How can GP practices challenge CQC inspection reports?

Following all physical inspections carried out by the CQC under section 60 of the Health and Social Care Act 2008 the CQC is under a statutory obligation to produce and publish a report of its findings.

For GP practices the published report usually consists of an inspection report displaying ratings for each key question inspected, as well as ratings linked to relevant population groups. Reports also contain an evidence table that highlights the information used by the CQC to arrive at its ratings decisions.

The CQC has two formal quality assurances processes that providers, including GP practices, can use to help ensure correct information is given to the public through the CQC’s inspection reporting obligations – the factual accuracy comments (FAC) process and the rating review process.

These processes give practices the opportunity to directly challenge the content of the inspection report and/or the ratings awarded.

FAC process

The FAC process focuses on the draft inspection report and provides GP practices with the opportunity to challenge the facts contained in that report and evidence table, as well as any judgments and ratings reached.

There are two stages to the FAC process:

1. The provider has 10 working days from the date of receipt of the draft report and evidence table to submit any factual accuracy comments. These should be submitted on the CQC’s FAC check form.
2. The CQC will review any FACs submitted and its response, along with the final report and evidence table, will be sent to the practice. The report is usually published within a few of days of it being sent to the practice.

Importantly, it should be recognised that the FAC process gives GP practices the opportunity not only to challenge factual statements but also to present additional evidence for consideration and to challenge ratings and judgments stated in the report and evidence table.

This can include challenges to regulatory breaches which could have a significant impact on the ratings reached.

The FAC process should be used as an opportunity to present additional positive evidence about a service that the CQC may have missed on inspection.

While the report focuses on the position of the practice on the day of the inspection, CQC guidance is clear that inspectors should take into account additional information sent to them by the provider shortly after the inspection. Such information could be reflected in the inspection report, for example if an issue highlighted was addressed in a prompt manner this can be acknowledged.

Ridouts has experience of assisting GP practices with the FAC process and has had success in getting regulatory breaches removed, ratings improved and ‘facts’ clarified in inspection reports and evidence tables.

Rating review process

The rating review process is only available after the final inspection report has been published. There are three stages to the process:

1. The Provider has 15 working days from the date of publication to submit a request for a review via an online form on the CQC website. There is a 500 words limit.
2. The CQC’s independent rating review team will determine whether it meets the grounds for review.
3. If a request is not considered to have grounds, it will be refused and the CQC will write to the provider explaining why. If a request is considered to have established grounds for a review, independent CQC staff will review the aspects of the process that were not followed correctly and determine whether any changes need to be made to ratings as a result.

The relevant inspection report and ratings will remain published throughout this process and practices are required to continue to display their ratings.

The only grounds for requesting a rating review are that the CQC has failed to follow its own processes for making ratings decisions. Providers cannot ask for a review of ratings on the basis that they disagree with the CQC’s judgments.

In our experience, the main ways we have been able to demonstrate grounds for review have been by highlighting individual CQC inspectors’ failures to respond properly to FACs, refusals by inspectors to take into account valid evidence presented to them and an incorrect application of the ratings limiters.

There is a risk that ratings can go down as well as up following a rating review request. The CQC also has the power to extend any review to include any of the other ratings reached in the report, even if they have not been directly challenged by the provider through the request. Therefore the risk extends to all ratings and not just those subject to the initial request.

The rating review process is the final formal CQC process for challenging ratings.

• If you require assistance or advice on challenging CQC inspection reports, our specialist solicitors can help. Please contact Ridouts Professional Services Ltd at info@ridout-law.com or by calling 020 7317 0340.