Current Regulatory Approach to General Practice

In this blog, Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care, highlights CQC’s current regulatory approach to general practice, and dispels some of the myths surrounding it.

General Practice, like the rest of Health and Social Care, continues to face unprecedented challenges as a result of the COVID-19 pandemic. The pandemic has seen health and social care services pushed to the limit, and general practice rising to the challenge by adapting rapidly to ensure people continue to receive the care they need, facilitated by a shift to a more remote consultation approach.

General Practice has also been instrumental in the successful delivery of the COVID-19 vaccination programme. Whilst this programme has been a success, we know it will not necessarily result in a decrease in workload for practices, and there is still currently a high demand for GP appointments.

In March 2020, we suspended our routine inspection programme in response to the pandemic and this remains the case. In its place we have adopted a risk-based approach, monitoring services using a mix of on-site and off-site methods and continue to only inspect where there is evidence of a risk to people using a service.

The CQC understands the huge pressure that general practices are under during this difficult time, and while we need to deliver our regulatory role, we don’t want to unnecessarily add to this pressure. Our role throughout the pandemic and beyond, has and will continue to be to ensure that patients receive safe care. But we recognise that we need to be responsive to the current situation, and through engagement with providers, professionals and stakeholders we have adapted our approach to take into account the challenges that general practice is facing. We are also working with system partners across health and care to ensure everyone is aware of the challenges general practice face and look for opportunities to work jointly to address them.

From July this year we introduced a monthly review of information we have about practices, and if we have found no cause for concern to re-assess the rating or quality of care of a practice, we will publish a statement on our website saying so. This reduces the need for physical inspections.

We will continue to respond to risk and we will re-inspect locations where there is a breach of regulations or where a service has previously been rated as ‘requires improvement’.

This means though that for practices rated good and outstanding, the frequency of inspections is set to decrease.

When we do inspect, we’ll spend less time on site and will work with GP practices to gather evidence in different ways such as interviewing practice staff using online video calls and with GP specialist advisors accessing clinical records systems digitally, meaning they won’t need to be on site.

Following on from the publication of our new strategy we will be developing our regulatory approach further to help us realise our ambition to be a more dynamic, proportionate and flexible regulator. Going forward we will increasingly make better use of technology to support how we gather evidence about a service and update a rating without the need for a visit. This regulatory approach will allow us to focus on those practices that need more support.

Our five key questions of practices remain the same:

• Are they safe?
• Are they effective?
• Are they caring?
• Are they responsive to people’s needs?
• Are they well-led?

Our comprehensive inspections will continue to address these five key questions, and this will remain standard for inspections of services that we have not yet inspected, or if a service has an overall rating of inadequate or requires improvement.

We will continue to inspect when we need to follow up on an area of concern. This could be a concern identified during an inspection that has resulted in enforcement action, or concerns that the public, staff or other stakeholders have raised with us.

These focused inspections do not usually look at all five key questions. They usually focus only on specific areas indicated by the information that triggers the inspection. These inspections may be unannounced.

We will continue to rate practices as either outstanding, good, requires improvement or inadequate, thus helping practices to identify where improvements need to be made and helping the public understand more about the quality of care being delivered at the service.

I know that everyone in general practice and across the whole of primary care is working incredibly hard to ensure people receive the services they need, and we are here to support you to do this. CQC will continue to work in partnership with providers, professionals, the public and stakeholders to develop a regulatory approach that supports General Practice to deliver good care.

For information about CQC’s regulatory approach towards GP practices, see our Mythbusters page: GP mythbusters | Care Quality Commission (cqc.org.uk)

And more information about how we regulate practices can be found on our website:

GPs: information for providers | Care Quality Commission (cqc.org.uk)