Why is the CQC changing the way it inspects practices?
Earlier this year the CQC launched a consultation to establish how it could change and improve the way it regulates some providers, including general practice. The CQC also reached the milestone this year of having rated every practice in England, 91% of which were found to be either ‘good’ or ‘outstanding’.
How will the inspection process change?
Most GP practices that are rated ‘good’ or ‘outstanding’ will only be inspected every five years, although the CQC will inspect a proportion of practices every year so some may find their inspection is sooner than this. This change was introduced from November this year.
The CQC will continue to re-inspect practices rated inadequate after six months and those rated as requires improvement within 12 months.
From April 2018, the CQC says that most of the inspections of good or outstanding practices will be ‘focused inspections’ rather than ‘comprehensive inspections’. All practices will have had a comprehensive inspection to establish their first CQC rating and most practices having a routine inspection (i.e. an inspection that has not been arranged to investigate a particular concern) between now and April will most likely continue to have comprehensive inspections.
The CQC says focused inspections are ‘smaller in scale than comprehensive inspections, although they follow a similar process.’ At the moment the regulator carries out focused inspections to look at something it is concerned about or if there is a change in a provider's circumstances (for example, if they’ve been involved in a merger).
The key change to underpin this new system will be the amount of data the CQC has about practices. The CQC says it will obtain this through its current CQC Insight model (which includes information such as QOF scores, GP patient survey data and data from Public Health England), local information from CCGs and a new online system of information collection from practices, which it intends to introduce in 2018. Practices will be required to submit data annually under the plans. Until the new system is in place the CQC will continue using ‘provider information requests’ as part of its pre-inspection planning.
As part of the changes the CQC updated its key lines of enquiry in November to standardise them across all the providers it regulates. You can find an updated version of these (which highlights where changes have been made) here. From November inspection reports will also be shorter and ‘easier to read’, the CQC has said.
The CQC also intends to ‘refine its approach’ for inspecting and rating population groups from April 2018.
What will the CQC look at during these focused inspections?
The CQC says the focus of inspections will be based on data it has gathered on a practice and on findings from previous inspections, although all inspections will consider performance on the 'well-led' key question.
By focusing only on practices’ weak spots, the new system will help maximise the opportunity for them to improve their ratings, the CQC believes.
What does all of this mean for practices?
The CQC says that new system will be less demanding for practices. However, it is unclear how much information practices will need to provide to the CQC each year under the new system of information collection and how submitting data will actually work.
In its response to the CQC’s consultation, the RCGP raised concerns about this aspect of the plans warning that it would ‘not reduce the overall impact of regulatory burden on GPs’ and will actually increase practice workload in the short-term’.
However, the CQC has since said that it will work with practices and LMCs, the GMC, NMC and NHS England to streamline and align requests for information with other organisations. It has also said it will only request information from practices that is not available from any other source and that it will carry out an impact assessment of the system before it is introduced.
In an email sent to practices in October CQC chief inspector of general practice Professor Steve Field said: ‘It is our belief that the changes that we plan to make over the next 18 months will bring real benefits to providers and patients. Minimising the impact of regulation on providers is at the forefront of our mind as we bring in these changes in phases, taking care to test and refine our processes as we go, and working continually with you, and your representatives.'
Timeline of when changes will happen
From April 2018
- Further changes to inspection report – reports will be streamlined further. The shortened report is being developed and tested before being introduced in April 2018.
- Inspecting and rating population groups – The CQC will refine its approach to inspecting and rating population groups to make the ratings easier to understand while highlighting the quality of care for individual groups.
- Focused inspections – Most inspections of providers rated as good and outstanding will be focused rather than comprehensive.
- New system of provider information collection – Practices will be asked to share information with the CQC on changes once a year. This will not be introduce until new digital systems are in place.