CQC's Next Phase of regulation: consultation update

Our special edition newsletter for providers and professionals working in primary medical services

20 October 2017

In this newsletter you will find information about:

• our response to our second consultation on the next phase of our regulatory approach, which was open between June and August 2017
• a summary of registration changes
• our plans for phasing in and implementing our next phase approach for General Practice. 

Dear colleague Today we have published the outcome of our recent consultation exercise setting out some important changes to the way we will inspect and monitor general practice in future.   Over a period of two months, we held 10 consultation events where we heard from providers, organisations and members of the public. We also received a total of 380 individual responses including over 200 from professionals and from those organisations representing them. I hope that our response document demonstrates that, as an organisation, we have listened and that this is reflected in our phased approach to how we implement these changes. We are taking this approach in response to some important issues raised during the consultation, enabling us to refine our proposals further.

We know that most providers continue to deliver high quality care. Of all sectors that we regulate general practices have consistently received some of the highest ratings. Our recently published State of Care report concluded that 93% of GP practices are now rated as good or outstanding, allowing us to implement our new approach to inspection. As set out in the General Practice Forward View we will introduce inspection intervals of up to five years for providers rated good or outstanding, although we will inspect a proportion every year. From April 2018 most of those inspections will be focused rather than comprehensive.

We can only plan this more targeted approach to inspection if we hold accurate, up-to-date information about practices. We will get this through our Insight model, local intelligence from closer working with CCGs, and through a new system of provider information collections we intend to introduce in 2018. The provider information collection will enable providers to share information with us on an annual basis about the quality of care provided, and enable us to make more informed decisions about how we plan our inspections. By targeting our inspections according to the intelligence we hold, we are able to focus our resource where it is most needed.

In line with the views that we received, we have decided to bring in these changes gradually, starting in November when we will introduce our new assessment framework for healthcare services in our inspections of: general practices; GP out-of-hours services; NHS 111 services; and independent doctor services. 

While I hope you will welcome this more proportionate approach to regulation – I also want to assure you that we are continuing to work with practices and their representative bodies to improve and refine how that process will work. We will also continue to work with NHS England, the General Medical Council and other stakeholders through the Regulation of General Practice Programme Board to reduce the demands on general practice workload by streamlining our data collections and identifying opportunities for closer working.

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. You will find a timetable for our implementation plans below.

Yours sincerely

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Our response to the consultation

In June 2017 we launched the second of our consultations on our next phase approach to regulation. Our response document provides more information about key changes on:

• Changes to the regulation of primary medical services and adult social care services, including the frequency and intensity of its inspections and how CQC monitors providers and gathers its intelligence.
• Improvements to the structure of registration and CQC’s definition of ‘registered providers’.
• How CQC will monitor, inspect and rate new models of care and large or complex providers.
• Updated approach to the ‘fit and proper persons’ requirement. 

Changes to registration

We will make changes to registration that will allow us to hold people to account at the right level when regulating providers. We will continue to inspect at location level.

• We will require all entities meeting our revised criteria for defining a provider to be registered with CQC. This requirement will be implemented in a phased way across different types of provider, with the first registrations of this nature in 2018/19. We will publish the schedule for these changes once detailed impact assessments have been completed. By implementing these changes we will make ownership relationships and links between providers clear to the public on our register.
• We will implement the proposals to registration structure in a phased way through provider information collections and as providers make changes to their registration. The information will describe the provider and the services it provides. Providers will need to inform us when these details change. In some instances, they will need to apply to us and have the change agreed before changing their service provision.

Updated guidance for providers online 

We have restructured the Guidance for Providers section of our website in response to feedback we have received over the past two years. Choose your sector from the main Guidance for Providers page to see the information that’s relevant to you.

When will our key changes happen?

From November 2017

• New assessment framework – We will introduce the new assessment framework for health care services in our inspections of: general practices; GP out-of-hours services; NHS 111 services; and independent doctor services. 
• Changes to inspection intervals – We will start to introduce maximum intervals between inspections of five years for providers rated as good and outstanding, although every year we will inspect a proportion. We will continue to re-inspect practices rated as inadequate after six months and those rated as requires improvement within 12 months. 
• Improved inspection report – Our inspection reports will be significantly shorter and easier to read.

From April 2018

• Further changes to inspection report – Our reports will be streamlined further. The shortened report is being developed and tested before we introduce it fully in April 2018. It will still include a summary from the Chief Inspector, with more detail contained in an evidence table as an appendix to the report. 
• Inspecting and rating population groups – We will continue to refine our approach to inspecting and rating population groups. We want to ensure that these changes will make our ratings easier to understand while highlighting the quality of care for individual population groups.  
• Focused inspections – Most of our inspections of providers rated as good and outstanding will be focused rather than comprehensive. The focus will be determined by what we know about each service – including data, information from the provider and other stakeholders, and the findings from our previous inspections. 

During 2018

• New system of provider information collection – Practices will be asked to share information with us on changes once a year. In line with our commitment to reduce the demand on GP practices we will not introduce this new process until our new digital systems are in place. We will continue to use a provider information request as part of pre-inspection planning until the provider information collection is introduced.  

To follow conversations about the next phase consultation or to ask us questions, follow @CareQualityComm and #CQCnextphase on Twitter.