November’s New-Look CQC Inspections: The Key Proposals

A consultation has begun on what changes the CQC will make to its inspection process from November 2017. There are already a number of proposed changes that will impact on the current preparations that GP practices make for their inspections, and the proposals aim to move away from the perception that they are a ‘box-ticking exercise’.

The proposed changes include:

  • An increased focus on poorly performing services
  • Better use of information from patients, inspections and partners
  • More unannounced inspections for high-risk care providers (and tighter monitoring)
  • More focus on the care needs of different Population Groups, and how well the care is co-ordinated across organisations
  • Keeping up with proposals for new ‘models of care’ instead of trying to shoe-horn them into existing groups

Key Questions

There is a big focus on the leadership element (‘Is the practice well led?’), and many of the proposed changes for GP practices relate to the Well Led criteria. The results from previous inspections showed that GP practices struggled in the following areas:

  • Having clearly defined leadership roles within the practice
  • A culture of continuous improvement
  • Having effective governance systems in place.

The intention here seems to be promoting a fuller understanding of leadership and what the standards mean.  The proposals ask managers to think about why it is important to look at compliance, areas of improvement, and how they manage & develop their staff. There is also a focus on adapting and changing to keep up with demands of the healthcare service.

Provider Handbooks

There are currently up to 14 Provider Handbooks covering all care providers, from dentists and NHS Trusts to prisons and substance misuse. The new proposals will reduce this down to just two.



This will mean that the criteria for the Key Questions, KLOEs and Prompts will be merged into a single provider handbook – some will apply to all services, while others will be specific to one or more.

Proposed Changes to KLOEs and Prompts 

With the proposed merging of handbooks and criteria, there will be changes to the Key Questions, KLOEs and Prompts for all the services. Inevitably that means that there will be lots of changes – new KLOEs are set to be introduced, several will change and some will be removed;

  • The Well Led Key Question has seen the most changes (5 new KLOEs, 14 new and 21 changed Prompts)
  • Several prompts have been moved from one Key Question to another (e.g. 4 prompts moved from Effective to Safety)
  • There are 7 prompts removed from Safety, Caring and Well Led
  • In total there are 122 changes to the GP Practice CQC criteria (KLOEs or Prompts that are new, changed, moved or removed)


Pre-Inspection Monitoring

Before on-site inspections, the CQC currently uses an ‘intelligence monitoring’ process. This uses information from a variety of sources to piece together a preliminary guide to how they perform, how they’ve been rated by patients and any safety/governance issues that may have come to light.

This is now going to be known as an ‘Insight Monitoring’ process, which proposals say will:

  • Use a wider range of information sources and more quality-related information
  • Be regularly updated (instead of just immediately prior to inspections)
  • Look at any changes since the previous inspection, focusing on improvements and levels of risk.

The frequency of inspections will be based on a combination of organisations’ previous inspection outcomes and their ‘insight monitoring’ results. How often a practice will be inspected will depend on factors including its last inspection outcome, and the number of times it was visited before achieving a pass.

There are also suggestions that membership of an accreditation body might form part of the data collection process, but it’s not clear what that will involve at this stage - it might refer to safety or management qualifications.

Provided Inspection Requests

Practices are currently asked to provide a report on their practice ahead of a planned CQC inspection, known as a ‘Provider Information Request’ (PIR), which looks at factors including their performance, and what services they provide. This is now planned to be done as a regular annual report rather than just a pre-inspection report, presumably so the CQC can build up a picture of how the practice has performed or developed year on year.


FPM Members have access to an extensive CQC Guidance Area and can download a host of up-to-date documents and procedures from the Policies and Procedures Library.

We are working hard behind the scenes to make sure all of our products are up to date with the latest changes set to be brought in by the CQC.


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