New CQC assessments risk 'overwhelming' GP practices, RCGP warns

The RCGP has criticised the new CQC draft framework detailing how it will assess GP practices, saying that it contains ‘vague expectations’ and does not recognise pressures faced by general practice.

The college said that the framework ‘risks increasing administrative burden’ and ‘overwhelming’ practices by encouraging providers to produce ‘large volumes of evidence across overlapping domains’, taking away time which should be used for patient care.

In terms of the CQC’s focus on identifying and addressing health inequalities, the RCGP raised concerns that practices serving highly deprived populations could be ‘disproportionately disadvantaged’ if contextual pressures are not appropriately recognised in the framework.

The college was responding to the CQC’s public consultation on the new framework, which includes expectations for providers to use AI, take responsibility for patients’ transition to secondary care, 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.

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’.

The RCGP said that ‘clearer, more transparent judgements’ require a framework that speaks ‘directly to how general practice operates’.

Among other recommendations (see box), it recommended that the pilot phase of the framework should ‘adequately represent general practice’.

In its response to the consultation, the RCGP said: ‘The framework spans 60 pages of dense descriptors with relatively vague expectations on how providers will be assessed.

‘While comprehensiveness is important, there is a genuine risk that this volume of material will overwhelm smaller or disadvantaged GP practices that lack dedicated governance or quality improvement resource.

‘General practice operates under severe workforce and funding pressures; time spent navigating lengthy assessment matrices is time diverted from patient care.’

Much of the language used in the framework ‘remains generic across primary care and community services’, the college said.

It pointed out terms used in the framework such as ‘admissions and discharges’, ‘handover and patient flow’ and references to ‘inpatient-style restrictive practices’ which do not straightforwardly map onto the realities of how general practice manages patients.

‘Ultimately, while the intention to create a sector-specific framework is welcome, the current draft does not yet provide sufficient clarity, proportionality or consistency to help practices fully understand how assessments will operate in practice,’ their response added.

The collage also said that qualitative judgements on whether a safety culture is ‘fully embedded’ versus ‘inconsistent’, remain ‘inherently subjective’ requiring the need for further clarification.

It added: ‘Perceived inconsistencies in inspection outcomes have the potential to undermine confidence in the regulatory process, making robust inspector training and calibration essential.

‘The inspection process should support improvement and learning, rather than inadvertently contributing to workforce stress, burnout or difficulties retaining staff in general practice.’

Pulse has contacted the CQC for comment.

The CQC already started piloting the new framework last month, with inspectors using ‘Word templates’ initially while new digital systems are built.

Once the new digital systems are built, they’ll be ‘refined and further tested ahead of final rollout’, the CQC’s deputy director of policy said.

It comes after IT problems with previous systems implemented by the CQC in the last few years caused staff ‘deep distress’, with 500 CQC reports ‘stuck’ in the watchdog’s system and unable to be retrieved due to IT issues.

The RCGP recommendations in full

Recognise external constraints facing general practice explicitly: The framework should acknowledge that general practice operates within a wider system and that many factors affecting quality—workforce supply, premises, secondary care access, social care availability—lie outside practice control. Assessment should focus on how practices respond under constraints.
Ensure standards are universally applicable across practices: The framework should be designed so that standards and rating characteristics are relevant and achievable across practices of different sizes, organisational models and populations. Expectations should focus on the quality and safety of care delivered rather than organisational scale, infrastructure or access to additional resource. While standards should apply consistently across the sector, evidence requirements should remain proportionate and avoid placing unnecessary administrative burden on providers.
Make greater use of existing data and minimise duplication: The framework should support a more transparent and proportionate approach to assessment, making greater use of routinely collected data and reducing reliance on the production of large volumes of bespoke documentary evidence. This would
reduce unnecessary administrative burden, improve predictability for providers and allow practices to focus more time on patient care while maintaining appropriate regulatory oversight.
Adopt a proportionate and intelligence-led approach to assessment: Assessment activity should be proportionate and intelligence-led, focusing regulatory attention where there are clear concerns about quality or safety, while reducing unnecessary burden on practices with a strong track record of delivering highquality care. This would support more effective regulation while minimising disruption to frontline patient care.
Ensure that inspector training aligns with the framework: The framework’s value depends on consistent application by inspectors. We urge substantial investment into inspector training, including calibration exercises, sector-specific knowledge, and mechanisms to address unwarranted variation in ratings.
Provide sector-specific guidance: Translate the generic language used within the framework into GP-relevant language, examples and evidence expectations. This should be developed in partnership with the profession.
Supplement framework with further guidance and case studies: Aspects of the framework still require further guidance to support understanding of how it will be applied in practice. Case studies will also allow providers to understand what ‘good’ and ‘outstanding’ look like in preparation for inspection.
Ensure the pilot phase adequately represents general practice: Before full implementation, pilot the framework with a representative sample of GP practices and use findings to refine the descriptors and assessment process.