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GPs delivering good care despite huge demands, but performance ‘unsustainable’

Despite unprecedented demand and ongoing issues with its workforce, general practice is still managing to deliver good care to the majority of patients in England, the CQC has today reported.

Releasing the most detailed analysis of general practice it has ever drawn up, the regulator said that 90% of practices have been rated as ‘good’, whilst only 8% were rated ‘requiring improvement’ and 2% ‘inadequate’ overall.

The report also praised GPs across the country for “driving change and embracing innovation to make sure they are able to deliver even better care into the future.”

It identified that a whopping 82% of general practices that were first rated as ‘requires improvement’ or ‘inadequate’ made sufficient changes to improve their rating at the most recent inspection.

Generally, clinics that had the highest ratings demonstrated strong leadership, a great understanding of all staff’s responsibilities and a clear knowledge of the needs of their patient groups.

“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,” said Professor Steve Field, chief inspector of general practice at the CQC.

“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.”

Prof Field argued that the challenge now is for this focus on quality to be maintained, and for general practice to be supported in giving patients the same high standard of care in future whilst also embracing and driving reform 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,” he added.

“The GP 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.”

RCGP: Improvements being made are not sustainable

But the Royal College of GPs (RCGP) claimed that although the results were clearly a positive sign, the “real story” was that this care was being delivered in incredibly difficult circumstances.

Professor Martin Marshall, the organisation’s vice chair, explained: “At a time when general practice is facing intense resource and workforce pressures, the findings of this report are testament to the hard work and dedication of GPs to work innovatively, and deliver the best possible care for patients.

“However, the fact that GPs are rising to the challenge in the face of ever-increasing demand, does not make it sustainable – we urgently need more investment in general practice, and thousands more GPs, as pledged in NHS England’s GP Forward View.

“To this end, we are pleased to see that the money practices have received as a result of the GP Forward View is being used well – and those practices that have improved since their first inspection should be particularly satisfied.”

Experts from the Nuffield Trust also expressed similar concerns that this situation was unlikely to be kept up in general practice.

“It’s good to see today’s report showing that the vast majority of GP practices provide good or outstanding care, and that standards are rising,” Nuffield Trust deputy director of policy Charlotte Paddison added.

“Given serious staffing and funding pressures, this is a testament to the professionalism and commitment to deliver good care evident in general practice.

“But more work is needed to ensure access to the best primary care for all patients. Pockets of poor care remain: one in ten practices needs to improve, and in 147 practices care was rated ‘inadequate’.”

Paddison also noted that the report suggests urban areas tend to do worse on inspection, with 17% of practices in London rated inadequate or requiring improvement – a discovery which backs up previous research by the think tank.

“We know that deprived urban areas tend to have a disproportionate number of GPs nearing retirement age, and fewer GPs per head,” she explained. “Addressing staffing issues needs to be a priority to support quality of care for the future.

“As we have said before, the lack of comprehensive national data on what happens in general practice is a serious stumbling block. We still do not even know how many consultations take place each year, or who receives them: this needs to be addressed.”

Imelda Redmond, national director of Healthwatch England Imelda Redmond also said: “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.”

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