Well, no one can accuse the new Government of dragging their feet. They seem to have hit the ground running with announcements and action to address the long-term issues across the NHS.

Strike Action by GPs

The result of the ballot on GP pay in Primary Care is overwhelmingly in favour of strike / work to rule action. This is not something that has been taken lightly. The government suggests pay rises in primary care for doctors and nurses and all staff of 6%, and the GMS will reflect this backdated to April.

However for those practices that have a weighted list, they only get paid for the weighted list and are in essence treating patients free of charge. They will not get the full 6% in total for all patients, so it increases the running costs of surgeries. If it happens again this year it will tip even more practices over the edge.

Closures are increasing which then puts pressure on other practices to mop up those patients.

As we have seen already, the long-running junior doctors strikes look to have been settled.

So, when Primary Care does 90% of the work for just 6% of the budget, and that funding figure has been declining each year, the point has now been reached when enough is enough.

It is encouraging that Wes Streeting understands the issues and is making some positive statements of restoring better relationships with all in the NHS.

I am optimistic that this Government will get involved in trying to avoid the type of strike/ work to rule action planned, that will affect the whole of the NHS not just Primary Care.

We need to be patient though, and ensure any action we take will be measured to highlight the issues we face and should be supported by all practices.

CQC

Interestingly, there has been a damning review of the CQC following the review set up by the Conservative Government in May 2024.

Wes Streeting the new health secretary has agreed that the service is not fit for purpose and radical reforms need to take place.

Before anyone retorts that he would say that of a Conservative review, it is worth reminding ourselves that the CQC was set up by the Labour government in 2008.

We will all have a view and an experience of CQC and will have different ideas on how it should operate.

From my perspective I am not averse to a regulatory body, but I do feel that one that covers so many areas of healthcare is not effective, as one size does not fit all.

In my experience within Primary Care, I have been thinking of the best way to regulate us fairly and equitably to reflect the work we do.

Having been through the CQC twice - once with a visit and the other over the telephone - I can see how hit and miss this can be.

Whilst we try and be ready for the visit at all times, once we get the telephone call and a date given, panic sets in. We all want to be the best at what we do but we fear the unknown, as inspections are often carried out by inspectors that have favourite agendas.  

No two inspections are going to be the same and so the varied results are to be expected.

There is a feeling that rather than finding all the good things practices do, it is finding all the areas where we do not perform as well. We are guilty of poor care, until we can prove otherwise.

So is there value in the current CQC inspection process? If not, what should be done to ensure that inspection is fair and a learning curve and not “we want to find you guilty of this that and the other?”

So how should Primary Care be regulated? If the CQC were abolished today, we would still be reporting to NHS England for QOF; we must publish the annual surgery survey; we have friends and family tests as well as having social media platforms that patients and practices rely on to give a fairer review of the practice.

No practice in my view gets it right the whole time and if I were looking for a new GP practice to join, I would look at all the reviews, and figures on QOF and other platforms and make a rational decision based on that.

The CQC ratings of Requires Improvement, Good, Outstanding etc paint a very generic picture and can be based on a single visit by CQC inspectors, some of whom do not have the knowledge of working in a GP practice and review based on theory, when we all know that practice is completely different.

So how do we root out bad practices, and what can be done with them?

Patients are the best inspectors, as practices performing poorly will see patients leave, and join a better performing practice in the area.

All practices will be reporting on so many things such as complaints, significant events, QOF, CQRS and so on and a trend should be apparent. Those with falling standards are the ones that need help, and resources should be put into them whilst those performing well should be left alone to get on with providing the care.

Conclusion

Talk is cheap, but action is key and there are some grounds for believing that things can improve, if the last month is anything to go by.

We cannot expect a magic wand today but hope we can see the light at the end of the tunnel.