‘Unsustainable’ GP pressure partly driven by rejected referrals, CQC warns

Unsustainable pressures on GPs are partly being driven by workload being passed from hospitals onto practices, the CQC has warned.

It includes ‘unsuccessful referrals’ to secondary care which mean that people need to be cared for longer by the GP while they wait for hospital treatment to go ahead, the regulator said in its annual state of health and social care report.

Since the pandemic, the number of patients registered with a GP in England has increased by 5% to 63 million but since 2016 the number of fully qualified GPs per 100,000 patients has fallen by 15%, the CQC noted.

The resulting increased need for GP services is putting ‘unsustainable pressure’ on the workforce with 76% of GPs reporting that patient safety is being compromised by their excessive workload.

‘This excessive workload comes, in part, from pressures in hospitals, which are passed on to primary care,’ the CQC said.

Workload dump is part of the reason GPs are currently taking collective action to protest against contractual terms and funding. Without a fair deal, more practices are likely to close, the BMA has warned.

Last month GPs said they had seen an increase in rejected referrals to secondary care, particularly from anonymous clinicians.

Targeted assessments of GP practices over the past year had clearly shown that access to GP services continues to be an area of concern for the public, the CQC said, but it acknowledged the efforts of staff in increasing the number of appointments.

The report found that rural areas had been hit particularly hard. The 10 ICBs with the highest proportions of patients waiting over two weeks to be seen were in comparatively rural areas, and half of them in the south west.

Across the NHS, issues with access to services are often exacerbated by deprivation, the report pointed out. This is highlighted by figures from 2023/24, which showed attendance rates for urgent and emergency care for people living in the most deprived areas of England were nearly double those for people in the least deprived areas

The CQC also highlighted concerns about quality of care and access to it for autistic people and people with a learning disability.

‘We are currently exploring the barriers and inequalities faced by these groups of people in accessing primary care, including the quality and consistency of annual health checks and action plans by GP,’ the report said.

This year’s report also strongly highlighted the impact of delayed care for children and young people within the wider NHS.

In some cases, it can mean an opportunity to intervene can be missed if the wait for a diagnosis is too long, the CQC warned.

‘Children who do not receive the care they need today are at increased risk of becoming adults with long-term mental or physical illnesses, which could affect their quality of life and their ability to contribute to society tomorrow,’ it concluded.

Mental health services were flagged as a cause for serious concern for both adults and children.

But continuing rises in demand for children and young people’s mental health services coupled with a lack of capacity due to workforce shortages is decreasing the chance of early intervention, it found.

A greater focus on children and young people’s services at both a national and local level is needed, including consistent funding targeted to areas of early intervention, the CQC said.

Ian Dilks, chair of CQC, said this year’s state of care report describes issues with access to and quality of care and the impact on people who use health and care services, with a particular focus on children and young people.

‘Action now – targeted funding for early intervention, better understanding of local need and improved management of demand, and genuine two-way communication with children and families – will help to ensure a healthier population tomorrow.’

RCGP chair Professor Kamila Hawthorne said: ‘GPs and the CQC have not always had the easiest of relationships, so we’re pleased to see that the unsustainable pressures general practice is facing are being recognised – and that many thousands more GPs are needed to keep up with the growing need for our care.

‘While this acknowledgement of the hard work that GP practices are doing to provide safe, timely and appropriate care is welcome, it’s long overdue as many of our members tell us about the additional pressures and unnecessary stress that CQC inspections – and preparations for them – have placed on them and their teams. Many report that CQC’s processes are ineffective, and in some cases discriminatory against practices run by GPs from ethnic minorities.

According to Professor Hawthorne, some RCGP members ‘have reported the most awful experiences of their practice inspections and we have been raising significant concerns with the CQC over a long time’.

And she added: ‘We have welcomed the recent Dash review and Professor Sir Mike Richards’ report on how and where the CQC needs to improve, We hope that this will be the start of a much more productive working relationship with the College and individual GP practices, as well as the first step towards creating a more proportionate system of inspection that is fair and fit for purpose – and that practices and patients can trust and have confidence in.’

Health secretary Wes Streeting said: ‘This report is further confirmation of Lord Darzi’s diagnosis of the challenges facing our health and care system and the appalling legacy this Government inherited. The NHS is broken and patients are being let down across all areas of our health services.

‘We have hit the ground running, ending the junior doctors’ strikes, recruiting 1,000 more GPs, and kickstarting work to improve children’s health to ensure they have the best start in life, including by banning junk food ads targeted at children, but it will take time to turn the NHS around.

‘This Government is working hand in hand with our 1.4 million NHS staff and patients to write the 10-Year Health Plan to get the NHS back on its feet, so it can be there for all of us when we need it, once again.’