It has been a year since we published our report Ethnic minority-led GP practices: Impact and experience of CQC regulation.
We started this work following concerns that ethnic minority-led GP practices may not receive the same regulatory outcomes from CQC as providers led by GPs of a non-ethnic minority background. The limited data within the health and care system meant we were unable to find a relationship between the ethnicity of practice leadership and its CQC rating. However, we were able to identify several contextual factors that can disproportionately affect ethnic minority-led practices and their ability to demonstrate how they provide good care. These relate to external system-wide factors, internal factors within a practice, and those from CQC.
In our research, some GPs from ethnic minority groups reported poor experiences of the inspection process and its outcomes. We are fully committed to being a fair regulator for all health and care providers. So, since publishing the report, we have focused on working to address the findings by embedding recommendations for CQC into our new approach to regulating. We have already made significant progress in some areas.
Changing our regulatory methods
Tackling health inequalities
Our research found that our inspection methods mean we are not always able to reflect the efforts that GP practices are making to respond to the health inequalities of their practice populations, as well as the outcomes of those efforts. This is particularly important where a practice serves a population in an area of deprivation, which was a factor that contributed to poorer ratings.
In our new approach, we will be using a single assessment framework with new quality statements to assess the quality of care. Quality statements are the commitments that health and care providers, commissioners and system leaders should live up to. We will look for evidence to show that GP providers are doing this. Some quality statements explicitly cover inequalities, such as:
- “We actively seek out and listen to information about people who are most likely to experience inequality in experience or outcomes. We tailor the care, support and treatment in response to this.”
- “We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.”
- “We make sure that everyone can access the care, support and treatment they need when they need it.”
But to improve outcomes for their patients, GP practices need other partners in the local health and care system to work collaboratively. Through our new approach, we’ll be able to have a better view of how inequalities are being addressed across health and social care systems. This will highlight the important role of GP practices in addressing identified inequalities.
More transparent judgements
We’ve also developed changes to how we collect and look at evidence to make our decisions and judgements more structured and transparent. When forming a view of quality, we’ve developed a scoring framework to enable us to make consistent judgements.
In the interim, we have enhanced the scrutiny of reports for all practices with a draft rating of inadequate, where special measures are being considered. This is to assure ourselves of the fairness and consistency of decision making. We will produce guidance for colleagues who review reports to identify factors that might be disadvantaging some GP practices.
Reflecting contextual factors
As well as the consistency of judgements, our research identified the need to consider the context. This found that our current methods do not allow us to consistently take into account the context a practice is working in – with ethnic minority-led GP practices more likely to be delivering services in areas of high deprivation. Some practices are disadvantaged for not achieving similar outcomes to those with very different contexts and patient communities.
In the longer term, we’re developing ways to better reflect context in our new regulatory model, such as socio-economic deprivation and population demographics. This will enable us to be more nuanced in assessing how GP practices are meeting the needs of people in the areas that they serve, without compromising on expected standards of care.
Until our new approach is implemented, we’ve strengthened our current methods when considering context. Inspection teams are now aware of how and when to take account of local contextual factors when making a judgement about how a practice delivers care to its population. The new process will ensure our inspectors reflect contextual factors in their reports.
To strengthen this, inspectors can refer some reports for further scrutiny and quality assurance. We are also developing a retrospective quality assurance process to monitor the effectiveness of this approach.
However, we are committed to keeping people at the heart of everything we do. We’re clear that we will not compromise on expected standards of care and that our ratings reflect the quality of care that patients receive from GP providers. We expect everyone to receive good care regardless of where they live or their background.
Using more data and experiences
Good quality data is vital to our judgements. We’re currently developing ways to make more use of data to give a better indication of how outcomes vary among practices working in similar circumstances.
People’s experiences are vital to inform our judgements about quality. Ethnic minority-led GP practices in our research had concerns that we were not getting feedback from a fully diverse range of patients, which could disadvantage these practices. Since publishing the report, we’ve been working to improve the quality and quantity of feedback we receive from people from all backgrounds.
This includes:
- testing how to capture equality data from people who submit feedback
- developing new tools to actively engage with people who we don’t tend to hear from to improve our online Give feedback on care facility
- developing outreach and engagement in local areas to gather feedback from people less likely to engage with us in other ways
- launching a project in January 2023 focused specifically on reviewing and improving ways to capture feedback from diverse ethnic groups about the care they receive in primary care settings, see our WRES action plan for more information
- producing videos in different languages to encourage people to give feedback on their care to promote our interpreting arrangements.
Read more information about how we ensure consistency when we use people’s views and feedback.
Our colleagues in CQC
Another point raised in the report related to the ethnicity of our colleagues. We have published our staff self-reported ethnicity data in Our Workforce Race Equality Standard (WRES): Annual Report 2021. We continue to monitor our representation, as we aim to be representative of the communities we serve.
Support for GP providers
Prompted by feedback from GPs who participated in research, we set out to identify how we could better recognise and share innovative practice by NHS GP providers to reduce health inequalities. Supported by funding from the Regulators’ Pioneer Fund, this work looked at how practices in areas of deprivation that are responding to health inequalities can have their innovation duly recognised in our regulatory processes. As a result of this work, we have published guidance on recognising innovative practice that summarises the key findings in a way that will be helpful for both GP practices and our inspectors.
We are committed to working with system partners including NHS England, the General Medical Council, Royal College of General Practitioners and the British Medical Association to ensure that ethnic minority-led GP practices get the support they need. Our priorities from our work to date include looking at support for single-handed practices and reviewing whether current arrangements are effective for practices in areas of deprivation that are experiencing disproportionate pressures, such as professional isolation and lack of funding.
What’s next
We know there is still more to do. We remain committed to the actions set out in the report.
Many of our next steps rely on the progression of our new regulatory approach. We’ll share more updates on this work as and when we start to implement it. Make sure you’re signed up to our bulletins to get the latest information about our plans.