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BMA calls for change to ‘crude’ rating system as CQC sets out new strategy


The BMA has called for the CQC to reconsider its ‘crude’ inspection rating system in response to the regulator’s publication of a new strategy.

In a report released today (27 May), the CQC committed to reforming its regulatory approach across the board after ‘extensive’ consultation with health and social care providers, the public and other organisations. 

As part of the plans, the CQC said its system of ratings will become ‘more dynamic’, stating it will update them ‘when there is evidence that shows a change in quality’, and that it ‘won’t always need to carry out an inspection to do this’. 

It also committed to moving away from ‘long reports written after inspections’, making them more accessible and easier to understand and being more transparent about what information it uses and ‘how we use it in our judgements and decisions about ratings’.

In the report, the CQC also said:

  • On-site inspections will remain a ‘vital part’ of performance assessments but it will ‘want to move away from relying on a set schedule of inspections to a more flexible, targeted approach’. 
  • It will use all of its regulatory methods, tools and techniques to do this, and will visit ‘when there’s a clear need to’.
  • It will be ‘smarter’ in how it regulates, meaning it will target resources ‘where we can have the greatest impact, focusing on risk and where care is poor, to ensure we’re an effective, proportionate and efficient regulator’, and will visit ‘when there’s a clear need to’.
  • The CQC will adapt to changing models of care, such as integrated care systems and digitally-enabled care, and will look at how services work together in a local system.
  • It will expand its definition of what it considers to be a ‘provider of care’ to ensure all parts of an organisation that are responsible for directing or controlling care are held accountable. 

However, responding to the report, the BMA restated long-held concerns about ‘the way the CQC operates’ and the ‘negative’ impact of inspections on staff and services and called for the regulator to rethink its system of inspection. 

BMA council chair Dr Chaand Nagpaul said: ‘Doctors have repeatedly told us how CQC inspections take significant time and resources away from direct patient care; that they are a poor measure of the quality of care delivered and that the aggregate rating system is crude and unfairly judgemental – failing to take into account the context of individual providers such as workload pressures, staff shortages or extenuating circumstances.’

‘While this strategy is moving in the right direction, to really improve patient safety CQC must reconsider its crude rating system of inspection – which does not occur in any other UK nation.’

Dr Nagpaul also called on the CQC to identify specific areas of improvement in services and to support positive change, ‘instead of instilling fear or blame in staff who are doing their best in a system under pressure’.

He added that it is ‘disappointing’ that there is no mention of staff wellbeing in the strategy, which he said is vital for ensuring high standards of care and retaining the workforce.

CQC chair Peter Wyman said: ‘Health and social care services are about people. Where people are not experiencing high quality care in a way that works for them and their individual needs, we must work together to change it. This is what our new strategy is about. 

‘The world of health and social care has changed dramatically since CQC was established over a decade ago as an independent regulator – not least in response to the Covid-19 pandemic.’ 

He added: ‘Our new strategy responds to these changes, setting out a plan to deliver regulation that better meets the needs of everyone using health and care services, driving improvement where it is needed and supporting those who work in and lead services to deliver the best possible care.’

CQC chief executive Ian Trenholm said: ‘Our purpose has never been clearer. In our assessments we will ensure that services actively take into account people’s rights and their unique perspectives on what matters to them. We will use our powers proportionately and act quickly where improvement is needed, whilst also ensuring we shine a positive light on the majority of providers who are setting high standards and delivering great care.  

‘This is not a static strategy – we will continue working with others to understand any further improvements required as we implement these changes, to make sure we are protecting people, and with others, driving change.’

At the start of the pandemic in March 2020, the CQC announced it was pausing routine inspections.

But GP practices had been asked to welcome CQC inspectors again from 19 October, as the regulator set the start date for its ‘transitional’ regulatory approach based on ‘risk’.

It then announced it would resume some of its GP practice inspections from April that had been paused because of the pandemic.


Patrufini Duffy 27 May, 2021 1:59 pm

I almost choked on my safe and effective pineapple. “Our purpose has never been clearer”.

Mr Marvellous 27 May, 2021 2:36 pm

“Where people are not experiencing high quality care in a way that works for them and their individual needs, we must work together to change it. This is what our new strategy is about. ”

What was the old strategy about then?

Patrufini Duffy 27 May, 2021 5:28 pm

Marvellous – yes, “in a way that works for them and their individual needs”. **Well that’s potentially 8 billion people’s individual personalised orders, as the world is all invited to this GP buggery show.

Dylan Summers 28 May, 2021 10:07 am

“we will ensure that services actively take into account people’s rights”

Ominous phrasing. It’s all very well to declare rights – I could declare that everyone has a right to a trip to the moon – but unless the resources are available to meet those rights, it’s a recipe for disappointment.

Subodh Kant 28 May, 2021 2:26 pm

So when is our BMA going to raise with the CQC as to the best ALERT TOOL to use when monitoring capacity in General Practice so that mitigating actions can be taken before patients come to harm? This seems to work well in acute trusts (e.g. amber, red, black alerts) and most other community units (e.g. District nursing) and is often commended by the CQC as a mandatory tool.

Patrufini Duffy 28 May, 2021 5:46 pm

Yes “people’s rights”…what, to Yasmin because I read it’s the “best”, antibiotics because I don’t know what a virus is, skin tag removal, aciclovir because I get too drunk too often, ear syringing because well why not, a home visit to a bored 25 year old (Mon-Thur only), to calpol and dash of Aveeno, referral to invisible dieticians because the cookies and cream is too delightful, gym classes because a walk is too hard…and rights ofcourse to your complaints policy. The new age of modern “medicine”.