Viewpoint: What does the CQC’s new approach to regulation mean for GPs?

The CQC is in the process of developing the way in which it regulates GPs. There will be a move to a dynamic assessment of GPs and a move to a single assessment framework. This new way of regulating the sector is designed to make regulation less complicated and more transparent for the CQC itself, GPs and their communities.

What remains?

Ratings are set to stay as also are the five key questions. The CQC describes this new strategy as a step change in the way that it regulates GPs. It wants GPs to view these changes as a refining of processes rather than changing what a 'good’ GP service looks like.

The CQC wants to make it easier for both GPs and those that use their services to understand its decision making process by making that process more straightforward.

What’s new?

The complicated system of key lines of enquiry used to support inspections will be replaced by simpler questions rooted in what people expect of GPs and what GPs should expect of their own services. Those questions focus on statements which the CQC considers to be more relatable both to GPs and the public at large than is the case presently.

The days of a GP being rated at physical inspections according to a set time frame would appear to be coming to an end. The consequent reliance on data to reach conclusions as to the quality of practices could see a move to even more intensive inspections and scrutiny where there is an alleged elevation in risk.

Evidence gathering

The CQC will look to be quite specific in respect of the evidence required to demonstrate a service which is good or outstanding. There will be a scoring system for each piece of evidence that will be required to provide certainty to GPs as to how evidence is to be interpreted.

The CQC is not keen to be overly prescriptive in how GPs demonstrate that they are meeting the standards required of them. The CQC wants to increase the consistency of its officers by reducing their ability to divert from an opinion about a service based on the evidence supplied by GPs.

Site visit-based inspections will likely be reserved for those practices which cause the CQC’s internal systems to alert them to an unacceptable increase in risk. This carries with it a consequent bias towards the CQC operating in an echo chamber where it is focusing its resource on what it considers to be negative practice. This focus will likely make the CQC more confident in the decisions it makes.

One-size-fits-all?

Benchmarking one GP practice to another is a redundant exercise. It is an artificial construction that you can compare ratings one against another. Each GP service faces its own challenges and the quality of care provided is deeply personal to each person with whom they come in contact.

Risk-focused inspections

One potential problem with this approach is that if the CQC is focused on the identification of risk it cannot be as focused on finding good practice. This has the unintended consequence that the CQC may fail to acknowledge what is good. The CQC continues to be focused on physically inspecting GPs who demonstrate, either through data or from visits, that there is a risk of negative practice occurring in a service.

Inspectors can adopt a laser-like focus on risk and this impacts greatly on the assessment of practices as a whole. It is the magnification of poor practice to the detriment of all the good that is done by practices which should also be focused on.

What’s next?

This is very much a crystal ball moment for the CQC and how it chooses to take its next steps will impact upon how it engages with GPs in the future. We don’t yet have absolutes from the CQC in terms of when this new strategy will come into force but it is likely to be soon. This strategy is not set in stone and is likely to be refined further still.

The bigger picture in the regulation of GPs has to be maintaining the quality of services. The way in which the CQC seeks to promote this is important to the sector. A new approach to regulating and inspecting GPs is welcomed but there remain many unknowns which we won’t have answers to until the strategy has been rolled out.

Abandoning ratings and not adopting such a rigid interpretation of what a good GP service looks like would be what the sector as a whole is hoping for. What the CQC is offering instead is a less flexible process which focuses more intensely on poor care but leaves those providers who meet its data-driven standards alone.