The State of Care in General Practice 2014 to 2017 recently published by the CQC makes for interesting and informative reading, especially as it is likely most readers will have undergone at least one CQC inspection by now and will be able to identify with – and make use of – a lot of the content.
By way of an introduction, the foreword by Professor Sir Steve Field tells us 7,365 practices were inspected and given a first rating after registration in October 2014. General practice has received among the highest ratings of all the sectors the CQC regulates. As of 16 May 2017, 9 out of 10 practices rated as good or outstanding. This may emerge as something of a surprise to many working in general practice in light of all the challenges we face – not least the ever-widening gap between the demands of a growing population living longer with complex medical needs and the capacity of general practice to meet those needs.
Patient Care in New and Innovative Ways
The report shares information from inspections where practices were found to be delivering patient care in new and innovative ways that benefit patients. As well as the wider community in some cases – to encourage others to learn, take inspiration or simply adapt what is relevant to help them improve. The practices found to be providing the highest quality of care generally were those that proactively engage with patients to identify local needs and use their understanding to create a strategy for providing services that respond effectively – and sometimes innovatively – to meet these needs. Practices that demonstrate strong leadership with good skill mix; have good external relationships and partnership working arrangements and those sharing learning with others in the wider health and care community.
At initial inspection 17% of all practices were found to be unsatisfactory: 13% were rated as requires improvement and a 4% as inadequate with action taken to protect the public where necessary and follow-up re-inspection of improvement(s) required. A few cases were so serious and patients were considered to be at such risk that the provider’s registration was cancelled using the ultimate power accorded to the CQC.
Professor Field reports that practices being open and willing to learn makes them more easily able to respond quickly to the issues identified in the CQC inspection reports and make quality improvements. Many practices are reported to have told the CQC their inspection provided valuable feedback on what they were doing well and where they needed to improve which resulted in them taking action on inspection findings and so improving the care they provide: as demonstrated by the percentage of practices originally rated as requires improvement or inadequate that improved their ratings following re-inspection.
Improvements Still Needed
The good news figure of 9 out of 10 practices rated as good or outstanding in May of this year also demonstrated one in every 10 practices was neither good nor outstanding and so needed to improve.
However, even with targeted input, some practices have been unable to sustain improvements. This supports the view put forward by the Chief Inspector in his foreword that good and outstanding GP practices can act as the driving force for service changes and more integrated care in their local area. Therefore, the CQC is completely behind the pledges made by NHS England in the General Practice Forward View to increase funding for general practice, improve leadership, increase the frontline workforce and skill mix and invest in infrastructure.
State of Care in General Practice – Next Phase
The findings of CQC’s first programme of inspections will serve as the baseline for the quality of general practice. It will be reflected in their awaited Next Phase of regulation.
The aim of the Next Phase will be a greater focus on outcomes for patients; understanding where the quality of care is changing; sharing what they know about what works well, together with the remaining challenges for general practice; while working collaboratively with commissioners and other stakeholders to reduce duplication of what the CQC asks of general practice and form a shared view of quality.