Agenda item

The Commission will receive a report on the Care Quality Commission’s inspections of G.P. Practices in Leicester City.

The Director of Operations and Corporate Affairs, Leicester City Clinical Commissioning Group (CCG) presented a report on the Care Quality Commission’s Inspection of GP Practices. He commented that overall, he believed that the results were positive and that Leicester performed well when compared with GP practices in the county areas with similar demographics.

Members heard that where improvement was needed, the CCG provided help and support and carried out practice visits. There were also mechanisms to monitor performance and information from all practices was looked at. The CCG also carried out desk top reviews and more formal reviews where appropriate but individual practice performance was managed by NHS England. The meeting heard that information from the CQC reports and intelligence received was used in making commissioning decisions.

The Director explained that the CCG were reassured that good service was being provided for patients but they were not complacent. They were aware of the frustrations experienced by patients when they could not get an appointment when they wanted; but feedback demonstrated that patients were satisfied with their experience when being seen.

The Chair commended the overall results of the inspections, noting that many of the practices had improved from their first inspection. It was noted that seven of the practices were rated as requiring improvement but the meeting heard that none of those seven had been given a CQC Improvement Notice.

A member welcomed the positive report but questioned whether it was good practice for GPs to be given advance notice of a forthcoming CQC Inspection. The meeting heard that the CQC needed to know that the relevant people would be present (and not on annual leave for example) when they came, but unannounced inspections also took place.

In response to a question about complaints, the Director explained that complaints were more appropriately submitted to NHS England, however the CCG used such information to obtain an informed view as to how the practice was running.

The Director was asked if the CCG were able to distinguish between the problems arising from the lack of resources and the issues that arose from poor management. Problems relating to waiting times for appointments were cited. The Director responded that there were obvious indicators where there was poor administration, but with the shortage of GPs and nurses, many surgeries were under considerable pressure which impacted on waiting times. The CCG had created four hubs around the city to alleviate some of the pressure and in addition, the CCG would be going abroad to recruit more GPs.  The Director added that in Leicester there was an inequality of funding and the CCG had been trying to eradicate that level of inequality. If, for example there was insufficient clinical time, they would look to see why and whether the practice was being given the appropriate level of funding.

A Member questioned what might happen if a GP became ill and the Director explained that one of the requirements of their contract was that there should be a Business Continuity Plan so that if for example the I.T. systems failed or a GP became ill, the continuity of care to the patients would be ensured.

A Member questioned how governance issues were monitored and the Director explained that there was a team of people managing contracts to ensure that performance was appropriate. They made recommendations on best practice and put forward examples to enable best practice to be shared.

A Member asked about figures for the resident population and the number of people who had registered for a GP practice. The Director responded that the resident population was approximately 390,000 compared to the registered population of approximately 400,000. The figure for the registered population was higher because some people from the county, opted to register with a city GP.

A Member commented that there was a high percentage of sole GPs and a lack of female GPs which impacted on women patients. The Director explained that GPs tended to be male, over 50s and mostly Asian.  The CCG gave an emphasis in recruiting to mirror the city’s population and in additional to the international recruitment campaign, they were also working with the university to encourage more graduates to remain in Leicester. They were looking at a new workforce model for graduates to spend some sessions in GP surgeries and some in secondary care alongside opportunities for continuing professional development.

The Chair drew the discussion to a close and stated that she would like the Commission to receive an update at a future meeting, on the workforce strategy and international recruitment.

AGREED:

1)    that the report be noted; and

2)    that the Commission receive an update at a future meeting, on the CCG’s workforce strategy and international recruitment.