More than four in five GP practices rated by the Care Quality Commission have been judged ‘good’ or ‘outstanding’, analysis by HSJ has found.

  • More than four in five GP practices rated by the Care Quality Commission have been judged good or outstanding
  • Calls for CQC to review GP inspections after first round of ratings
  • Seventeen practices rated inadequate or requires improvement for every inspection area

HSJ collated information from the 792 GP practice inspection reports published by the CQC since it began rating them in October.

An overwhelming majority of practices (652 or 82.3 per cent) were rated good and 24 (3 per cent) received the top rating of outstanding. Only one in 10 practices (87) were rated “requires improvement”, and 29 (3.7 per cent) were given the lowest rating of “inadequate”.

The findings contrast with the substantial public and political concern about access to GP services at present. The past year has also seen prominent national NHS leaders call for substantial reform of primary care provision.

The CQC ratings are unlikely to be a good basis for directly comparing the quality of GP practices and other providers. However, the different impact of the regimes for GP practices and acute hospitals can be seen in the much larger proportions of the former rated good or outstanding.

HSJ also analysed practices’ ratings for the five areas the CQC examines - safe, effective, caring, responsive and well led - and across its six patient groups, which include older people and those experiencing poor mental health.

We found those GP practices rated inadequate performed poorly across all these areas. They were all rated inadequate in relation to safety and, apart from one practice, for leadership. They were also all judged to be inadequate across all patient groups, with one exception.

Seventeen practices were rated inadequate or requiring improvement for every area and patient group.

All practices rated as requiring improvement overall also had requiring improvement or inadequate ratings for safety. However, most were rated good for being caring and responsive.

Although more than 85 per cent of practices were rated good or outstanding overall, only three were rated outstanding across all areas.

There are around 8,000 practices in England, so around one-tenth have ratings so far.

In response to the findings, Nuffield Trust visiting fellow and Greenwich GP Niraj Patel said the CQC should move to more targeted inspections for the sector after it had visited every practice once.

He said inspecting all of them initially was important to “understand the landscape” of primary care, as it had been “considered to be a black box”.

“But I think it would be sensible to have a stock take at that point to understand what is it that we want to achieve,” he added.

“If we want to achieve a safe primary care system, then what we don’t want to do is overburden good and excellent practices. What we want to do is concentrate on the ones that need improvement.”

Dr Patel said “primary care organisations may also be very different in five years’ time” with “fewer, quite different contractual models”. This might require a rethink about the most appropriate inspection model. The NHS Five Year Forward View’s proposed new models of care involve substantial changes to GP provision.

University College London professor of healthcare improvement Martin Marshall, who is also a practising GP, said the CQC’s approach would “need to be [evaluated] in order to understand what the benefits are on one side and what the costs are on the other”.

“At the moment we don’t know enough about it, and too much of regulation is driven by ideology than it is by evidence,” he said.

British Medical Association GP committee chair Chaand Nagpaul said GPs had been “asked to adapt to a system that has been employed in hospitals rather than actually be appropriate for assessing GP services”.

He added that the rating process was “very unfair to some practices for whom there may have been circumstances [explaining] the way in which care was being provided at a moment in time”, but that had been “tarred with a label for the foreseeable future”.

A CQC spokeswoman said: “This is the first cycle of inspection of general practices in England and we are reassured that the majority so far are rated good.”

6 May 2015 3pm: Updated to make clear we are not suggesting the CQC ratings should be used to judge that GPs are better quality than acute hospitals, or that direct comparisons can be made between the two sectors using the makeup of CQC ratings.

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