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CQC: High ratings in primary care mask ‘volatile picture’ of deterioration and improvement

16 October 2020

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Almost nine in 10 (89%) GP practices received a ‘good’ rating from the Care Quality Commission (CQC) in 2019/20, while 5% were awarded ‘outstanding’, according to the regulator’s latest report.

In its annual assessment of the state of health and social care sectors, the CQC found that only 1% of GP practices were rated ‘inadequate’ and 4% as ‘requires improvement’.

But the regulator said that while it was clear providers were able to maintain the quality of care they provided, there was ‘by and large no improvement overall’.

It added that the overall ratings picture masked ‘a more volatile picture’ of the improvement and deterioration that happens at a service level, with 173 practices declining from a rating of good over the last year, and 192 improving their rating to ‘good’ on re-inspection.

The report analysed ratings data up to the end of March, instead of July, due to the Covid-19 pandemic and the suspension of routine inspections.

Access to care pre-Covid

The CQC also looked at some of the key issues impacting general practice and other sectors it regulates in the past year.

‘Pre-Covid-19, care [across all sectors] was generally good, but with little overall improvement and some specific areas of concern’, the report said, including that ‘some people were not able to access the care they needed when they needed it’.

People were experiencing problems in getting through to practices by phone to make appointments or waiting several weeks to be seen, while some groups, including the homeless, sometimes faced issues in registering at practices.

The CQC said it had heard of a range of positive initiatives to improve access to care in general practice, such as the use of care navigators, advanced nurse practitioner-led services, social prescribing schemes and extended opening times.

Using technology

The regulator found that the accelerated move to offering remote consultations in general practice as a result of the Covid-19 pandemic had proved beneficial to many, with most people saying they wanted it to remain available in the future

‘As the pandemic gathered pace, health and care staff across all roles and services showed resilience under unprecedented pressures and adapted quickly to work in different ways to keep people safe,’ the report said.

It did however warn that the use of the technology raises concerns over GPs potentially missing diagnoses, and that it could exclude patients who lack proper digital access.

Some smaller GP practices also experienced a digital barrier, as they lacked equipment such as computers and webcams or had poor access to Wi-Fi, while some staff did not feel confident using the new systems, the report added.

‘Pent-up demand’

Covid-19 caused a huge disruption to routine care at primary care level, the report said, with figures revealing a substantial drop in the number of new referrals to treatment and a rise in the length of time patients were waiting for a diagnostic test.

This shows that ‘there is huge pent-up demand for care that needs to be addressed’, particularly for patients with time-sensitive conditions, such as cancer, it added.

‘Primary care services need to make sure that people and patients are given the confidence to interact with them early, provide a range of different ways for people to access the care they need, and make it easy for them to do so,’ the report said.

‘New opportunity’

Ian Trenholm, CQC chief executive, said: ‘Pre-Covid, the health and care system was often characterised as resistant to change. Covid has demonstrated that this is not the case. The challenge now is to maintain the momentum of transformation, but to do so in a sustainable way that delivers for everyone – driven by local leadership with a shared vision and supported by integrated funding for health and care.

‘There is an opportunity now for Government, Parliament and health and care leaders to agree and lay out a vision for the future at both a national and local level.’

He added: ‘Covid is magnifying inequalities across the health and care system – a seismic upheaval which has disproportionately affected some more than others and risks turning fault lines into chasms. As we adjust to a Covid-age, the focus must be on shaping a fairer health and care system – both for people who use services, and for those who work in them.’