Prof. Steve Field’s monthly blog

Monthly column for providers and professionals working in primary medical and dental services from Prof. Steve Field, Chief Inspector of General Practice

This month I want to talk about our annual report to Parliament, State of Care. This is our assessment of health and social care in England in 2017/18. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve.

State of Care

This year’s State of Care tells a story of contrasts. It highlights both the resilience and the potential vulnerability of a health and care system where most people receive good care, but where access to this care increasingly depends on where in the country you live and the type of support you need.

Findings in primary care

In primary care, quality has largely improved despite the well-documented challenges around demand and funding, coupled with significant workforce pressures.

We saw improvement in our ratings of general practice. Ninety-one percent of GP surgeries were rated as good, and 5% outstanding. Just 1% are now rated as inadequate. Ratings for the safe key question have also improved, with 93% of practices now rated as good for safety at 31 July 2018, up from 88%.

The story was similar in dentistry as 90% of the practices inspected in the year to 31 March 2018 met the regulations and are providing safe and effective care. Ninety-two percent of those who received requirement actions improved upon reinspection.

Our findings are testament to the hard work that you do as providers and I want to take this opportunity to thank you for your hard work.

Common themes

There were a number of common themes and drivers of positive change across primary medical services. Strong leadership, including an empowered practice manager was central to driving improvement. We highlighted this in our Driving improvement report earlier in the year. Strong leadership and positive culture can instil within the whole practice team a vision and commitment to improvement.

We are also seeing a growing number of services establishing multidisciplinary, multi-agency teams. Nursing teams, physician associates, pharmacists and others such as paramedics are providing good quality care and taking some of the clinical workload off GPs. Partnership working can improve people’s access to primary resources and give better, local access to secondary care consultants at a practice.

The Lakes Medical Practice in Penrith is one such example of this commitment to multidisciplinary working playing a role in driving improvement. The practice employed an inhouse Well-being Practitioner who provided psychotherapy to help improve outcomes for patients with long-term conditions. It offered holistic, joined-up services that catered to people’s needs, which included a six week in-house chronic pain group, where patients could learn about how to respond to stress through meditation and relaxation. Following a proactive programme, the practice had reduced the number of patients prescribed benzodiazepines and opiates from 180 to 20.

In general practice, satisfaction remains high. The most recent GP patient survey shows that almost 84% of patients described their overall experience of their GP practice as very or fairly good. As part 1 of our report says though, our reviews of care in local systems show that too often services are focusing on their own goals, rather than working with others to provide person-centred care. The fragmented nature of different services can be difficult for people to navigate.

Our challenge

This month I spoke at Best Practice Annual Conference on the future of primary care regulation. A common theme of the conference was how practices are working together and facilitating this partnership working. Collaborative working is one positive step in improving access, quality and patient outcomes, although we are yet to see this taking place across all of England.

As I said at the outset, this year’s report highlights the resilience and the vulnerability of the health and care system. The resilience is evidenced by the fact that our findings show that quality overall has largely been maintained, despite a challenging environment, but the vulnerability stems from people’s experience of care being determined by how well parts of the local systems work together.

My challenge to you as providers is therefore to take inspiration from the work of those at the Lakes Medical Practice, and other teams doing similar excellent work to provide more accessible, seamless care by working across health and social care as part of a local system, with complete focus on the patient. In this report we made similar challenges to Parliament and to commissioners to change the way services are funded to enable this working, but you as providers have a role too.

I hope you find the report useful and informative.

Have a great month everyone.


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