Last month the Care Quality Commission (CQC) brought into force its quality ratings for independent doctor and clinic services.

The regulator of health and adult social care in England recently published its State of Care Report into the independent doctor and clinic services providing primary medical care.

The report is based on CQC inspections carried out between January 2017 and October 2018 of private GMC-registered GPs and clinicians together with independent or private clinics providing primary medical services.

The CQC looked at a sample of over 123 of its inspection and follow up inspection reports as well as considering the views of its senior inspection staff and the opinions of members of the public using those services. The inspection reports encompassed services such as private GPs, travel clinics, slimming clinics, circumcision clinics and allergy clinics.

The state of care report finds that whilst many services are providing good care, there are still a proportion which need to improve, particularly in respect of safe, effective and well-led care. The reports states that “in all our inspections, we find that many common issues are interlinked and, where they are combined, this increases the risk of poor quality care for patients.”

The services inspected were measured against the CQC’s five key questions: • Were services safe? • Were services effective? • Were services caring? • Were services responsive? • Were services well led?

In terms of whether services were safe, the report identifies issues such as inadequate record keeping of consultations and reasons for prescribing medications outside of the norm; lack of awareness of safeguarding requirements; failures to share relevant information with the patient’s NHS GP or other health professionals; and failures to properly manage infection prevention and control and to maintain equipment.

The report found that a quarter of independent doctor services and slimming clinics were not providing effective care at first inspection. Particular areas of concern included not keeping up to date with or following current best practice; inappropriate prescribing; not gaining appropriate consent and inconsistent practice when making referrals to other services or practitioners.

Of some reassurance is that the report identified very few concerns in terms of how caring the services were. In general, patients’ privacy and dignity were respected and there were high levels of satisfaction amongst patients consulted about their care.

Overall, many services were strong on understanding and meeting patients’ needs but there were areas of improvement for some which included collecting proper feedback from patients; providing sufficient information on how to make a complaint; and ensuring that formal translation services were arranged for patients when needed.

It is obviously very important that services are well-led in order to guarantee both patient safety and effective treatment. The report identifies that some treatment providers are failing in this area. In those cases, there were ineffective overall governance frameworks and inadequate arrangements to identify, record and manage risks and to share information with staff to learn from mistakes. Policies and procedures were out of date and were not properly risk assessed, recorded or accessible.

Whilst most services which were re-inspected had improved on follow-up inspection, some of these findings will be of concern to patients who are trying to access private or independent care, often for reasons such as the length of NHS waiting lists for treatment. Many patients would likely believe that they would receive superior treatment in the private sector than that offered by the NHS simply because they were paying for it themselves but clearly this may not be the case.

The introduction of the quality ratings for private and independent practitioners in primary care is a welcome step in the fight for patient safety. The quality ratings should help patients to identify care providers offering safe and effective care which will hopefully improve treatment outcomes for those patients.