Health and care services in England risk developing “chasms” of unequal care in spite of the “extraordinary” response of the NHS, including practices, to the pandemic crisis, according to a major review of services.

In primary care, the situation has been “volatile” even though 94% of practices were found to be good or outstanding, according to the annual Care Quality Commission assessment.

The CQC finds that, before the pandemic, care was generally good with some problem areas, especially in emergency and maternity care.

CQC chief executive Ian Trenholm said: “Pre-COVID, the health and care system was often characterised as resistant to change. COVID has demonstrated that this is not the case. The challenge now is to maintain the momentum of transformation, but to do so in a sustainable way that delivers for everyone – driven by local leadership with a shared vision and supported by integrated funding for health and care.”

He added: “There is an opportunity now for Government, Parliament and health and care leaders to agree and lay out a vision for the future at both a national and local level. Key to this will be tackling longstanding issues in adult social care around funding and operational support, underpinned by a new deal for the care workforce. This needs to happen now – not at some point in the future. COVID is magnifying inequalities across the health and care system – a seismic upheaval which has disproportionately affected some more than others and risks turning fault lines into chasms. As we adjust to a COVID age, the focus must be on shaping a fairer health and care system – both for people who use services, and for those who work in them.”

Royal College of GPs chair Professor Martin Marshall said: “The College is working to support struggling practices through our practice support work and it’s encouraging to see that through this scheme and others, since last year, almost 200 practices have made improvements bringing them into the good category. The COVID-19 pandemic has been the biggest challenge to the NHS – and general practice has been no exception. GPs and their teams worked incredibly hard from the start of the pandemic to change the way they deliver services in order to keep patients as safe as possible, stop the spread of the virus, and allow staff to continue working, delivering patient care. General practice has been open throughout the pandemic, although care is currently being delivered differently to usual, in line with official guidance, with most consultations being delivered remotely.”

Danny Mortimer, chief executive of the NHS Confederation, said: “The evidence about the disproportionate impact that the first wave of coronavirus had on exacerbating inequalities is overwhelming, yet we are hurtling towards the second surge with the Government seeming to have learnt very little about it judging by its limited and slow action particularly in relation to test and trace. This could now have a devastating impact on communities and on the NHS’s ability to cope.”