General practices rated inadequate by the Care Quality Commission (CQC) typically demonstrated a lack of practice nurses or a very low number of practice nurse sessions, according to the CQC annual report.
The State of Health Care and Adult Social Care in England broke down the common characteristics of both outstanding and inadequate practices. Outstanding ones demonstrated good relationships in a multi-disciplinary team and effective staff training and support. Inadequate practices were less likely to have practice nurses, with weak leadership and isolated working.
Heather Henry, the co-vice chair of the NHS Alliance and the chair of the Alliance’s pratice nursing group said good care relies on a ‘tripartite’ model of nurses, GPs and practice managers working respectfully in equal partnership.
‘Most GPs say that the thing nurses are extremely good at is following clinical procedures and I think this is a protective factor when it comes to the quality of primary care.
‘I’ve worked to address poorly performing practices over many years and it raises flags for me when the practice does not employ a nurse, or only for a few hours or there is a rapid turnover of nursing staff,’ she added.
Nursing safe staffing, both in the community and in acute care, was one of the bigger areas of concern highlighted in the report particularly the decline in the number of senior nurses and leaders.
Statistics from the Royal College of Nursing (RCN) showed that there are 2800 fewer senior nurses in the NHS than in April 2010. But both the RCN and the CQC are concerned that discussions around safe staffing focus on numbers alone. ‘Instead it should be about having the right number of people with the level of skills to make the appropriate clinical decisions at the right time,’ states the report.
Janet Davies, the chief executive of the RCN, said that there must be more investment in training nurses, keeping nurses and listening to nurses.
‘Inadequate leadership and year on year cutbacks leads to ineffective organisations and compromised care. This report is stark but the issues it raises are not new – there needs to be a concerted effort from government, the NHS and local managers to ensure that there is enough staff to get through the coming winter and the years to come.’
The report collated results of CQC inspections over the last year of primary care, hospitals and social care. Eighty-two per cent of primary care settings were rated good and 3% were rated outstanding. Only 4% of practices were deemed to be inadequate.