seeing the benefits of larger practices and joined up models of working,’ it said.

‘These include offering appointments to patients outside normal working hours by taking shared responsibility for extended accessibility, and providing a wider range of services than most practices are able to deliver on their own.

‘There are clear improvement opportunities for services rated below "good" and "outstanding" – in particular, for smaller isolated practices where collaborative working would be hugely beneficial.’

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