I am still asked “how should I choose my GP practice”, and I usually give a guarded reply which amounts to “It depends what functions/services you value most”. Continuity of care is a rarity these days, and with more and more part time GPs the problem will get worse. Patients are not “ill” on days that suit a Dr working 2-3 days a week. Children are ill suddenly, and so practices where partners offer a daily surgery, albeit with a different doctor, are valued. One thing to consider is whether there is an “individual list” system, or a “shared list” system. In the former it can be harder to see your doctor, but it may be worth waiting especially for older patients with chronic conditions. In the latter system patients are often fitted in quickly but usually see a different Dr each time if it is an emergency (as defined by the patient)! Mothers of young children usually prefer this type of system, but not always. Does the practice have an active Patient Participation Group?Other things to consider are whether the practice is a teaching practice, what the turnover of staff is, and whether they have a QPA (Quality Practice Award) which is in date. If you know a family who have had a death recently, the quality of any palliative or terminal care is pertinent, but remember “dead patients don’t vote“. Despite all this, and the Care Quality Commission report, most patients will still ask their neighbours…
It’s a pity that we don’t know the quality of care for comparison in the other 3 UK health regions, thus emphasising that there is no NHS. Rather than reporting the bad news, the Times could report that 90% of GP care is good quality, and ask “Are you lucky enough to be in a post code with good GP care and good choice?” as many areas have reduced choices, even in cancer care.
Seven million patients are treated at GP surgeries with serious safety problems, according to the first comprehensive review.
Inspectors urged patients to switch to better performing surgeries after finding that one in seven had issues with safety and one in ten was not good enough overall.
They uncovered “pockets of persistent poor care” including out-of-date medicines, a failure to follow up on test results, delayed cancer diagnoses and a lack of checks on the medical qualifications of staff.
Smaller surgeries were more likely to do badly, the review showed, with the worst half the size of the best. They have been ordered to end “professional isolation” by linking with neighbouring surgeries to share resources and expertise.
The Care Quality Commission (CQC) has finished inspecting all 7,365 GP practices that existed when it started its revamped regime three years ago. Nine in ten were good or outstanding, significantly better than hospitals or care homes. It initially found that one in three was not safe enough, forcing inspectors to take action including shutting dozens of surgeries. One in seven still had safety problems, however, covering seven million patients, with 13 per cent “requiring improvement” and 2 per cent, with almost a million patients, “inadequate” for safe care.
“Safety is the one clinical area that we worry about,” Steve Field, chief inspector of GPs, said. “You find surgeries where they have lots of [test] results that haven’t been acted on, they might have out-of-date medication, their fridges might be at the wrong temperature so the vaccines might not work. It’s really poor leadership.”
Professor Field recently had to intervene to replace out-of-date emergency adrenalin that could have led to the death of a patient, he revealed. He urged patients to use ratings on the CQC website to switch to a better surgery. “I was in a surgery two weeks ago where they said they’d had 300 patients move to them because they were rated outstanding,” he said.
The average “inadequate” practice has 5,770 patients compared with 10,126 for the average “outstanding” one. Professor Field said that smaller places often found it harder to stay up to date, manage services well and employ nurses to help patients with long-term conditions. He said that most should be linked to other family doctors and social services. “I suspect that if you’re a weak leader but a good clinician and you’re part of a larger group, the quality of care will be better,” he said.
Ministers have promised GPs £2.4 billion as they struggle with rising patient numbers and Professor Field said that this had to get through before a “winter crisis”. Richard Vautrey, chairman of the British Medical Association GP committee, said: “These positive results are undoubtedly down to the hard work of GPs and practice staff, but many are in an environment where they are increasingly struggling to deliver effective care.”
The union has clashed with Professor Field, insisting that his inspections were not fit for purpose. Dr Vautrey insisted that the process “remains overly bureaucratic and continues to result in GPs spending time filling in paperwork when they should be treating patients”.
Jeremy Hunt, the health secretary, said: “Nearly 90 per cent of GP surgeries in England have been rated as ‘good’ or ‘outstanding’ — and that is a huge achievement for GPs given the pressures on the front line.”
What do we know?
- Every GP practice has an overall rating shown on the CQC website
- Each practice is also given sub-ratings assessing whether it is safe, clinically effective, caring, responsive and well-led
- The NHS GP patient survey assesses whether people would recommend their surgery, whether GPs give them enough time and whether they see the same doctor
- There is little other official data on GPs
- Patients can post ratings on websites such NHS Choices