Behind the headlines: Are there really more ‘failing’ GP practices than successful ones?

Maya Dhillon looks at a Daily Mail article criticising the number of ‘failing’ GP practices following an analysis of CQC ratings and explores the figures being omitted from the headlines.

A Daily Mail ‘exclusive’ has reported that millions of patients are receiving ‘sub-standard’ care at hundreds of failing GP surgeries. The analysis was carried out by medical negligence solicitors Patient Claim Line by reviewing the results of CQC inspection reports, with the Daily Mail clearly focussing on those practices that had received a rating of ‘requires improvement’ or ‘inadequate’. While none of the figures reported by the Daily Mail are incorrect, the angle taken ignores the truth that the large majority of practices are performing at or above expectations according to the CQC.

‘Alarmingly, practices have been allowed to remain open despite being rated ‘inadequate’ or ‘requires improvement’ by the care regulator.’

While nobody will deny that all patients deserve high-quality care, the use of ‘alarmingly’ is fear mongering and misleads readers about how CQC rankings work. ‘Requires improvement’ means that a service is not performing ‘as well as it should be’ and has been told by the CQC how it needs to improve. Suggesting that practices should shut down because changes are needed is ridiculous – the whole point of a regulator is that it works with practices to improve. If, as the Daily Mail seems to imply, we shut all practices that require improvement immediately, that would leave thousands of patients without treatment and services – which would be far more dangerous and put more pressure on surrounding practices having to deal with a sudden influx of patients.

Regarding ‘inadequate’ practices, the Daily Mail does not explain to its readers what that rating entails. For practices rated as ‘inadequate’, the CQC will have taken action against the person or organisation that runs it. That action could include: imposing conditions/limits on what a practice can do; placing a provider in ‘special measures’; fining providers; prosecuting cases where patients have been harmed or at risk of harm; and more. These ‘inadequate’ practices are not open and running as usual – there will have been stringent measures and precautions put in place, and re-inspections will have been planned to see whether or not the CQC’s findings and actions have been taken into account.  

‘As of their most recent CQC inspections, 278 GP practices were rated outstanding, 5,193 good, 261 requires improvement and 31 inadequate. It means there are now more failing than outstanding surgeries in England.’

This is the real issue with the Daily Mail’s report. We obtained the most recent (11 December) numbers from the CQC’s rankings, so they differ slightly from the report but materially tell the same story. The data for GP practice rankings in England showed:

• Outstanding – 291 (4.8%)
• Good – 5,392 (89.7%)
• Requires improvement – 288 (4.8%)
• Inadequate – 39 (0.6%)

This means that there are 327 practices that are ‘below standard’ (rated as ‘requires improvement’ or ‘inadequate’). 

However, that completely neglects the fact that 95% of practices in England are rated as ‘good’ or ‘outstanding’ which was also the case in March 2019. That is an overwhelming figure, especially when less than 1% of practices are ‘inadequate.’ The Daily Mail barely acknowledges that the majority of practices are performing at or beyond the CQC’s expectations; burying that 95% figure at the bottom of the piece, alongside a comment from RCGP vice chair Dr Victoria Tzortziou-Brown. She brings up very valid arguments; i.e. more appointments than ever are being delivered despite a lack of fully qualified GPs, as well as concerns over the watchdog’s credibility following an independent review of the CQC. But unless you scrolled to the very end of the article, you wouldn’t come across those facts.

‘Meanwhile, the latest NHS figures show GP partners, who own their practice and account for the majority of family doctors, now earn an average of £140,200 a year, despite only one in three working full-time.’

It wouldn’t be a British tabloid without taking a swipe at GP earnings and working hours, even when irrelevant to the point it is trying to make. Nobody is arguing that GPs don’t earn more than the average salary. We can give the usual, and rational arguments as to why that is: 10-year education and training for a highly skilled role certainly justifies a large salary (more so than for bankers); or the very fact that there are fewer GPs means their salaries are naturally higher.

But GP partners actually saw a 17% real-terms drop in income in one year. £140,200 is still no small salary, but the Daily Mail has made it sound like this is an ever-rising figure, when in reality it is a very stark drop, indicative of the general practice landscape. And, while partners do account for the majority of GPs, there has been a substantial shift in the past decade, with the proportion of salaried GPs increasing. The average earnings for a salaried GP is much less than that of a partner – £69,200 on average. 

Shouting that ‘there are more failing than outstanding surgeries in England’ without stating that there are 90% ranked as ‘good’ is misleading and unfair. It is fear mongering and distorting the truth to bolster anti-GP sentiment among the public. We don’t need to get into the admitted ‘inadvertent disadvantages’ to minority ethnic GPs in CQC inspections or other questionable actions; indeed, our readers will only know them too well. It’s just a shame that a national title would not think to include them, rather than misrepresenting the state of general practice.