Single-word ratings linked to GP suicide concerns in CQC consultation report

The CQC has cited the suicide of a GP when highlighting criticisms of its one-word rating system, as part a consultation on improving its assessment process. 

The revelation came as part of the published results of a consultation with the sectors it regulates on changes to its assessment process. However, changing single-word ratings is not within the scope of the possible changes.

On a section on the impact of ratings, the watchdog included the following testimony: ‘One contributor, having noted the suicide of a GP locally who was not coping with the demands placed upon them, reflected that one-word ratings could be unfair and potentially risky. 

‘It was suggested that if things moved towards Requires Improvement or Inadequate, there needed to be a supportive approach placed around that team to protect and assist, rather than punish for all to see.’ 

The CQC told Pulse that it was working to ‘fully understand the context’ around the testimony and to understand ‘if there are any concerns about the welfare of the practice staff’.

A CQC spokesperson said: ‘While the submission didn’t indicate that they believed ratings or assessment activity were directly linked in this case, given the sensitivity we are working with our partner in the consultation to ensure we can follow up with the respondent to fully understand the context and if there are any concerns about the welfare of the practice staff.’

A spokesperson for NHS Practitioner Health, the national GP mental health support service, told Pulse: ‘Around half of those who access NHS Practitioner Health cite workload issues, struggling and feeling overwhelmed as factors contributing to their stress or anxiety.

‘Even the most experienced GP can be faced with an issue that represents “the straw that breaks the camel’s back” – this can come in the form of a single-word CQC rating that may be unrepresentative of their professional ability.’

A 2024 inquest into the death of an ‘exceptional GP’ recorded a conclusion of suicide after hearing evidence of ‘work-related stress’.  

The Government scrapped one-word Ofsted ratings in 2024 following a review partly prompted by concerns for the mental health of school leaders, following the tragic suicide of primary school head teacher Ruth Perry. The review concluded that one-word grades were ‘reductive’ and ‘fail to provide a fair and accurate assessment of overall school performance across a range of areas’. 

However, the Government said at the time it was not considering making the same change for the CQC. 

NHS Practitioner Health has said monthly registration for its support service is typically between 160 and 230 GPs, with higher numbers reported in the winter months. 

The proposals the CQC put forward for its consultation included removing scoring from rating judgements, improving its IT systems, and replacing the ‘single assessment framework’ model with multiple sector-specific frameworks.

The watchdog has now revealed its draft primary care framework, which includes expectations for providers to use artificial intelligence (AI) and take responsibility for patients’ ‘transition’ to secondary care. It said GP practices will be judged on how well they transition patients between services, with a focus on continuity of care and plans ‘coproduced’ with patients. 

The CQC has been working on rebuilding its reputation since the damning Dash review, published in 2024, which said its ‘significant failings’ had led to ‘a substantial loss of credibility’.  

This has included reinstating the primary care chief inspector role, after the Dash review said the regulator lacked ‘expertise’. Professor Bola Owolabi, a practising GP, was appointed to the role last year. Last month, she wrote in Pulse that regulation had a role to play in addressing healthcare inequalities.