The Care Quality Commission (CQC) yesterday published its report “The State of Care in General Practice 2014-2017”, following the completion of its programme of comprehensive inspections of all registered GP practices in January 2017.

Encouragingly, 90% of practices were rated as good or outstanding, which the CQC commended given the challenges currently faced by general practice. GP practices consistently received among the highest ratings of all the health and care sectors regulated by the CQC. The report sets out some common themes and characteristics which contributed to GP practices providing high quality care and looks at the ways GP s have managed to improve the quality of care following an inspection.

Challenges facing general practice

The report notes that general practice is facing unprecedented challenges, with an ageing population, an increasing number of people with chronic conditions and patients with increasingly complex healthcare needs. The general practice workload has increased substantially over recent years without a corresponding increase in funding or the workforce.

Inspection key questions

The CQC asks five key questions when inspecting services: are they safe, effective, caring, responsive to people’s needs and well-led? The CQC found that the vast majority of practices are caring, responsive and effective and that problems are more frequently related to approaches to safety and how well led and managed a practice is.

The CQC was concerned about the overall performance in safety and the main issues included problems relating to poor systems and processes to manage risk to make incidents less likely to happen again. Well-led practices instilled a culture where staff work together for the good of patients’ health and the practices know what they will do if things go wrong. Those practices which required improvement needed to share their values and offer development opportunities to clinical and non-clinical staff.

High quality care themes and characteristics

By reviewing inspection reports, the CQC was able to identify key factors and characteristics that drive excellent care. These are:

  • Proactively identifying and effectively responding to local needs;

  • Innovative approaches that deliver real impact;

  • Sharing learning internally and externally;

  • Multidisciplinary working;

  • System-wide engagement;

  • Thinking strategically and planning ahead;

  • Size of practice;

  • Influence of effective practice management; and

  • Leadership.

Improving quality of care

The report also draws upon the experience of those practices which have improved from an inadequate to a good rating, highlighting the factors that have enabled this improvement:

  • Acknowledging the problems;

  • Governance;

  • Leadership; and

  • Support from external bodies

Going forward the CQC intends to adopt a more proportionate approach, working with commissioners and other stakeholders to reduce duplication and effectively share information. Any moves which could help to ease the burden on overstretched practices should be welcomed and the CQC notes the importance of adequate investment to ensure high quality patient care.

There remain pockets of poor practice which the CQC will monitor to ensure patient safety, but overall the report demonstrates that GPs are managing to provide a good service to their patients under increasingly challenging circumstances, for which they should be applauded.