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Better CQC ratings linked with higher GP funding

by Anviksha Patel
4 December 2019

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Greater core funding in general practice is ‘significantly associated’ with higher CQC ratings, according to new research.

The research, published in the BMJ Open, found that increased funding per patient was associated with higher CQC ratings across the ‘caring’, ‘effective’, ‘responsive’, ‘safe’ and ‘well-led’ areas of assessment, as well as the overall rating given to the practice.

The researchers concluded that ‘good-quality care’ follows ‘good funding’.

The cross-sectional study covered three years of data from over 7,000 practices in England and looked at the association between CQC ratings and practices’ capitation funding.

Using the data, researchers evaluated a mean capitation payment per patient for each year from 2014 to 2017 and revealed that 13% are more likely to receive an ‘outstanding’ CQC rating if they had higher capitation funding.

Meanwhile training practices are 2.3 times more likely to be awarded ‘outstanding’ than non-training GP surgeries.

Funding inconsistency

The findings also show funding is not keeping up with population demand in deprived areas and also in areas with higher ethnic minority populations.

One of the study’s authors said the results demonstrate why GPs are struggling to meet CQC criteria.

Dr Mark Ashworth, reader in primary care at King’s College London and former London GP, said: ‘It shows GPs are struggling to provide high-quality care in the space of insufficient funding. If they do get good funding, that good-quality care follows.

‘We found a lot of evidence that additional funding in primary care really does translate into improved quality. Quality care cannot be delivered without quality investment in primary care.

‘Many of the practices who were not doing well with CQC ratings were receiving very low payment per patient.’

He added: ‘There were two specific areas where the funding didn’t seem to have kept up with the population needs, so you get back into that discussion of inverse care law, where needs are highest. It appeared that in deprived areas and areas with higher ethnic minority populations, the funding wasn’t keeping up with population demand. It was particularly hard to deliver high-quality care in those areas.

‘A message to policy-makers is additional funding appears to be necessary in more deprived communities.’

‘Revisions necessarily’

The study concluded: ‘This study suggests that measured and inspected dimensions of the quality of care are related to the underlying funding allocated to each general practice, implying that additional funding may be associated with higher levels of primary care quality.’

It added: ‘Our findings suggest that revisions to the primary care capitation formula are necessary to ensure that additional funding is provided in urban areas of high deprivation and ethnic minority populations in order to address quality of care inequalities.’

Professor of primary care at Imperial College London, Professor Azeem Majeed, said the study confirms funding is important in determining the quality of services but noted it does not prove what the underlying reasons are.

He said: ‘The study makes the point that better-funded practices have – on average – better CQC ratings than less well-funded practices. This confirms that funding is important in determining the quality of services provided by general practices.

‘One caveat with the study is that as it is cross-sectional is does not show ‘causality’ – ie it may be that the practices that score more highly in CQC inspections may be better organised and therefore more efficient; and it is this that makes them better funded (rather than the other way around).’