Small GP practices pose worst risk to patients’ health, says watchdog

ONE in three GP surgeries has been found to be putting patients at risk, with traditional small practices among the worst offenders, NHS inspections have found.

Visits to all 7,365 practices across the country found out-of-date and contaminated medicines and mounting backlogs of test results, including cancer referrals, left for weeks. At some practices, there were no permanent staff at all, while in one case, a man doing the work of a GP had no medical qualifications. The report by the Care Quality Commission (CQC) found that larger practices were more likely to get good ratings.

It comes amid a drive by health officials to push surgeries into 1,500 “superhubs” instead of allowing individual practices to work alone. The CQC report said the average list size of practices with the worst rankings was 5,770 patients, around half the average size of those rated “outstanding”.

The findings are the first full set of results from a new system of checks on GP surgeries which began being introduced across the NHS three years ago. In total, 33 per cent of practices were found to be “inadequate” or “requiring improvement” for

safety. After interventions by CQC – resulting in the closure of more than 100 practices – 15 per cent of surgeries are still unsafe, despite being issued with warnings. The surgeries, covering six million patients, were found to be putting patients at immediate risk, by not having up-to-date medicines to hand.

In other cases, “large backlogs” of medical correspondence, including test results and hospital reports had not been followed up for weeks. Prof Steve Field, CQC chief inspector of general practice, said some of the most shocking findings involved a Brighton practice seeing patients despite having no GPS, using a man who had claimed to be a doctor’s assistant – despite even lacking those qualifications.

At Cornwallis Surgery, in Hastings, inspectors found a backlog of 800 documents requiring action, including four-month-old breast screening results, and out-of-date vaccines. Prof Field said the “clear majority” of GP surgeries were safe and of high quality but some of the worst failings occurred when smaller surgeries became “isolated” making them more likely to fail to keep up with modern practice.

“It’s really about professional isolation and about not linking with other surgeries – about having small teams with none or few nurses, no systems to check medication is up to date, to monitor scans and tests and to make sure findings are acted on,” he said.

Earlier this year, ministers revealed plans to enrol surgeries across the country into 1,500 “super hubs”.

But patients’ groups have said too many vulnerable patients are being forced to travel further.

More than 550 GP surgeries have closed in England since 2012, with remaining surgeries expanding to take thousands more patients. The average list size has risen by 18 per cent in a decade.

The CQC report found that, overall, practices that were rated outstanding had an average list size of 10,126 while those ranked inadequate had an average size of 5,770. “Where the practice is bigger – seen by having a bigger patient list – the rating is better,” the report states, highlighting the role of “superpractices” with as many as 60 GPS working together.

Last night, the Daily Mail reported that the CQC last year investigated four complaints a day involving care homes and home help, which led to 100 care homes being struck off the register.