The role of the CQC (Care Quality Commission) as an independent regulator is to register health and adult social care service providers in England and to check, through inspection and ongoing monitoring, that standards are being met.
All GP practices in England must be registered with the CQC.
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Duty of candour
The duty of candour for organisations aims to ensure providers are open and honest with people when something goes wrong with their care and treatment.
To meet the duty of candour patients should expect:
- a culture within the service that is open and honest at all levels
- to be told in a timely manner when certain safety incidents have happened
- to receive a written and truthful account of the incident and an explanation about any enquiries and investigations that the service will make
- to receive an apology in writing
- reasonable support if they were directly affected by the incident.
If the service fails to do any of these things, the CQC can take action.
'Fit and proper person' requirement
When a service provider is a health service body, it must not appoint or have in place in the practice anyone who:
- is not of good character
- does not have the qualifications, competence, skills and experience necessary for the office, position or work for which they are employed
- is not able by reason of their health, after reasonable adjustments are made, to properly perform tasks intrinsic to their office or position
- has been responsible for, been privy to, contributed to or facilitated any serious misconduct or mismanagement (whether unlawful or not) in the course of a regulated activity.
Types of inspection
- Reviews the provider in relation to the five key questions leading to a rating for each on a four-point scale.
- Assesses all six of the population groups.
- Takes place at the same time as the CQC inspects a number of practices in a CCG area.
- Usually one day on site and usually announced.
- At least once every three years.
- Follows up on a previous inspection, or responds to a particular issue or concern.
- May not look at all five key questions and six population groups.
- Team size and composition depends on the focus of the inspection.
- May be unannounced.
How practices are rated
GP practices are rated as:
- requires improvement, or
For each practice, the CQC inspection will rate performance at four levels:
- level 1: rate every population group for every key question
- level 2: an aggregated rating for each population group
- level 3: an aggregated rating for each key question
- level 4: an aggregated overall rating for the practice as a whole.
The rules for aggregating ratings are as follows:
- outstanding = 2 outstandings + the rest good
- good = 1 outstanding + rest good or 1 requires improvement + rest good
- requires improvement = 2 requires improvement + rest good or 1 inadequate
- inadequate = 2 or more inadequates
The aggregated population group ratings (level 2) do not directly tie into the overall key question ratings (level 3), which can lead to some odd results.
How the CQC monitors practices
CQC Insight is used to monitor potential changes to the quality of care provided. It brings together the information the CQC holds about your practice in one place.
This helps inform the Annual Regulatory Review, which is used by the CQC to prioritise its inspections where the information suggests the quality of care at a practice has changed since its last inspection.
Dealing with a poor rating
GP practices rated as inadequate for one or more of the five questions or six population groups are given a time period for reinspection, no later than six months. During this period the practice must show improvement.
If a practice fails to make enough improvement and is still rated inadequate for a question or population group, the CQC will place it into 'special measures' following consultation with NHS England. Practices are placed in special measures for up to six months, and must improve within this period to avoid having their registration cancelled.
Support for practices placed into special measures:
- RCGP's practice resilience course
- Practices that might be at risk of being placed into special measures are advised to contact their LMC
Disputing your rating
If you believe the rating you receive does not reflect the service you provide, consider requesting a review of the ratings and importantly, the underlying facts and judgements. There are a number of routes for practices to challenge the CQC’s judgements.
CQC inspections can be tricky to handle. We can offer further support for GP practice before, during and after your CQC inspection.