26.12.15
Professional isolation common at ‘inadequate’ GP practices
Professional isolation and failing to share learning are two common factors in general practices rated as “inadequate”, according to the Care Quality Commission (CQC).
During a recent Health Select Committee evidence session into primary care, Professor Steve Field CBE, chief inspector of general practice at the CQC, said there are a “large number of smaller practices in inner cities that are failing and are inadequate”.
“We think most of that is due to professional isolation—that they are not connecting with local practices. It is not really the size; it is the fact that they do not learn and share with others. Some of those are very poor,” he said.
Prof Field noted that in small practices, 10% of those in in special measures do not have any nurses. “There is a direct correlation between inadequate practices – on fewer nurses, fewer sessions – and outstanding practices, which have really good multi-professional care, using nurses and therapists, and a few now are using physician associates and pharmacists. The bigger the practice, the more multi-professional they are,” he said.
During the session, MPs were told that there is a good picture for the majority of general practice with 85% rated as good or outstanding, with the vast majority providing “safe, effective care”.
“Only 4% are outstanding…but, at the other end, 4% are inadequate,” said Prof Field. “If you compare that with hospital and social care, it is a good news story for general practice, although the 4% that are inadequate are generally worse than I thought they would be before I started.”
Dr Chaand Nagpaul, chair of the BMA General Practitioner Committee, British Medical Association, who also gave evidence, said he found it extraordinary how well GPs are managing to continue to provide services in the face of what seems to be an impossible task, where they have seen the “biggest resource reduction compared with any other sector in the NHS and the greatest expansion of volumes of care”.
He also stated that the CQC process is not measuring like for like. “Practices vary at the moment in funding per head by twofold. You cannot compare two and say one is great and one is not without understanding that.”