Workforce crisis undermining practices' ability to sustain improvement, warns CQC

The overall quality of general practice in England is high - with 95% of practices rated good or outstanding - but capacity problems across the profession are undermining improvement, the CQC has warned.

(Photo: Robert Johns/UNP)

The continuing high quality of general practice is encouraging given that the profession is 'having to evolve in the way it delivers care in response to growing demand and an ageing population', the CQC's annual 'State of Care' report warns.

A total of 5% of GP practices in England are rated outstanding, while 90% are good, 4% requires improvement and just 1% inadequate, the report shows. These scores are by far the best recorded for any sector rated by the watchdog - among hospitals, for example, more than one in four are rated either inadequate or requires improvement.

Among primary care out-of-hours providers, none are now rated inadequate and just 4% are rated requires improvement - a sharp improvement from the position in 2018 when one in five out-of-hours providers were rated in the two lowest categories.

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Map: How CQC ratings for general practice vary across England

The CQC report highlights concerns about access and staffing in mental health services, pointing to a 'real deterioration in some specialist inpatient services' that have affected quality. Adult social care has also suffered from staff and funding shortages, the report warns.

In general practice, the high quality of care provided in the face of significant pressure is 'testament to the dedicated practice teams', the CQC report says.

However, it warns that 'getting access to services can be a challenge' and warns that patients' experience of primary care can be affected by 'insufficient integration between different types of services'.

Some GP practices have moved 'up as well as down' in ratings, and there are 'signs that improvemnet has become harder to achieve and to sustain', the report adds.

GP ratings

An evaluation of changes to practices ratings after re-inspection shows that 'a large group of GP practices have failed to improve and move out of the lower ratings and more than a third of practices rated as inadequate have not improved on re-inspection'.

The CQC report warns that 'ongoing capacity pressures on general practice as a whole may affect the ability to improve' and calls for funding to be targeted to support general practice.

BMA chair Dr Chaand Nagpaul said: 'Patients should be able to expect good standards of care right across the health service but the unacceptable variations of care highlighted in this report shows that many are being let down as a result of historic underinvestment.

'While mental health and learning disability services are highlighted as being particularly poor performing, there are clearly pressures right across the health service which will only be heightened as we enter the winter months.

NHS workforce

'As well as addressing the workforce crisis, we need to see investment and resources being delivered across primary, community and secondary care, to address these unacceptable variations and ensure patients have access to the high level of care they deserve.'

GMC chief executive Charlie Massey said: ‘The CQC’s State of Care highlights the risks created by workforce problems in the health system and the impact this is having on patient care. Our own research has highlighted the impact that such pressures are having on doctors and the wider workforce, and the need for supportive working and training environments.'

An NHS England spokesperson said: 'Despite the busiest-ever summer in emergency departments - and more than half a million more visits than the same time last year – it’s good to see CQC saying hospitals, family doctors and mental health services continue to deliver good quality care -  a testimony to hardworking NHS staff.'

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