The Care Quality Commission has published its annual assessment of the state of health and social care in England and found that quality ratings have been maintained overall in primary care with 90% of GP practices rated as good and 5% as outstanding.
It said this shows that despite the pressures facing general practice, we are still seeing high quality services for patients, which is testament to the dedicated practice teams.
However, it added that many people can struggle to get access to the care they need and want including that very first important conversation with a GP. People who shared their experience with the CQC said they waited weeks for a non-urgent appointment with a GP. While people have reflected that they would rather see their usual GP who they recognise and who understands their own history, needs and preferences, they described a range of difficulties in booking appointments to see any GP.
Where patients struggle to access non-urgent services in their local community, including GP and dental services, this can have a direct impact on secondary care services. Figures for emergency admissions after attending the emergency department are continuing to rise year-on-year. This peaked at 31.2% of attendances in December 2018, and in July 2019 it was 28.9% – the highest figure for July in at least the last five years.
The report said that the overall quality of services in the primary care sector in 2018/19 is high, which is encouraging news for a sector that is having to evolve in the way it delivers care in response to growing demand and an ageing population. But at the same time, getting access to services can be a challenge, and insufficient integration between different types of services can affect people’s experience of primary care.
Variation in quality across the country
While nationally 95% of practices are rated as good or outstanding, there are five areas where less than 80% of practices achieve that level of rating, with the poorest being Peterborough, where only 11 out of 16 practices (69%) are rated as good or outstanding, and which includes two of the 82 practices in England currently rated as inadequate.
All the inadequate practices are distributed across only 49 local authority areas. Two-thirds of local authorities have no inadequate GP practices, whereas Northamptonshire hosts four practices rated as inadequate, and Waltham Forest, East Sussex, Birmingham, Barnsley, Swindon and Lincolnshire each host three.
The CQC have reported previously that some GP practices have not been able to improve or to sustain improvement because of issues with poor leadership and management, but ongoing capacity pressures on general practice as a whole may affect the ability to improve. The report said this highlights the need to carry on delivering the commitments made in the NHS Long Term Plan, and to target funding appropriately to support general practice.
Harnessing developments in technology
Primary care services have been trying new, and sometimes innovative approaches to delivering care, according to the report. Although it is still early days, it is beginning to see how working at a larger scale and in different ways can improve people’s care and experiences.
The report also said that the most significant change that it has seen through its regulatory work is the provision of online appointments alongside telephone appointments, as they can offer quick access to a consultation with a GP. Although this represents only a small proportion of all GP appointments, the fact that online appointments are starting to appear alongside traditional face-to-face appointments is a significant change and raises important considerations about how to make best use of them to benefit all patients.
It also highlighted that technology such as health monitoring apps and online communities can help people to access health care and support, and make decisions about their own care. However, there are some challenges in understanding how this information should be used. Furthermore, technology isn’t for everybody – individual patients have different needs and circumstances, particularly those with more complex needs who may need more personal interactions or people who prefer a more traditional service.
Peter Wyman, Chair of the Care Quality Commission, said: “The fact that quality ratings across health and social care remain broadly stable – due to the dedication and hard work of staff and leaders – should be celebrated. But at the same time, we need to acknowledge that people’s experience of care is not always good – too many people are facing unacceptable challenges and cannot get the right care in the right place and at the right time.
“This report points to examples that show how providers are working together more effectively – often using technology to help – to ensure that people get the care they need when they need it. But their efforts must be supported by Parliament, commissioners and national and local leaders in order to deliver real change in how and where people are cared for, and how they are supported to stay well.”
This year’s State of Care draws on quantitative analysis of inspection ratings of almost 32,000 services and providers, in addition to other monitoring information including staff and public surveys, and performance. It also draws on qualitative analysis of interviews and focus groups with CQC inspection staff and voluntary organisations, secondary analysis of ‘Share Your Experience’ comments and inspection reports, and case studies of the experiences of people who use services and innovative providers.