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Tired GPs greatest threat to patient safety

Regulator should focus on real issues that affect patient safety, say GP leaders

Louise Prime

Thursday, 13 October 2016

Exhausted doctors are a far greater threat to patient safety than practices having no policy to monitor the use of blank prescriptions or being behind with legionella risk assessments, GP leaders insisted this morning. They called on the Care Quality Commission to focus on what really matters to general practice rather than beating GPs with a stick for failing to go on refresher courses while they cope admirably with rocketing patient demand.

The CQC this morning published its latest annual assessment of the quality of health and adult social care in England. It reported that 83% of the GP practices inspected were ‘good’ and 4% were ‘outstanding’; 51% of the core services provided by NHS acute hospital trusts were ‘good’ and 5% ‘outstanding’; and 71% of adult social care services were rated ‘good’ and 1% ‘outstanding’.

The regulator acknowledged that the quality of care provided by primary medical services remains high. But it said primary care must consider how it will respond to the increasingly difficult conditions that it faces, in order to maintain quality, now and in the future.

The BMA praised the “remarkable level of achievement” of almost nine in every ten practices inspected being rated as good or outstanding, particularly in the current climate. But both the BMA and the Royal College of GPs pointed out that practices being rated as needing improvement because they are struggling to meet quality standards often results from factors beyond their control – such as shrinking budgets, significant increases in patient consultations and difficulties in trying to recruit sufficient GPs to meet patients’ needs.

RCGP chair Dr Maureen Baker said: “Once again, we see a throwaway line in a CQC report distorting the real story that the overwhelming majority of GP practices are doing an excellent job of delivering safe care to the highest possible standards.”

She insisted: “The biggest threat to patient safety is tired doctors: GPs, and other members of the general practice team, who are worn out as a result of trying to manage rocketing patient demand as our service carries out 1.3 million patients consultations every day, against a backdrop of a decade of dwindling resources. It is not a GP practice without a policy in place for monitoring the use of blank prescription forms or because it hasn’t carried out a legionella risk assessment.”

She said that although it is crucial to urgently address any variations in quality of care, “we should be working to support practices – not be beating them with a stick because a GP has not attended a refresher training course.”

She demanded: “We need the CQC to focus on the issues that are really important to general practice and work with us to ensure that the pledges in the GP Forward View are delivered swiftly and effectively so that practices are appropriately resourced – with sufficient GPs – for us to do our jobs.”

The CQC welcomed the rise of collaboration in primary care, with practices forming new models of care, joining together in federations, and involving care users from an early stage; but it also called on health and social care services to work much better together.

CQC chief executive David Behan commented: “What distinguishes many of the good and outstanding services is the way they work with others – hospitals working with GPs; GPs working with social care and all providers working with people who use services. Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more people whose needs aren’t meet, less improvement and more deterioration.”

* The state of health care and adult social care in England 2015/16. Care Quality Commission, October 2016

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