Care Quality Commission's reports on local GP practices

[BigED]

...and it's not looking great at Dulwich Medical Centre:

http://www.cqc.org.uk/sites/default/files/1-565650623%20GP%20IM%20V101.pdf

Here's hoping the promised increased levels of inspection help to focus minds and actions.

More information and links to other practices via this site:

http://www.cqc.org.uk/content/our-intelligent-monitoring-gp-practices

Oh, and remember, it's not a league table. Oh no, heaven forfend.

[first mate]

This is worth a read

http://www.theguardian.com/society/2014/nov/18/one-in-six-gp-surgeries-england-risk-patients-poor-care

Note that Melbourne Grove- a dire example of the preferred model of super-chain GP Practices (Concordia owned)- has not yet been looked at.

[Dopamine1979]

Interesting link Firstmate. I think this comment below it hit the nail on the head:

'Be very, very wary about the agenda behind this report. We are being softened up to accept the most massive attack on our GPs there has ever been since the NHS first formed.

I'm part of the Save Our Surgeries campaign in east London. Since the summer, we have been campaigning against cuts to the funding for GPs. The campaign started when it became clear that cuts to one funding stream alone would force 98 practices in England - 22 of them in three east London boroughs - to close. For those that don't close, the cuts mean cutting back to basic services, fewer staff and longer waits for appointments.

We succeeded against the odds in getting NHS England to move on this and an emergency fund has saved 16 practices - for now. But this is a token gesture to shut us up. GPs are on one of three contracts. We are certain that as well as the immediate cuts to GMS contracts that we have campaigned on so far, GPs on PMS contracts will be facing absolutely massive cuts from next year - to be announced, no doubt, once the elections are over. And we are already seeing cuts the surgeries on APMS contracts in Tower Hamlets & Waltham Forest - despite the fact that these business contracts, designed for chains of surgeries staffed by salaried GPs are supposedly the preferred model for NHS England.

There are two major problems causing long appointment waits. The first is a chronic shortage of GPs - they haven't been able to persuade enough young doctors to train for general practice for years now. The second is funding. With some practices facing budget cuts of up to 40%, this is a situation that is not going to change any time soon.

The real agenda here is that NHS England actively want a very large number of GP surgeries to fail, so that they can replace the family doctor model, where GPs get to run their bit of the NHS with genuinely clinical-need-led autonomy, with a fully privatised model, where surgeries are owned by companies and the doctors are just salaried employees. Some of these might be owned by groups of business-minded GPs, but the majority will end up in the hands of UnitedHeath and Care UK. If anyone wants to know what that could mean, I recommend googling to find out what happened when UnitedHealth took over five practices In Camden (sorry, don't have the link to hand). Basically, when they failed to make enough profit, they sold on the contract within five years to another healthcare company - without telling staff, doctors or health officials. And this was after running down the services to cut costs. The second healthcare company, looking at similar figures, found a spurious reason to close one of the practices altogether. Camden's primary care commissioners were absolutely furious - but powerless to do a thing.

So please, please look at all these negative stories on the NHS and ask yourself 'what else could be going on here', because this government knows perfectly well that it is losing the argument on the NHS, because people can see for themselves what a disaster the last four years have really been.'

[Monkey]

But the report correctly identifies DMC as a priority for inspection whereas my small family doctor has been identified as a low priority. The agenda of the people behind the report does not seem all that skewed.

Who's behind the save our surgeries campaign? Is it the same GPs who got a massively good deal but failed to show us the goods?

[Bic Basher]

306 Medical Centre had it's CQC report in July which met the required standards.

http://www.306medicalcentre.nhs.uk/website/G85091/files/INS1-495559267_1-493951095_Dr_Mahreen_Chawdhery_20140203_Inspection_Report.pdf

I would say that since the Dulwich Hospital surgery closed, 306 is busier at all times, yet my mother went in on Monday and was able to get an appointment for Tuesday morning.

[Robert Poste's Child]

Monkey Wrote:

-------------------------------------------------------

> But the report correctly identifies DMC as a

> priority for inspection whereas my small family

> doctor has been identified as a low priority. The

> agenda of the people behind the report does not

> seem all that skewed.

>

> Who's behind the save our surgeries campaign? Is

> it the same GPs who got a massively good deal but

> failed to show us the goods?

