The chief inspector of GPs’ most instructive contribution to the debate on primary care this week was not the data dump of risk ratings for England’s 8,000-odd practices, but the one surgery he singled out as providing “outstanding” services across the board.
Salford Health Matters runs three surgeries in more deprived areas of Greater Manchester.
It is one of the largest GP providers in the area, takes prevention and its role in the community very seriously, and runs an extended set of services. It operates a drop-in service for homeless people and makes it as easy as possible for them to see GPs.
One of the biggest problems in primary care is persistent underprovision in poorer areas and bad access verging on discrimination for some migrants, sex workers, homeless and other vulnerable people.
They are often in need of good primary care. There is a risk of the sector’s problems being mistakenly treated as a general dissatisfaction with appointment speed and convenience.
‘One of the biggest problems is persistent underprovision in poorer areas’
Another unusual characteristic of Salford Health Matters is that it is a social enterprise rather than a partnership. All its GPs are employees and work across all its sites, and it has what the Care Quality Commission calls a “very good skills mix”, with extensive use of advanced nurse practitioners.
The practice is one of the first two to be given ratings by the CQC; hundreds more are due in coming weeks. These ratings will become a new force for the overhaul of services and the provider landscape.
Transparency about which practices are bad, as well as adding to the sense of crisis in the sector, will act as another “stick” forcing some GPs to overhaul their services, join or merge with neighbours, or throw in the towel altogether.
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The report on Salford Health Matters confirms that glowing judgements will not be given just for being good at the basics, but for displaying the characteristics of modern primary care such as scale, extended services, blurred boundaries with community and acute care, health promotion, use of technology, and good leadership.
‘The CQC’s findings should help others change the way they work more quickly’
The CQC is right to judge services in this way and its findings should help others change the way they work more quickly.
Perhaps more important, given the pressure within primary care to change is already immense, is that the inspection regime must help resolve some of the disagreements and policy dilemmas that have been skirted around by officials, and will otherwise hamper change.
Top of the pile is that inspections are confirming the need for capital funding to improve and create new primary care premises, which in many areas is urgent.
The CQC could help spell out the gap between what exists and what is needed.