What makes a good GP surgery? Understanding the differences between higher and lower performing practices as rated by the Care Quality Commission (CQC) in Leeds and Bradford

Problem

This study aimed to identify key quality indicators in Primary Care and factors that are associated with better and worse performance of Leeds practices as graded by the Care Quality Commission (CQC). Many practices are rated as ‘good’, but it is unclear as to what this means, and what the differentiating features are between a practice that is rated as ‘outstanding’, compared to one that is rated as ‘good’. By qualitatively analysing CQC reports, this study can be applied as an effective quality improvement tool to help practices strive for improvement and understand the CQC gradings.

Approach

A qualitative analysis of nine CQC reports was conducted. Practices for inclusion were identified as members of the Leeds GP Confederation and Bradford District and Craven Health and Care Partnership. Surgeries rated as ‘inadequate’ were excluded from the study. Reports and practice information including overall gradings, domain gradings, year of inspection, deprivation scores and practice size were collated from practices across Leeds and Bradford. Three reports from each category ‘requires improvement’, ‘good’ and ‘outstanding’ were selected at random. The reports selected for analysis were analysed by two researchers following the process of framework analysis, a subtype of thematic analysis selected due to the structured nature of the reports. An iterative process was used to ensure the points identified were relevant and the main themes were identified and mapped appropriately.

Findings

141 complete data sets were included in the study. No ‘inadequate’ reports were found, four ‘requires improvement’, 132 ‘good’ and five ‘outstanding’ overall ratings were achieved. The ‘requires improvement’ reports were all published in 2021 and 2022 and the ‘outstanding’ reports in 2016. The ’requires improvement’ practices were rated poorly in the safe, effective, and well-lead, while ‘Outstanding’ practices obtained higher gradings in the well led, responsive, and effective domains. The qualitative analysis focused on organisational, patient, and clinical factors, with patient factors identified as the least common theme in the reports in all three rating categories. ‘Requires improvement’ practices were found to have easy to identify failings regarding record keeping and safety. Whereas the factors making practices ‘outstanding’ were much more nuanced, such as practice culture and innovative practice.

Consequences

Primary Care has a vital role in public health through the prevention of disease, prolonging health and promoting health. Patient’s experience of GP impacts greatly on their perception of healthcare. A bad experience or poor care can impact future interactions with services including urgent and emergency care services. By increasing awareness of quality indicators and acting as a quality improvement tool for practices to identify how they can prevent ‘requires improvement’ gradings and strive for ‘outstanding’ status, this project aims to improve both patient experiences, practice recruitment and the culture within the practice.