It looks to me as though these reports are more about monitoring performance against government targets than the quality of the patient's actual experience. I'm with Elm Lodge, who are in the same priority band as DMC, but I find them excellent and it has been a completely different experience from the depression-inducing DMC.

[Bic Basher]

Today's Dulwich & Herne Hill edition of the Southwark News has an expose of one in three Southwark surgeries are putting patients at risk.

DMC is the second worst surgery in the borough in the Band 1/Elevated Risk category.

[Jeremy]

Bic Basher Wrote:

-------------------------------------------------------

> DMC is the second worst surgery in the borough

Does not suprise me whatsoever.

Although I've been wondering recently whether the surgery is intrinsically bad, or do they just have far too many patients? They've had an influx of new patients over the last few years (I suspect as a result of many recommendations on here circa 2009, as well as access to the popular Lanes midwife service) and have clearly struggled to keep up...

[Dopamine1979]

I think these headlines are somewhat misleading. Read the actual criteria on the CQC report that they are using to make this 'risk' judgement though. Alot of it is to do with targets such as lowering patients' blood pressure low or diagnosing lots of cases of dementia. I don't think much of it is what you or I would consider 'bad' or 'risky'.

[Ant]

DMC has been shit since long before 2009. I'm sure too many patients is a large part of the problem, but I'd be surprised if it was purely down to that.

[Earl Aelfheah]

They actually don't do that badly on responsiveness, (considering how difficult it is to be seen there).

[Bic Basher]

Believe it or not, despite the large amount of patients on it's books, DMC doesn't have as many as the Forest Hill Road Group Practice.

Forest Hill Road - 12,620

DMC - 10,564.

Source: NHS Choices.

[BigED]

A long time ago, in a part of London far far away, I worked in the NHS in primary care. One of the things we did was to compare GP patient records with local population figures - the former greatly outnumbered the latter. then we did what was called "ghosthunting", where the GP records would be cleaned up and have all the deceased patients removed (they were often easy to spot - the records showed hundreds of centenarians across the borough) as well as checking whether ones who had not been in contact for years were still living in the area. I've no idea what the arrangements are now, but in those days, GPs got paid partly on the basis of numbers of registered patients, so there was no incentive to clean up their records.

All this got me to wondering. Bic Basher wrote:

"Forest Hill Road - 12,620

DMC - 10,564.

Source: NHS Choices."

I looked up the 2011 ONS Census estimates (total population, all ages) for SE22 postcodes: 29,687.

If just these two practices claim over 23,000 patients (i.e. not counting practices in The Gardens, Melbourne Road, Lordship Lane/306), I have to wonder whether we might still have a ghost problem in our GP records. (And I do understand that some of these practices will have patients living in other postcodes, but that cuts both ways).

[Penguin68]

One of the (slight) problems with cleaning ghost records is that this is frequently done by checking whether patients have attended surgeries/ had prescriptions etc., and cleaning out those who haven't for some years. When I was younger (much) I would go years without needing to see a doctor or receive treatment - I was a healthy young adult - but I was still a patient of a GP practice (earning money for them by being on their list) and wouldn't have wanted to be punished by being excluded because I was well.

So in cleaning it is important not (just) to base your cleaning on attendance records - it is the healthy young who effectively subsidise the old unwell (which is now me) - by generating capitation fee income without generating cost.

Having said that, it would be far easier to judge effectiveness if we had a 'proper' patient base to work from. A practice with a lot of ghost patients is being heavily subsidised at the expence of practices whose lists are clean. It would also allow good practice to be properly identified - copying a practice with apparently good results (taking into account only their nominal lists) but which is actually serving far fewer patients may give a distorted view of good practice.

[Bic Basher]

BigED Wrote:

-------------------------------------------------------

>

> I looked up the 2011 ONS Census estimates (total

> population, all ages) for SE22 postcodes: 29,687.

>

> If just these two practices claim over 23,000

> patients (i.e. not counting practices in The

> Gardens, Melbourne Road, Lordship Lane/306), I

> have to wonder whether we might still have a ghost

> problem in our GP records. (And I do understand

> that some of these practices will have patients

> living in other postcodes, but that cuts both

> ways).

The catchment areas for most of the SE22 surgeries also include parts of SE5, SE15, SE23, SE24 and SE26, so isn't full representative of all of ED's residents.

Forest Hill Road surgery is on the edge of Honor Oak, so will attract residents who live in SE23.