The state of independent care

The Care Quality Commission plays a vital role in monitoring and managing the care quality of NHS providers – a position it also pholds for independent and private sector providers. In a new report, the health service regulator delves into the detail of almost 100 inspections to reveal the state of independent care in the UK

Published by the The Care Quality Commission (CQC) in late March, The state of care in independent doctor and clinical services providing primary medical care report gives an overview of care derived from the inspection findings for doctors (private GMC-registered GPs and clinicians) and clinics providing primary medical services in the independent or private sector. The regulator analysed a sample of 85 inspection reports for independent doctor and clinic services and themes from a review of inspection reports for 38 independent slimming clinics.

The practices involved ranged in size and scale from individual, single-handed practitioners to private organisations that may operate for one or more days a week in private practice. The unifying factor is that none are commissioned by the NHS or provide NHS services.

Overall, the CQC found that private providers in many cases are ‘responding to the needs of their patients’, providing care services that are adequately tailored to the needs of patients. While the CQC doesn’t have the power to rate these services, it uses the same taxonomy of whether a service is safe, effective, caring, responsive and well-led. We explore how these services stack up.

Safe

Worryingly, the CQC concluded that just under half of independent doctor services and slimming clinics were not providing safe care when inspected for the first time. Thankfully, many had put these issues right on re-inspection.

Providers had significant issues with information sharing, with some not complying with General Medical Council guidelines. Others had problems recording and managing care records, with some written in foreign languages, illegible or incomplete. Safeguarding issues around children were also noted. In some serious breaches, unlicensed medicines were being prescribed to patients.

Effective

Here, too, the CQC noted significant issues in relation to independent providers. On first inspection it found that a quarter of independent doctor services, and around a quarter of slimming clinics, weren’t providing ‘effective care in accordance with the relevant regulations’.

Clinics were failing to keep up with evidence-based best practice, in some cases, prescribing ineffectively. In one example, a patient at a slimming clinic was experiencing negative side-effects from medicines, but wasn’t referred for additional help.

Caring

On a more positive note, the CQC found that patients appear happy with the care they receive from independent providers. Many used the feedback provided by patients to improve services and to fix issues that arise from care.

Responsive

Responsiveness, the CQC notes, is about how services “responded to and met people’s needs, and how they listened to and learned from concerns’. Private providers, on the whole, appear to be listening to, and learning from, their patients, but there are pockets of poor performance. Some were unable – or unwilling – to provide information in other languages, while others failed to have simple, easy-read information available. In some worrying cases, clinics were found not to be upholding their duties under the Equality Act.

Well-led

Leadership influences all aspects of care provision – and poor management will create an environment where poor care can become acceptable.  In some clinics the CQC discovered inefficient and ineffective governance frameworks and quality monitoring systems. In some cases, audits either didn’t happen at all or, when they did, failed to spot significant issues and risks. Others were failing to improve their services, with few – if any – plans for service development and improvements in quality.

Conclusions

Overall, the care provided by independent healthcare organisations varies – as it does within the NHS. The NHS is transparent about the care provided whereas, in some cases, private patients may be unaware of CQC reports or inspections that have taken place. To tackle this, from April 2019, the CQC will start to introduce ratings for independent doctors and clinics in an alignment with the approach it takes to NHS services. This will give patients the full picture and enable them to make truly informed judgements about where to receive their care.

You can download a copy of the The state of care in independent doctor and clinical services providing primary medical care report here.

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