Royal College of GPs calls for pause in CQC inspections and end to one-word ratings

The RCGP's governing UK Council has today voted to call for a temporary pause of routine CQC inspections, and for an end to the one-word rating system currently used in CQC reports.

The College has now written to Primary Care Minister Stephen Kinnock MP, copying in the CQC Interim Chief Executive James Bullion, to lay out its concerns with the regulation regime as it currently stands, and make these recommendations.

The RCGP has repeatedly raised concerns about the way the CQC operates in England including the excessive impact of routine inspections on GP workload, and negative experiences reported by GPs and their teams associated with them. It has also called out the potential bias inspections have shown against ethnic minority-led GP practices.

In today’s meeting, RCGP Council agreed to call for a temporary pause of routine CQC inspections in general practice, to enable the Government and other stakeholders including patient organisations and the RCGP to work with the CQC to co-design and implement an improved regulatory system for primary care. It was argued that this would allow the CQC to make key improvements recommended in the recent reviews by Dr Penny Dash and Professor Sir Mike Richards, including to reinstate the role of Chief Inspector for Primary Care and review the current single assessments framework. It is hoped a pause would also help rebuild expertise within the organisation, and improve relationships with GP practices to restore credibility, as the Dash report recommended.

The proposed pause would only be for routine inspections. The College is clear that inspections of practices where patient safety concerns have been raised should continue. 

Council also voted to call for an end to the existing one-word ratings provided by the CQC within inspection reports and explore alternatives that would provide greater nuance, support and transparency for patients and professionals. This is something that has already been adopted by OFSTED in relation to schools.

Professor Kamila Hawthorne, Chair of the RCGP, said: “Patient safety is paramount in general practice, and the College recognises that if implemented effectively and proportionately, inspections of GP practices can help to keep patients safe, and support practices that are struggling. However, today’s decision by our governing Council shows the strength of feeling amongst our members that the CQC, as it stands, is not fit for purpose.

“We regularly hear reports that preparing for CQC inspections is highly and unnecessarily stressful at a time when GP teams are already working under intense pressure, and that the CQC’s processes are ineffective and, in some cases, discriminatory against practices run by GPs from ethnic minorities. As such, the College has been raising significant concerns about the current CQC inspection regime for a long time.

“The College has been encouraged by recent reviews by Dr Penny Dash and Professor Sir Mike Richards that both outline the need for significant improvements in the way the CQC operates. In our view, to continue to apply the current, deeply flawed, inspection regime would be actively harmful - diverting resources and attention away from patient care and perpetuating a distorted and inconsistent picture of GP services.

“We are therefore calling for a temporary suspension of routine CQC inspections until an improved, cost-effective and evidence-based approach to assessments and inspections has been agreed and implemented. Of course, patient safety is our number one priority, and inspections of practices where patient safety concerns have been raised should continue.

“A pause in routine inspections, as we’re recommending today, will allow for the sensible recommendations outlined in the recent reviews and in our letter to be implemented, as well as serving as an opportunity for the CQC to rebuild trust, credibility and expertise.

“Similarly, we believe that moving away from a rating system that relies on simplistic one-word ratings, and evaluating alternatives that would provide greater support and a more nuanced and rounded view, would be an important step to creating a fairer and better regulation system that practices and patients can have confidence in.

“We are making these recommendations to the Government and the CQC in good faith - ultimately, we want to have a constructive working relationship with the regulator, so that we can work together to improve patient safety. We are hopeful that implementing these recommendations will be the first step towards creating a more proportionate system of inspection that is fair and fit for purpose.”

Full text of letter

Dear Minister,

I'm writing to highlight the outcome of RCGP Council discussions today and to call for an immediate temporary pause in routine CQC inspections of general practice, to enable the Government to work with the CQC and other stakeholders, including patients and the RCGP, to design and implement an improved regulatory system for primary care providers. We believe this to be a key step in the process of creating a more proportionate system of inspections that is fair and fit for purpose, that practices and patients can trust and have confidence in.

We also want to see a move away from a CQC inspections rating system that relies on simplistic one-word descriptors and to evaluate potential alternatives which would provide greater support and a more nuanced and rounded view for patients and professionals. This is especially important for smaller providers such as GPs, where the personal and reputational impacts of an adverse inspection outcome can be felt much more acutely, compared to a larger organisation such as, say, an NHS Trust.

The recent independent review into the operational effectiveness of the Care Quality Commission by Dr Penny Dash found 'significant failings' in the workings of the CQC. Together with Professor Sir Mike Richards’ report into the CQC's single assessment framework, the Dash review has highlighted the need for the CQC to improve the operational efficiency, transparency, and communications of their inspection processes. The CQC itself has also recognised the need to take action to improve the way it works. RCGP has raised concerns for several years about the CQC's operations after receiving numerous examples of negative experiences of inspections and differential application of standards from general practices, as well as identifying potential negative bias during inspections of ethnic minority-led GP practices.

We want to work with the Government and the CQC to ensure a better regulatory system, in line with our core charitable objective "To encourage, foster and maintain the highest possible standards in general medical practice". In our view, to continue to apply the current, deeply flawed, inspection regime would be actively harmful, diverting resources and attention away from the provision of patient care and the task of reforming the regulatory system, and perpetuating a distorted and inconsistent picture of the quality of GP services.

We are therefore calling for a temporary suspension of routine CQC inspections in general practice until an improved, evidence-based and cost-effective approach to assessments and inspections has been agreed and implemented. This pause in routine inspections would allow the time and space for the Government and key stakeholders to work with the CQC to make the necessary improvements to address key concerns set out by the recent relevant reviews, including fixing the provider portal and regulatory platform, reviewing the Single Assessments Framework to make it fit for purpose and appointing a Chief Inspector for Primary Care. A pause could also assist in rebuilding primary care expertise within the organisation and improving relationships with GP practices to resurrect credibility, as the Dash report recommended.

As patient safety must always be a priority, inspections of practices where patient safety concerns have been raised should continue.

The RCGP is aware of the review of patient safety across the health and care landscape being led by Penny Dash, to evaluate whether the current structure of regulatory organisations impacting quality, including the CQC, is functioning effectively and efficiently. This is an important opportunity to ensure the regulatory framework supports high standards of care across the healthcare system. It is crucial that the expertise and experience within primary care is carefully considered as part of this review, and RCGP hopes to contribute as a key collaborator in shaping a regulatory landscape that is fair, supportive, and fit for purpose.

I look forward to meeting with you to discuss these steps, and how the RCGP can continue to work with you to encourage, foster and maintain the highest possible standards of patient care in general practice.

Yours sincerely,

Professor Kamila Hawthorne Chair of Council

CC James Bullion, Interim Chief Executive CQC

Dr Penny Dash, Chair, North West London Integrated Care Board

Further information

RCGP press office: 0203 188 7659
press@rcgp.org.uk

Notes to editors

The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.