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Third of GP practices failed to meet new CQC standards

Inspectors have uncovered a catalogue of failings at some GP practices, with medicines stored in a way that puts children and patients at risk of infection and rooms so dirty they had maggots.

The Care Quality Commission (CQC) health regulator carried out inspections at 1,000 practices across England and found examples of “very poor care” that put patients at risk.

While many people received an excellent service, a third of surgeries (34%) failed to meet at least one of the required standards on good practice and protecting patients.

In nine practices “there were very serious failings that could potentially affect thousands of people”, the CQC said, and in 90 practices follow-up inspections had to be ordered to ensure improvements were made.

Some GPs left private medical files laying around, had medicines that were out of date, filthy treatment rooms and employed staff who had not undergone criminal record checks.

In one of the better-performing practices, inspectors found maggots and dirty conditions, while in another consulting rooms had no doors and people could hear what was being said to the GP.

In some surgeries, emergency drugs were out of date and fridges were not always checked to ensure they were at the right temperature.

The CQC said this puts children in particular at risk because failure to store vaccines at the right temperature can reduce their effectiveness, leading to an outbreak of a contagious childhood disease such as measles.

The reports come as Professor Steve Field, the CQC’s new chief inspector of general practice, set out his new approach for the inspection and regulation of GPs and GP out-of-hours services.

“We found some surgeries where there were out of date vaccines in the fridge,” he said, adding that people who wrongly think they are immune could become “very, very poorly and then die”.

Steve Field

CO Summit 2013: Chief inspector of general practice Professor Steve Field

He said a woman who thought she was immune to German measles due to vaccination could potentially give birth to a deaf and blind baby.

“You are talking about problems which can damage this generation and the next generation,” he said.

Professor Field said patients across the board had difficulties getting appointments.

In one Birmingham practice, people were queuing outside in order to make an appointment, he added.

At one practice, both GPs had referred each other to the GMC for incompetence. They were no longer working in the practice.

In another practice in Leeds, the inspectors turned up but there were no GPs.

At Dale Surgery in Sneinton in Nottinghamshire, inspectors found maggots and other insects, as well as dust and cobwebs.

The surgery immediately sorted out the problem but inspectors said there was “no regular, effective and on-going monitoring of these standards”.

Professor Field said: “We can talk about the fact we found maggots in a treatment room.

“And when we asked the question - and this is a good practice - the nurse said yes we do seem to have a bit of a problem. But they sorted it straight away.”

Professor Field said there was a widespread belief that out-of-hours GP care was “risky” because GPs don’t have access to medical records and do not know the patient.

Professor Field’s new-style inspections will start in April 2014 and will involve a CQC inspector, a GP, a practice nurse or practice manager and a trainee GP.

Inspectors will visit every clinical commissioning group area in the England area once every six months, inspecting a quarter of the practices in that area.

Every practice will have been inspected by April 2016 and given Ofsted-style ratings. From January, new inspections will also focus on GP out-of-hours services.

Professor Field said: “We need to make sure that everyone, from the most well-off to the most disadvantaged, can get access to really good primary medical care; this is something which I intend to champion as chief inspector.

“When something goes wrong in general practice, it has the potential to affect thousands of local people.

“GPs don’t work in isolation, so we will also be considering the quality of communication between out-of-hours care and other local services, including GP practices, care homes and emergency services.”

Some 37% of GP practices inspected on the standard relating to their workers failed to meet it, while 24% of practices inspected on the standard relating to safety and suitability of premises also failed.

Some 23% of practices inspected on their management of medicines failed the standard, while 22% failed the standard on cleanliness and infection control.

But just 5% failed a standard on the care and welfare of people who use the services and only 3% failed on respecting and involving people who use services.

Dr Maureen Baker, chair of the Royal College of GPs, said: “Breaches of procedure cannot be condoned - even if they are isolated incidents - but the inspections were largely targeted at particular practices which had already been identified as having problems.”

 

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Readers' comments (9)

  • michael stone

    I'm not sure if this was explained above or not - but these were NOT Practices selected at random: they were practices which had already 'caught the eye' as potentially having some sort of problem.

    Steve was talking about this on BBC Radio 4.

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  • All the money paid to GPs and now this! Our team works weekends and we try to avoid contacting OOH GP for reasons stated above. We monitor patients and if they can't be managed at home, or there is significant deterioration, we have them admitted to hospital (this doesn't happen very often by the way).
    One GP referred a patient to us who had UTI, couldn't move, and when we arrived appeared also to have cellulitis. We called an ambulance who stated that the GP ought to have called them straight away. Why didn't he?

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  • This investigation seems to focus on the clinical environment more than issues that patients comment on most. My patients continually complain that they must wait weeks to get an appointment to see a doctor and often have little confidence in the doctor when they do get seen. Will the CQC set standards for access and waiting times for appointments?

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  • GP practice administration can be pretty poor even in practices where the environment and medical care are good.

    My practice managed to make such a mess of their flu vaccine programme that hundreds of frail elderly patients and the chronically ill had to queue outside the premises on the pavement for over an hour. Some were visibly in pain and distress & at least one was using her oxygen cylinder, which she had to carry. No seats, no shelter, no information.

    Couldn't see any nurses or doctors advising patients on vaccines either - just a few HCAs giving the jabs! Clinical questions were greeted with blank bewilderment, as were my concerns about the safety and welfare of their patients outside in the cold. I sent a written complaint, but have heard nothing at all.

    Appointments are hard to get, even for the able bodied with cars, but repeat prescriptions have reached dangerous levels of chaos with requests and prescriptions (signed and unsigned) regularly mislaid and taking up to a fortnight to issue.

    I think they could do with an extended survey, focused on those patients least able to make a fuss about lousy services. But at least GPs have been forced to recognise that filthy premises and unsafe systems ARE their responsibility, so maybe this will encourage the others?

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  • Simple: close them down. Like others have commented GPs make an absolute fortune, if they're not offering an acceptable service close the practice and move their list.

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  • Let me say I am no supporter of poor standards !

    However , I am disappointed to note the somewhat ignorant comments regarding access to GP's

    Did no one stop and think that patient demand may be exceeding that which is available ?

    More GP's are required !

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  • I wouldn't expect a GPs salary for my more humble role. I'm only a nurse.

    I think my colleague Ms Jones may have forgotten that there's a multidisciplinary team involved in GMS services, but there's no doubt that GPs run their practice as their own private business, from which they take profits, pensions and a very good income.

    I would expect any GP to provide a safe environment to deliver patient care, especially if they owned those premises.

    I would expect GPs to employ enough ancillary and cleaning staff to ensure cleanliness and enough admin. staff to ensure practice systems aren't left in chaos, especially since 70% of their staff costs are met by the NHS and this makes it really cheap to employ good people.

    I would expect GPs to manage medicines safely and not to put patients at risk from unsafe drugs or unsafe/dirty practice equipment.

    It's hard to say whether there's an overall shortage of GPs in my prosperous & pleasant home town, let alone nationally. But the poor standards found in this survey are not confined to a few deprived inner city practices!

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  • Wonder why I got a letter from my surgery this morning to make an appointment to discuss my medications? Ha! There are 2 on the list I haven't re-ordered for about 3 years!!

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  • added to the above... I forgot to mention, it's the receptionists that print off the prescriptions and put in a pile for the GP sign!!! Obviously, never checked!

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