CQC reveals how it intends to assess GP practices in new draft framework

The CQC has revealed a new draft framework for assessing GP practices, including expectations for providers to use artificial intelligence (AI) and take responsibility for patients’ ‘transition’ to secondary care.

The proposed primary care and community services framework said that 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. 

It is one of four sector-specific assessments which will replace the ‘single assessment framework’ that the watchdog currently uses for all providers. 

However primary care leaders warned that GPs may find some of the new expectations outside of their ‘core’ scope.

The watchdog said that GPs have until 12 June to give their views on the framework, by responding to a survey. The overhaul follows two damning reviews of the regulator published in 2024, which said its ‘significant failings’ had led to ‘a substantial loss of credibility’. 

For all frameworks, the regulator has said it will retain the ‘five key questions’ on which assessments are based, as well as overall single-word ratings, but it will replace numerical scoring with rating judgements and reintroduce ‘key lines of enquiry’ (KLOEs). 

One ‘outstanding’ rating characteristic on the framework said: ‘Care plans for transition between services, referral and discharge are coproduced with people and those close to them to reflect their individual needs and personal preferences in managing their risk. Plans are continuously reviewed to ensure they are up-to-date and include appropriate support for people and carers.’ 

Another new expectation included in the framework is for providers to use population health data to reduce health inequalities, and share findings across neighbourhoods ‘as well as regionally or nationally’. 

The use of AI and other ‘innovative technology’ is also incentivised in the framework, ‘to ensure people have timely access to care, treatment and support’. 

To achieve an ‘outstanding’ rating, the framework suggests that ‘staff identify, assess and implement new and innovative approaches to delivering care, for example artificial intelligence in clinical care pathways’. 

Professor Azeem Majeed, a GP and head of the Department of Primary Care and Public Health at Imperial College London, welcomed the move towards a sector-specific framework but warned some of its additional features goes ‘beyond what many GPs would consider their core role’. 

He told Pulse: ‘The proposed new CQC primary care assessment framework is a significant development for general practice, particularly the move away from the “one-size-fits-all” Single Assessment Framework towards sector-specific standards. 

‘Replacing numerical scoring with rating judgements and reintroducing KLOEs should provide greater clarity on what inspectors are looking for. However, there remains a risk that “rating characteristics” could be open to subjective interpretation by CQC inspectors.’

Professor Majeed went on to warn that the expanded focus on neighbourhood health and health inequalities may go beyond what GPs consider to be their remit.

He said: ‘The increased focus on population health data and reducing health inequalities at a regional or national level suggests that the CQC is looking beyond what many GPs would consider their core role. For many practices, this may feel like an expansion of expectations, requiring additional administrative and strategic work on top of an already heavy clinical workload. 

‘While many GPs may welcome the greater use of AI tools, the evidence for their benefits in primary care is currently very limited. It is important that an emphasis on AI does not inadvertently push practices into investing in tools that may have limited impact on areas such as efficiency, access, patient experience or health outcomes. 

‘The emphasis on “co-produced” referrals is a positive aspiration for patient-centred care. However, in a system where secondary care waiting times are at record highs, advice and guidance pathways are increasingly used and referrals are often rejected, many GPs will find it challenging to be held accountable for the “transition” phase once a referral has been made.’ 

In 2024, a review into the single assessment framework had called for the CQC to ‘abandon’ it, arguing the services it regulates ‘are diverse and it has not proved helpful in practice’.     

CQC reforms to date have included reinstating the primary care chief inspector role, after the 2024 Dash review said the regulator lacked ‘expertise’. Professor Bola Owolabi, a practising GP, was appointed to the role last year. In January, she wrote in Pulse that regulation had a role to play in addressing healthcare inequalities.   

Pulse has contacted the CQC to comment on how the framework will change inspections for GPs.