Ethnic minority-led GP practices: impact and experience of CQC regulation

In this blog, Dr Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care, discusses the results of CQC’s research into the impact and experience of CQC regulation on ethnic minority-led GP practices.

Here at CQC, using our independent voice to challenge inequalities is an integral part of the work that we do. We seek to amplify the voices of people most likely to have a poorer experience of care or have difficulty accessing care, whilst also ensuring that our commitment to equality and human rights underpins how we register and inspect services.

When we received concerns from ethnic minority-led GP practices, I was keen that we addressed these. The concerns were that ethnic minority-led GP practices were more likely to have a poorer regulatory outcome than other practices.

We set out to complete a research project to look into these concerns. We have now published our report and I want to take this opportunity to outline our key findings and recommendations.

At the heart of this work was including the voice of ethnic minority GPs. We did this through a variety of ways, including surveys, focus groups and an Expert Advisory Group. We also used available data around ethnicity and CQC ratings.

Our findings

Our research didn’t establish a direct link between ethnicity and ratings. But it did identify contextual factors which can disproportionately impact ethnic minority-led practices, including their ability to show how they provide good care.

Ethnic minority-led GP practices are often not operating on a level playing field in terms of where they work, and the support available to them. It is clear from the experience of the GPs who spoke to us that the challenges they face can be magnified by factors which are outside of their control. This makes it harder for them to evidence the quality of care that they offer.

We found that ethnic minority-led practices are more likely to serve populations with higher levels of socio-economic deprivation and poorer health. This impacts their ability to achieve national targets used in our assessments, as well as facing increasing challenges around recruitment and funding.

Ethnic minority-led practices are also more likely to be operated by just one GP without other partners to offer support. This can present challenges around resourcing and capacity, impacting the ability of a practice to show how it is meeting regulatory requirements. All of these factors interconnect as a cycle of inequality, with poor regulatory outcomes being a symptom of this uneven playing field.

The cycle of inequality

Sadly however, there was not enough data in the wider health and care system to establish any relationship between ethnicity of practice leadership and ratings. CQC does not record ethnicity data at registration, and we were unable to match data we received from other organisations with our own.

What this means for us

This project has highlighted the fact that disparities do exist. I am keen that as a regulator we set out steps to address these. As a first step CQC will be reviewing and strengthening how we consider the context in which a GP practice works when we make assessments. We will also take the learning from this work into our developing approach to assessing integrated care systems. We’ll also ensure that as we develop our new regulatory model it does not disadvantage single handed practices.

We will continue our work through the Regulators’ Pioneer Fund, looking at ways to identify innovation in areas of deprivation and share good practice as part of our assessments.

We will also look at improvements for how we collect and record ethnicity data, working with our system partners to do the same, so that more information is available to be able to explore inequalities going forwards.

I’m looking forward to continuing to work with our partners to address this important issue, including through a roundtable group lead by Bola Owolabi, Director of Healthcare Inequalities at NHSE/I. This group will look at solutions to help tackle the issues of health inequality, including those raised in this report.

Everyone, wherever they are, has the right to safe, high-quality care and GPs should be supported to achieve this. We need to see a system response that acknowledges and reflects the context in which a practice operates — and is committed to understanding what this might mean for the way commissioners and regulators assess them.

We want all GP practices to operate in an environment that supports them. This project has helped us to identify areas where more support is required. This is only the start of this work, and we will continue to monitor our approach going forwards.

You can read the full report here.

We also produced a short podcast series exploring issues raised by the project.