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GP performance improving, says regulator report

Report shows growing overall 'care injustice' around England

Adrian O'Dowd

Thursday, 11 October 2018

GP performance is improving in England but overall care across the whole NHS varies too much depending on where patients live, creating “care injustice”, according to the annual report* of the Care Quality Commission (CQC) published today.

In its State of Care report, the NHS regulator said most people were still getting good care when they could access it but there was growing “care injustice”, with access to good care increasingly dependent on how well local systems worked together.

The CQC annual assessment of the quality of health and social care in England draws on analysis of inspection ratings of almost 30,000 services and providers, in addition to other monitoring information including staff and public surveys, and performance.

It also uses qualitative analysis of interviews with people who use services, experts and CQC inspection staff.

Overall, quality of care has been largely maintained, and in some cases improved, from last year, says the report.

GP services were improving and in the report’s safety category, 93% of GP practices were rated as “good” – up from 88% in 2017.

Overall, as of July this year, 5% of GP practices were rated “outstanding” (up from 4% in 2017), 91% of GP practices rated “good” (up from 89% in 2017), 4% of practices rated “requires improvement” (down from 6% in 2017), and just 1% of practices rated “inadequate” (down from 2% in 2017).

However, not everything was ideal in primary care said the report authors, who expressed some concerns over the GP workforce in the light of the government enthusiasm to move towards a seven-day service.

“While more than 40% of GP practices now provide access outside of their normal hours, the general practice workforce is increasingly stretched, and there was wide variation in the proportion of patients in local areas that were satisfied with the appointment times they were given, from 45% to 79%,” says the report.

“The general practice workforce is stretched, with a larger workload and the number of GP full-time equivalents falling from 34,592 in September 2015 to 33,890 in December 2017.

“These pressures may be affecting people’s access to their GP practice. Satisfaction with GP services among the general public in most of the UK has fallen to its lowest level for 35 years.”

Overall, people’s experience of care varied depending on where they lived, and those experiences were often determined by how well different parts of local systems worked together, said the CQC.

CQC’s reviews of local health and care systems found ineffective collaboration between local health and care services.

Ian Trenholm, chief executive of the CQC, said: “This year’s State of Care highlights both the resilience and the potential vulnerability of a health and care system where most people receive good care, but where access to this care increasingly depends on where in the country you live and how well your local health system works together. This is not so much a ‘postcode lottery’ as an ‘integration lottery’.”

Responding to the report, BMA council chair Dr Chaand Nagpaul, said: “It is a testament to hardworking doctors and their colleagues that the NHS has managed to maintain high standards of care overall, despite the ongoing pressures of rising demand, workforce shortages and chronic under-resourcing.

“In particular, it is encouraging to see such a high proportion of GP practices performing so well and improving on last year’s figures at a time when the profession faces its own unique struggles.

“However, it is clearly worrying when almost half of A&E departments are rated as requiring improvement or inadequate, and more than a third of mental health trusts are not meeting safety targets.”

Danny Mortimer, deputy chief executive of the NHS Confederation, said: “This concerning report makes it clear that it’s time to get serious about transformation. The delivery of integrated care at scale must be central to the long-term plan for the NHS and supported too by the long overdue green paper for social care.”


*The state of health care and adult social care in England 2017-18. Care Quality Commission, 11 October 2018.

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