GP practices get ready for inspections

Dr Jim Hogan, the clinical lead of the Portsmouth Clinical Commissioning Group
Dr Jim Hogan, the clinical lead of the Portsmouth Clinical Commissioning Group

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From next year GP practices will have Ofsted-style inspections which could see low performing surgeries close. Health reporter Priya Mistry looks at how the inspectors have put practices in to categories to see which will be seen first

The first wave of reports have been published which will determine which GP practices will be the first to have Ofsted-style inspections.

The Care Quality Commission (CQC) has worked with the information it currently has on surgeries across the country to find out which surgeries will be first to the new inspections.

The CQC has produced 38 indicators on whether patients at a surgery could be at ‘risk’ or ‘elevated risk’ beyond what would be expected normally for each of these.

Then a percentage is calculated, and depending on what percentage you have, you are placed in a band.

Band one would be perceived as the highest concern, which therefore means these practices will be first in line for a formal inspection.

Band six would be perceived as the lowest concern and mean these practices will be inspected at a later date.

So how do practices in the Portsmouth and the south east Hampshire fare?

Nationally the average of GP practices falling into the top four bands – six to three – is 78 per cent.

In Portsmouth, that figure is 87.5 per cent, in Fareham and Gosport (F&G) it’s 90.5 per cent and in South Eastern Hampshire (SEH) it’s 96.2 per cent.

In Portsmouth 17 out of 24 practices fall into the first band six, in F&G 12 out of the 21, and in SEH it’s 21 out of 26.

And on the other end of the scale, two practices fall into band one in Portsmouth, while there are two that also fall into this category for Fareham and Gosport.

Dr Jim Hogan, is the clinical lead of the Portsmouth Clinical Commissioning Group, which buys in health services for the city.

He says: ‘We welcome the monitoring of general practices quality data published by the Care Quality Commission.

‘We are really pleased that the majority of the practices in our area are of “low concern” to CQC and are providing safe and high quality services to people.

‘We are closely involved with NHS England in the monitoring of practices and are aware of the issues faced by some of our practices, including those who will be inspected as a priority by CQC.

‘We are working closely with them to provide support to tackle these and ensure all of our practices provide safe and high-quality care.’

The CQC say putting GP practices into bands is not a way of ‘ranking’ surgeries, but a way to determine which practices will be inspected first.

Professor Steve Field, chief inspector of general practice, says: ‘There’s a lot of good and outstanding care taking place across the country as our data and recent reports show.

‘It’s important to remember that the data is not a judgement as it is only when we inspect we can determine if a practice provides safe, high-quality and compassionate care.

‘The data is a further tool that will help us to decide where to inspect and when.’

As reported, in August this year the CQC announced that GP practices will be faced with a new inspection regime.

Those deemed to be providing inadequate care will be given deadlines for improvement or face closure.

A pilot system of ‘special measures’ – similar to what schools face under Ofsted – which started last month – and cover all practices in England.

Surgeries will face longer inspections than currently undertaken and four outcomes can be given – outstanding, good, requires improvement or inadequate.

Where aspects of a service are rated inadequate, practices will have six months to improve.

If they fail to get better they will be put into special measures and if after a maximum of a further six months they are still found to be inadequate, they will have their registration with CQC cancelled and/or their contract ended by NHS England.

In cases where patients are at risk, or little confidence in the practice’s capacity to improve on its own, then the practice will be placed straight into special measures.

Nick Kerswell, head of regional engagement for the CQC, says: ‘We used indicators that we already had to see which practices would come under inspection first.

‘There were 38 questions and each practice was scored based on the information held.

‘If a practice had a score greater than seven per cent, then they are placed into band one.

‘If they are less than 2.5 per cent then you are placed into band six.

‘In between those are other percentages to place you between the remaining bands.’

It has been welcomed by patient watchdog group Hampshire Healthwatch.

Manager Steve Taylor says: ‘It’s important to remember the intention of these findings is not to judge and rank, but to prioritise inspections.

‘Each practice will know what they have to work on.

‘It’s good there is transparaency and what this does is give patients control.

‘It’s good people will know more about what’s going on and it gives patients more control and say in the care they receive.’

To find out more about the rankings and practice reports, go to

Whiteley Surgery

The Whiteley Surgery has a percentage score of 7.9 per cent.

The number of risks the practice, in Yew Tree Drive, had was four and one elevated risk:

- Number of patients with high blood pressure and hypertension;

- Low diagnosis of Chronic Obstructive Pulmonary Disease;

- Number of patients that said they would rate either ‘very good’ or ‘good’ for their doctor treating them with care and concern;

- Number of patients who found doctors being ‘good’ or ‘very good’ at involving patients in their care plans;

- Elevated risk found by the CQC for the practice was for the percentage of diabetes patients that may have a blood pressure reading higher than 140/80.

Lowering blood pressure for diabetic patients means they have a reduced risk of macrovascular and microvascular disease, according to the National Institute for Health and Care Excellence.

Fareham Health Centre

A DOCTOR from the Fareham Health Centre says he is ‘bitterly disappointed’ with the practice’s band placement.

The risk areas for the practice are:

- Number of patients that said they would rate either ‘very good’ or ‘good’ for their doctor treating them with care and concern and involving patients in their care plan;

- Elevated risk in diabetic patients with high blood pressure;

- Number of patients that said nurses were ‘very good’ or ‘good’ at treating them with care and concern, or involving patients in care plans;

- Patients offered stop-smoking help at appointments.

Dr Dean Hatfull says: ‘There’s an error in our smoking cessation figures which were taken from surveys done between April 2013 to March 2014.

‘We passed our initial CQC inspection in March this year, so are bitterly disappointed with the low rating and will be looking into these few areas.’

Waverley Road Surgery, Southsea

THE Southsea practice says it’s ‘disappointed’ with the low banding.

The surgery was classed as having five risks, including:

- An elevated risk for a low uptake of women for cervical screening;

- High use of more expensive antibiotics, which should be reserved for ‘resistent diseases’;

- Diabetics with high blood pressure, which could increase risk of other health problems;

- Patients with psychoses such as bipolar who do not have a comprehensive care plan.

Dr Alice Emerson says: ‘We’re disappointed with the results of the CQC’s new monitoring report, although it’s important to note the CQC itself makes clear these findings are not a judgement on the quality of care our patients receive.

‘We will study this report carefully to see whether there are any lessons we can learn.’

University Surgery, Portsmouth

THE risk factors found for this practice gave it a score of 14.5 per cent.

However it’s important to note the University Surgery, in The Nuffield Centre, St Michael’s Road, Southsea, is predominantly for students.

The elevated risk factors that were highlighted for the practice was:

- Ratio of expected to reported prevalence of coronary heart disease;

- Ratio of expected to reported prevalence of Chronic Obstructive Pulmonary Disease;

- The percentage of women between the ages of 25 and 65 that have had a cervical screening;

- The percentage of patients with diabetes who are on the register that have had the flu jab;

- Risks in percentage of patients aged over six months to under 65 years old, in the “at risk” category that have had the flu jab;

- Number of diabetic patients that are on the register with other problems.