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CQC’s Strategy for Inspection of Primary Care

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With the CQC under a period of evolution – and promising that GP practices that are rated as good or outstanding won’t be re-inspected for up to another five years – we thought we’d take a closer look at how its monitoring, inspection, and reporting of GP practices will change in the coming years.

The good news is that the CQC seems to be listening to the concerns of the GP practice. Using its experiences since it began inspecting, the CQC is promising to pay more attention to areas of unidentified or emerging risks, and also to adadpt its procedures and processes by understanding more about the evolution of new models of care.

A new localised approach

The CQC places the value of community knowledge and care developed for local residents high on its list of inspected factors. In fact, community presence features highly on the list of common reasons for practices to be rated as ‘outstanding’. It is comforting to know that the CQC is promising to practice what it preaches: it is going to build local relationships as it moves towards a better understanding of local issues and priorities.

It promises to be more dynamic and flexible towards the new models of care, including those emerging through the Forward View Vanguard Programme.

The CQC’s new approach in practice

Looking at each of its functions in turn, this is what the CQC says about its evolution of approach:

- Monitoring

Having collected a lot of data nationally, the CQC is going to use this to develop a new model for monitoring GP practices in the development of an ‘insight model’. The CQC promises that this will be flexible, while developing a “single shared view of quality with providers, people who use services, and our partners, including NHS England, the General Medical Council, and the National Institute for Health and Care Excellence.”

This should help it evolve a common framework that envelopes the five KLOEs: safety, effectiveness,caring, responsiveness, and leadership.

The CQC is likely to ask GPs to share their views about what constitutes quality of care and examples of good practice, so be prepared to answer candidly – your view could help shape the future of CQC work.

One of the main factors that we found in our assessment of CQC’s recent outstanding and inadequate ratings was leadership. The CQC is currently piloting a GP Practice Leadership Assessment Tool, which should help to identify areas that need readdressing and specific training requirements.

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- Inspections

Instead of a standard period between inspections, you can expect your current and future inspection ratings to affect when subsequent inspections will be conducted: the higher the CQC’s concern about a GP practice, the more frequently it will be inspected. This means that you could wait as long as five years for your next inspection.

On top of this, the way that the CQC will inspect is going to change. It might decide to conduct a full inspection (as it does now), or a partial inspection concentrating on only those areas of concern.

You’ll also find that inspection teams become more ‘specialised’ to provide greater flexibility in line with its new approach.

- Reporting

Although some GP practices have expressed their concern at having their inspection ratings published so visibly, the CQC isn’t going to alter its approach to this. However, it recognises that as the models of care evolve, it will need to develop consistent reporting principles while maintaining flexibility for the level of reporting of larger GP practices, federations, and corporate models.

No real change expected here.

When to expect these new practices to be embedded

This new methodology behind monitoring, inspecting, and reporting of GP practices by the CQC is not going to be introduced overnight, but is a five-year plan of evolution. You can still expect to be monitored and inspected, though the way that the CQC does so will change over time. It will become more targeted, and (in the case of good or outstanding practices) inspections will be at longer intervals.

However, the CQC does provide a caveat: it says that it reserves the right to inspect sooner, “depending on what (our) ongoing monitoring of wider intelligence (insight) about a service is telling (us).”

In other words, while the CQC is going to change the way it does things, every GP practice will need to remain at the top of its game to benefit from those changes.   

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