Speaking to GPonline’s Talking General Practice podcast, Professor Bola Owolabi – a practising GP – said that the move marked a significant shift away from the regulator’s current ‘single assessment framework’ that had drawn criticism for failing to account of the unique pressures of primary care.
The change follows a period of intense scrutiny for the regulator, following a report by the now chair of NHS England Dr Penny Dash in 2024, which identified major failings within the organisation, including inconsistent and unclear ratings, inspectors lacking expertise, and long delays publishing reports.
Professor Owolabi told Talking General Practice that the previous ‘one-size-fits-all’ approach that was used for all providers, would be replaced by a framework tailored specifically to general practice. She said the CQC had also made ’significant strides’ in addressing concerns around its IT infrastructure and delayed inspection reports.
Sector expertise
Professor Owolabi said the new assessment model would reintroduce ‘rating characteristics’, providing clearer descriptions of what ‘good’ or ‘outstanding’ looks like in a clinical setting, to replace the more abstract ‘quality statements’ that many practices found confusing. She added that the goal was to return to a system where professional judgment and sector-specific expertise were at the heart of every inspection.
‘As a GP myself, I recognise the pressure of the day job itself and what it takes to provide excellent general practice to patients,’ she said. ‘And I understand that even the anticipation of a CQC inspection can bring about a degree of pressure. But through this renewed approach, I’m determined to make sure that we get the balance right between the rigour of regulation, but being mindful of the context in which people are doing their work.
‘And part of the things that we’re doing is setting out clearly: what does good look like? Because [CQC inspection] is not an exercise in catching people out. It’s an exercise in affording colleagues the opportunity to demonstrate how, day-to-day, they are delivering that highest quality of care to their patients.‘
Professor Owolabi said the regulator was currently working through over 1,600 responses it received to its consultation on plans to overhaul assessments, which closed in December. The regulator will be using the responses alongside working closely with the RCGP and other stakeholders, including the Institute of General Practice Management, to shape what the sector-specific framework for general practice looks like.
Piloting a new approach
‘We hope that sometime in the spring we will begin to pilot and test the new approach, because we want to make sure we get it right,’ she said. ‘It’s not about the speed of the rollout; it’s about the efficacy of the rollout. So, it’s going to be a pilot-test-check approach both with our providers and with our colleagues in the CQC, and then onto the full rollout once we’re certain that the framework is responsive to the needs of the sector through the pilot phases.’
Acknowledging the high levels of stress currently facing general practice, Professor Owolabi said she hoped the new framework would feel more supportive than punitive. She explained that going forwards the CQC intends to ensure that inspection reports explicitly reflect the context in which a practice operates.
She said that factors such as patient demographics, deprivation levels, and the wider system pressures, including funding challenges, would be reflected in the reports.
Quality of care
However, she said: ‘What patients will expect, though, is that the quality is maintained regardless of where you are. We can’t have a postcode lottery of quality of care. But what we can do is take the context into account so that when we report our findings, we are acknowledging the circumstances in which the practice is operating.’
As a GP in a deprived ex-mining community in the Midlands, Professor Owolabi led a practice that turned itself around from an ‘inadequate’ to ‘good’ CQC rating. She said that this experience informed her passionate commitment to ensuring regulation is fair and grounded in the realities of the frontline and can help support practices to improve.
‘We are still a socio-economically deprived community, but the practice is now rated good across the board,’ she said. ‘It’s a training practice, training nurses, GP registrars, and my hat off to my colleagues at the practice who have made that happen.
‘And so, the job of the CQC is to signpost practices to others who are struggling similarly so that we can all learn from one another and continue to push forward on that shared purpose of high-quality care for patients.’