Support, don’t punish, struggling practices, say GP leaders

Authors: Abi Rimmer 

Publication date:  27 Sep 2017

Negative headlines about general practice ignored many recent achievements made despite capacity problems, reports Abi Rimmer

Headlines generated last week by a report from England’s health services inspectorate, which found that 90% of general practices had been rated as “good” or “outstanding,”[1] may have raised more than a few eyebrows.

“One in seven GP practices in England failing on safety,” declared the Guardian,[2] while the Times reported that “7m patients are urged to leave unsafe GP surgeries.”[3]

Steve Field, chief inspector of general practice at the Care Quality Commission, said that his agency’s report had been intended to be a good news story for general practice. “Nearly 90% of practices are either good or outstanding, and some of the outstanding ones are absolutely amazing,” he said. “Many of the good ones have outstanding features as well. Of course, if you look at the data it does mean that a few aren’t.”

The Times headline was sparked by Field’s comments that he had visited a practice that had seen an increase in patient numbers after a positive CQC rating. “I didn’t say that seven million people should [switch practices]—I was astonished that was a headline,” Field said.

He added, “I said two things. One, that there is some evidence that some patients are moving if [practices] are rated outstanding, and secondly that some of those outstanding practices are also telling us that they are not having a problem with recruitment of doctors any more, compared with other local practices.

“The other thing I said was . . . if you move into an area and you don’t know which practice to go to, ask your friends, but also look at the CQC website, and if it is rated good or outstanding, that is a good sign.”

Negative focus

Richard Vautrey, chair of the BMA’s General Practitioners Committee, said that he was disappointed by the media coverage. “I raised my concerns with CQC, and I think they shared my deep disappointment in the way that certain sectors of the lay media focused on the negative, when the negative was a very, very small section compared with the overwhelming positivity of a story that should have been celebrating general practice.”

Vautrey pointed out that many practices that had been struggling previously had made improvements. “I think what we have seen is that when practices in their initial inspections were told of areas that they needed to address, in the vast majority of cases they addressed them very, very quickly. That suggests that with the right support, and the right help, even those practices that are deemed to be needing improvement can actually make that improvement very quickly.”

Martin Marshall, vice chair of the Royal College of General Practitioners, echoed Vautrey’s frustration at the way the story was reported. “Nine out of 10 practices are doing either well or outstandingly in an environment that’s really tough. That is remarkable and something to celebrate.” He said that it was unlikely that patients would leave a practice that was given a poor CQC rating. “The reality is that most patients are satisfied with the healthcare that they are being provided and don’t behave like consumers.”

No room for more patients

Even if patients wanted to leave a practice, Marshall said, other practices would probably not have the capacity to take them. “Our emphasis must be on supporting the practices that are struggling in order to do better, so that everybody has good access to care, rather than pretending that we have enough flexibility in the system to allow patients to make a move.”

Michelle Drage, chief executive of Londonwide Local Medical Committees, the capital’s umbrella organisation for the committees that represent GPs, backed calls for struggling practices to be supported. “When people are struggling, the last thing you want to do is make things harder, and [yet] that tends to be what happens,” she said.

The CQC report said that 17% of practices in London were rated inadequate or as requiring improvement. This was not surprising, Drage said, considering the challenges faced by doctors in the capital. “It’s not surprising that London GPs are struggling, given the long term funding shortages that we’ve got across the health service in London, not necessarily just general practice. We’re all vying for the same depleted pot,” she said.


  1. Iacobucci G. CQC rates 90% of general practices as good or better. BMJ  2017;358:j4391. [Link]   [Link] .
  2. Greenfield P. One in seven GP practices in England failing on safety. Guardian 21 Sep 2017. [Link] .
  3. Smyth C. 7m patients are urged to leave unsafe GP surgeries. Times 21 Sep 2017. [Link] .

Abi Rimmer The BMJ

Cite this as BMJ Careers ; doi: