There have been some quite significant changes introduced by the CQC in recent months.  It can be hard to keep up with all them, so here is a quick summary of exactly what those changes are.

The background to the changes is an independent review of the CQC in 2024, which led to the then Health Secretary Wes Streeting declaring it as “not fit for purpose”.   The report highlighted a raft of failings including inspectors lacking the necessary experience, an inconsistency across visits and a huge backlog of assessments.

As a result, the CQC committed (amongst other things) to more sector-focussed regulation, more inspections and faster inspection outcomes.  The current raft of changes are these plans being put into action.

Disappointingly, the CQC has not introduced a general practice (or even primary care) specific focus.  Instead, the focus is on primary care and community services combined.  Professor Bola Owolabi has recently been appointed as Chief Inspector of Primary Care and Community Services.

In terms of practical changes the CQC is currently trying to do two things at the same time (which is leading to some of the confusion).  It is trying to increase the number of reviews it carries out, and it is also changing the assessment framework that it uses.  It is doing these two things in two different ways.

To increase the number of reviews it carries out it has introduced what it terms a “Return to Good and Outstanding” project.  This is a programme of visits that started in March and is specifically targeted at practices that hold a current rating of good or outstanding, had their last inspection report published between 2017 and 2022, are considered lower risk and have no ongoing regulatory activity.

These are slimmed down versions of a full visit.  They focus on the non-clinical aspects of care (there is no GP specialist advisor as part of the assessment team), and the primary person required for the visit is the practice manager.  On the latest podcast Ed Kennedy shares his experience as practice manager on the end of one of these visits.  The practice only receives 5 days notice of the visit, and the rating of the practice cannot be changed as a result – it can only trigger a full inspection.

At the same time the CQC is targeting practices for a full visit that that have been identified as high risk and not assessed, practices with previous enforcement action assessed for follow up, and practices with ratings older than 7 years.

These are the current inspections that are taking place.  At the same time, the CQC is changing its assessment framework.  It ran a consultation on the proposed new framework which ended on the 12^th June.

This framework is long, and it tries to encompass practices, primary care organisations and community service providers which inevitably makes it unwieldy.  The focus on access, continuity, and partnership working across the system potentially opens the door for a wider range of assessments for practices in future than we have had in the past (nearly 90% of practices are currently rated as “good”), but we will have to wait and see how this plays out.

The CQC has stated that there will be a programme of pilots and testing of the new assessment system between June and October, with a final evaluation in November 2026. Pilot assessments will run alongside existing inspections. Participation in a pilot is voluntary, and the CQC has said if a practice chooses not to take part, there will be no regulatory consequence.

Whether all these changes will improve the effectiveness of the CQC remains to be seen.  At present the challenge is simply keeping up with all the changes the CQC is making at once!