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General Practice delivering improvement and innovation, despite facing “very real” pressures

The most detailed analysis yet of the quality and safety of general medical practice in England has found that nearly 90% of general practices in England have been rated as ‘good’, making this the highest performing sector the Care Quality Commission (CQC) regulates.

With GPs facing ongoing pressures around capacity, patient demand and workload and at a time of service redesign, the best general practices are driving change and embracing innovation to make sure they are able to deliver even better care into the future.

In a national report, published Thursday, September 21, 2017, the CQC has found that at the end of its first inspection programme of general practices when many had been re-inspected, 4% were rated ’outstanding’, 86% were ’good’, 8% were ‘requires improvement’ and 2% were ‘inadequate’ overall.

This is an improvement from the first ratings awarded to general practices (prior to any re-inspections) when overall, 4% were ‘outstanding’, 79% were ‘good’, 13% were ‘requires improvement’ and 4% were ‘inadequate’.

CQC’s regulation of primary care is supporting people to receive better care in general practice by setting clear standards of quality and safety and ensuring providers meet them, by sharing examples of what is working well, and by encouraging extra support for the sector through the General Practice Forward View.

82% of the general practices that were first rated as ‘requires improvement’ or ‘inadequate’ improved their rating following their most recent inspection.

The report also notes that on re-inspection, 2% of general practices were rated as inadequate for their safety. This improved from 6% in the first ratings CQC awarded. General practices with the highest ratings are those that demonstrate strong leadership; have an understanding of everyone’s responsibilities in the practice team; have a clear knowledge of the different needs of their patient groups; and recognise the importance of working as part of their wider local health economies.

Prof Steve Field, Chief Inspector of General Practice at the Care Quality Commission, said: “This is the first time that we have such a detailed national view of the quality of general practice in England, made possible through CQC’s regulation. Having inspected and rated 7,365 general practices across the country, we have found that the clear majority are safe and of a high quality. Where we identified concerns, most practices have taken action and improved. GPs, practice managers and other primary care staff should be commended for their efforts.

“The challenge is for this focus on quality to be maintained and for general practice to be supported in continuing to give patients this same high standard of care in future while embracing and driving the changes elsewhere in the system. The pressures on GPs are very real but we have found many practices are already delivering care in new and innovative ways to benefit their patients and the wider community.

“The General Practice Forward View sets out the plan for sustainable and high-quality primary care in England. Nearly eighteen months later, the commitments made must continue to be targeted and delivered appropriately to meet people’s local primary care needs. Otherwise, improvements in the quality of care will come to a standstill. We want to encourage continual improvement in the quality of care in general practice so that patients, whoever they are and wherever they are in England, get the high standard of care they have come to expect and deserve.”

In October 2014, CQC formally introduced its new regulatory regime for primary medical services. This saw the start of expert-led, specialist inspections that focused on what matters most to people using services – whether they are safe, caring, effective, responsive and well-led – as well as the introduction of performance ratings of ‘outstanding’, ‘good’, ‘requires improvement’ and ‘inadequate’ to help people make informed choices about their healthcare.

CQC has used these findings to develop how it monitors and inspects general practices across the country. Under proposals that CQC consulted on earlier this year, practices rated as ‘outstanding’ or ‘good’ would be re-inspected at intervals of up to five years, while those rated as ‘inadequate’ and ‘requires improvement’ would still be re-inspected by CQC after six months and 12 months respectively. Also, practices would be able to showcase their performance more proactively through annual data collections that would be used by inspectors to decide when to inspect. CQC will continue to respond quickly to protect people, when necessary.

Visit cqc.org.uk/publications/major-report/state-care-general-practice-2014-2017 to read the report in full.

Director of Healthwatch England, Imelda Redmond said:

“GPs are the frontline of the NHS, so it is encouraging to see most practices coping well with current pressures and continuing to provide their patients with good quality care.

“There is still variation in places, but as the CQC’s report underlines, one of the best ways practices can improve is to welcome and recognise the importance of patient feedback. This includes dealing with people’s complaints compassionately and learning from when things go wrong.

“We know that people are keen to share their comments and ideas with their GPs, but most don’t know how. But by keeping it simple, through the use of private and more personal channels such as comment boxes and follow-up text messages, practice staff can make it easy to share feedback and send a strong signal to patients that they are willing to listen.

“Healthwatch is here to help busy surgeries not only improve how they engage with their patients but also help GPs and practice managers explain how this insight is being used to give people the care they want.”