CQC chief inspector: ‘Regulation can help address healthcare inequalities’

In an exclusive op-ed, GP and CQC chief inspector of primary care Professor Bola Owolabi CBE sets out how smarter regulation can support GP practices in deprived areas and help tackle entrenched healthcare inequalities

Without targeted action, inequalities in healthcare will only continue to increase. At the CQC, we continue to see significant unwarranted variation and inequalities across the system, and primary care is no exception. 

During my career, I have endeavoured to tackle healthcare inequalities head on, focusing on reducing inequalities through integrated care models, service transformation, and using data insights for quality improvement. At the CQC, all aspects of the regulatory processes – registration, notifications, inspection, enforcement – can be powerful tools to address healthcare inequalities.

I have worked as a GP for over 25 years at practices in the Midlands and seen people from different backgrounds including some of the most socio-economically disadvantaged. One thing that always stands out to me, is the inequalities faced by people accessing and experiencing primary care services.

People living in the most deprived areas in England experience significantly poorer outcomes across multiple measures, with deprivation creating a cascade of disadvantage in access to healthcare. The 2025 GP Patient Survey highlights that people living in the most deprived areas can find it harder to access GP appointments. The fragmented nature of the current system also means that more vulnerable people are falling through the gaps, for example, older people, people with dementia, autistic people and people with a learning disability, and people with complex mental health needs.

At the CQC, we hear examples of people with autism or a learning difficulty finding it difficult to book appointments on the phone or online, and don’t feel that reasonable adjustments are made to support them. We have previously outlined our concerns around Black men’s mental health, and inequalities affect Black people along the entire care pathway, including access to GP appointments and how GPs assess, diagnose and refer people for treatment.

A survey carried out by the NHS Race and Health Observatory found that 51% of participants reported some form of discrimination when they visited their GP. This includes racial and ethnic discrimination where people said that their primary care providers treated them differently because of their ethnicity. People in ethnic minority groups also said they felt they were taken less seriously by staff and reported poor experiences with communication. When we look at areas of deprivation across England these reports become more common, and inequalities in people in minority groups become more apparent.

The impact and importance of context are also apparent in the experience of ethnic minority-led GP practices. Disproportionately situated in areas of deprivation and bearing the impact of socio-economic factors, the knock-on effect on practices’ ability to achieve national targets can also affect their ability to evidence good care to the CQC, and their rating.

Having been in this role for six months now, I’m clear that our approach needs to be contextual and consider operating environments.  When I took on a leadership role at a GP practice in a deprived area which had a CQC rating of ‘inadequate’, it was one of the toughest challenges of my career to date. The staff were trying to provide the best care they could under the circumstances and the community had endured many years without a high-quality general practice. They were struggling to meet the needs of the community who had a diverse range of needs and poor health, and recruitment and funding was proving to be a challenge.

The practice was being squeezed from all angles and wasn’t providing the care the patients needed or deserved. With the support of the local Community Health Trust, PPG, staff at the practice, CCG and senior GP colleagues in the local area, we were able to turn the practice around under a new care model. This demonstrates the important role that primary care providers can play directly in addressing healthcare inequalities, whilst acknowledging our contribution to system efforts to address the social determinants of health.  

The Government has taken an ambitious yet important look at addressing health inequalities in the 10-year plan by aiming to create a more equitable health system in which regardless of people’s background or where they live, everyone will have equal access to healthcare services. One of the key factors in this plan is reviewing the formula through which GP funding is allocated to prioritise funding for areas with higher socio-economic disadvantages.  I was privileged to have co-chaired the working group which put forward this funding formula review as one of its key recommendations. We looked at other structural changes that can materially drive down healthcare inequalities, and many of these priorities are now reflected in the 10-year health plan.

In my previous role as NHS England’s Director of the National Healthcare Inequalities Improvement Programme, I worked to develop NHS England’s Core20PLUS5 approach to reducing healthcare inequalities. It identifies people in inclusion health groups, who are often socially excluded and face barriers in access to healthcare, and have extremely poor health outcomes. This approach lends itself well to continued implementation in general practice given its emphasis on the secondary prevention of clinical conditions which are amenable to primary care intervention. We need to use this as a lens for our CQC activity and think about this approach when we inspect services and develop our regulatory approach going forward.

Tackling healthcare inequalities is both a personal and professional priority for me. At the CQC, we use our regulatory influence and independent voice to drive system change. These changes can not only reduce inequalities, but improve outcomes for people using the services, and support primary care providers in delivering these services. We can work with GPs to use their voices and experiences to influence policy and champion patients as working together is key to tackling these inequalities across the health and care system.

Professor Bola Owolabi CBE is a GP and chief inspector of primary care and community services at the CQC