• First time that CCGs and STPs have been ranked by CQC ratings for best and worst performing GP surgeries in their region
  • Huge variation uncovered: five CCGs with 10 per cent of more surgeries rated inadequate, and four CCGs with 20 per cent of more rated outstanding
  • Nuffield Trust says the best performing CCGs and STPs point towards a culture of strong leadership, investment and peer led improvement

HSJ analysis shows for the first time which clinical commissioning groups and sustainability and transformation plans have the highest proportion of the worst and best rated GP surgeries.

HSJ reviewed all Care Quality Commission GP inspection reports published by 1 March 2017 to reveal the proportion of GP surgeries in each CCG that received a rating of inadequate, requires improvement, good or outstanding. The data covers 6,476 GP inspections across England, out of a total of 7,705 by the CQC, accounting for 84 per cent of all surgeries. The regulator is still to publish the rest of its GP inspection reports.

The data revealed wide variation across the country, with five CCGs with at least 10 per cent of practices rated inadequate. In contrast, 32 CCG areas have at least 10 per cent of GPs rated outstanding, with four of those having more than a fifth of GPs in their region rated outstanding.

Per capita spend and the deprivation of an area does not seem to affect the amount of poor GP practices in a CCG area.

Map: The CCG areas with best and worst performing GP practices

Map key

  • Green = 0-0.1 per cent of surgeries rated requires improvement or inadequate
  • Yellow = 0.1-10 per cent of surgeries rated requires improvement or inadequate
  • Orange = 10-25 per cent of surgeries rated requires improvement or inadequate
  • Red = 25-100 per cent of surgeries rated requires improvement or inadequate

Rebecca Rosen, senior fellow and the Nuffield Trust, said: “It’s a tradition of leadership, investment in primary care and focus on peer led improvement that define the high performers”. She pointed out that Rushcliffe CCG, which has 27 per cent of surgeries rated outstanding, has been using data on quality to drive peer review and peer performance, as has Tower Hamlets, which has been working since 2008 to drive up the quality of its general practice.

HSJ has also mapped the data against STP areas to show which face the biggest primary care challenges.

Map: The STPs with best and worst performing GP practices (key same as above)

Derbyshire STP has 19 per cent of practices rated outstanding, followed by West, North and East Cumbria STP with 17 per cent of surgeries receiving the top rating.

In contrast, Mid and South Essex STP has almost 8 per cent of practices rated inadequate, followed by Suffolk and North East Essex STP with 4.6 per cent.

Dr Rosen said Nottinghamshire and parts of Cumbria have “spent years” driving collaboration in primary care. She said for STPs to get GP surgeries to work at scale, just investing money “might not get you where you want to be”, and cash injections need to be paired with “support teams” going to practices to get management operating systems in place. The worst performing areas would “need serious organisational development leadership change” to bring improvements, she said.

Table: Top five CCGs with the highest percentage of GP surgeries in each CQC rating

CCG% of GP surgeries rated requires improvement and inadequateCCG% of GP surgeries rated inadequateCCG% of GP surgeries rated requires improvementCCG% of GP surgeries rated goodCCG% of GP surgeries rated outstanding
Havering 48.4 Castle Point, Rayleigh and Rochford 13.6 Havering 45.2 Fourteen CCGs had 100 per cent of its GP surgeries rated good:

 

Corby, Fylde and Wyre, Isle of Wight, Lancashire North, Leeds North, Newark and Sherwood, Newbury and District, North and West Reading, North Lincolnshire, Scarborough and Ryedale, South Tees, Thanet, Vale of York, Warwickshire North, Wyre Forest

 

 Nottingham West 46.2
Waltham Forest 37.1 Thurrock 13.6 Waltham Forest 37.1 Ashford 28.6
Thurrock 36.4 Oldham 12.1 Mansfield & Ashfield 31.8 Rushcliffe 27.3
Barking & Dagenham 34.5 Portsmouth 11.1 South Reading 31.6 North Derbyshire 22.9
Mansfield & Ashfield 31.8 Barking & Dagenham 10.3 Slough 28.6 North Tyneside 19.2
        South Lincolnshire 28.6 South Warwickshire 19.2

Table: Top five STPs with the highest percentage of GP surgeries in each CQC rating

STP% of GP surgeries rated inadequate and requires improvementSTP% of GP surgeries rated inadequateSTP% of GP surgeries rated requires improvementSTP% of GP surgeries rated goodSTP% of GP surgeries rated outstanding
North East London 27.6 Mid and South Essex 7.7 North East London 24.0 Humber, Coast and Vale 95.5 Derbyshire 18.6
Mid and South Essex 23.1 Suffolk and North East Essex 4.6 Black Country 17.9 Somerset 95.2 West, North and East Cumbria 17.4
Black Country 19.9 Cambridgeshire and Peterborough 4.0 Buckinghamshire, Oxfordshire and Berkshire West 15.5 Herefordshire and Worcestershire 93.5 Devon 14.6
North West London 16.8 Lincolnshire 3.8 Mid and South Essex 15.4 West Yorkshire 92.5 Nottinghamshire 12.6
Buckinghamshire, Oxfordshire and Berkshire West 16.7 North East London 3.6 North West London 14.6 Hertfordshire and West Essex 92.3 Norfolk and Waveney 10.5

Topics

Mapped: CCGs and STPs with the best and worst GPs