Timeline of CQC Reform (2023–2026) 

2023 — The New Single Assessment Framework Announced 

• CQC confirms it will replace the old inspection model. 

• Introduction of six evidence categories and quality statements. 

• Early pilots begin in selected trusts and community providers. 

2024 — Rollout Begins Across England 

• GP surgeries start receiving communications about the new model. 

• CQC launches the provider portal for continuous evidence submission. 

• ICS assurance framework drafted, linking primary care to system‑level oversight. 

2025 — Transition Year for Primary Care 

• Mixed model of old inspections plus new evidence collection. 

• CQC begins remote monitoring of GP access, complaints, safeguarding and digital triage. 

• First ICS‑level assessments conducted, including primary care performance indicators. 

2026 — Pilot and Strengthened Oversight 

By mid‑2026, the CQC has not fully rolled out the new GP‑specific framework. Instead, the regulator has begun a formal pilot (June–October 2026) to test the new sector‑specific model. 

Key milestones include: 

• January 2026: CQC begins updating ratings remotely where evidence is sufficient. 

• March 2026: ICS assurance formally integrated into CQC’s regulatory cycle. 

• June 2026: Pilot of the new GP‑specific framework begins; practices remain under the Single Assessment Framework during testing. 

• Summer 2026: Enforcement powers strengthened, especially around access and safety governance. 

What Has Actually Changed for GP Surgeries? 

1. Continuous Assessment Replaces Episodic Inspections 

Under the old model, practices could go years without an inspection. Now, ratings can change at any time based on: 

• Patient feedback 

• Complaints 

• ICS data 

• Safety alerts 

• Portal evidence 

• Remote monitoring 

This is the biggest cultural shift in CQC regulation since 2014. 

2. ICSs Now Influence GP Ratings 

From 2026, CQC’s oversight of ICSs includes: 

• Access performance 

• Continuity of care 

• Population health outcomes 

• Workforce stability 

• Digital maturity 

GP surgeries are now part of a system‑level regulatory picture, not standalone providers. 

3. Access and Continuity Are Now Core Evidence Areas 

CQC’s focus has moved decisively toward: 

• Same‑day urgent access 

• Appointment availability 

• Digital triage safety 

• Continuity for complex patients 

• Equity of access for deprived communities 

This aligns with the government’s commitment to “same‑day urgent care for those who need it.” 

4. Stronger Safety Governance Requirements 

Expect tighter scrutiny around: 

• Safeguarding documentation 

• Medicines management 

• ARRS role supervision 

• Remote consulting safety 

• AI and digital tool governance 

Practices must demonstrate active oversight, not just policies. 

5. The Provider Portal Is Now Central 

Every GP practice now has a live digital profile that CQC updates continuously. 

Practices must: 

• Upload evidence regularly 

• Respond promptly to CQC requests 

• Keep governance documents current 

• Monitor automated data feeds (complaints, incidents, access metrics) 

The portal is now the primary compliance tool. 

6. New Enforcement Powers 

From 2026, CQC can: 

• Issue warning notices more quickly 

• Add conditions of registration without a site visit 

• Update ratings based on remote evidence 

• Treat access failures as a safety issue 

This is designed to reduce variation and intervene earlier. 

Where Do KLOEs Fit Into the 2026 CQC Model? 

Although the CQC is piloting a new GP-specific assessment framework in 2026, GP surgeries are still assessed under the Single Assessment Framework (SAF), which is structured around the five key questions and 34 quality statements that replaced the previous Key Lines of Enquiry (KLOEs). 

The CQC has published draft GP-specific assessment questions as part of the 2026 pilot. However, these are not yet live, are not used for ratings, and do not form part of current inspections while the pilot is ongoing. 

Notably, the inclusion of structured, KLOE-style questions within the pilot provides a strong indication that a question-based framework may be reintroduced in some form when the revised assessment model is implemented, although this has not yet been formally confirmed by the CQC. 

Draft KLOEs 

SAFE 

• S1 – Systems, processes and training keep people safe 

• S2 – Safeguarding is effective 

• S3 – Medicines management is safe 

• S4 – Learning from incidents improves safety 

• S5 – Premises, equipment and IPC are safe 

• S6 – Staffing levels and skill mix support safety 

EFFECTIVE 

• E1 – Care is evidence‑based 

• E2 – Staff have the right skills, training and supervision 

• E3 – Clinical audits and outcomes drive improvement 

• E4 – MDT and inter‑agency working is effective 

• E5 – Consent and capacity are lawful and documented 

CARING 

• C1 – Patients are treated with kindness and compassion 

• C2 – Patients are involved in decisions 

• C3 – Privacy, dignity and cultural needs are respected 

RESPONSIVE 

• R1 – Services meet local population needs 

• R2 – Access is safe, timely and equitable 

• R3 – Reasonable adjustments are made 

• R4 – Complaints are handled well and used to improve care 

WELL‑LED 

• W1 – Leadership sets a clear vision and culture 

• W2 – Governance systems ensure safe and effective care 

• W3 – Staff are supported, valued and engaged 

• W4 – Continuous improvement is embedded 

• W5 – Duty of candour is upheld 

Why This Matters in 2026 

• The new GP‑specific KLOEs are draft only. 

• The SAF remains the live framework for GP practices. 

• The pilot (June–October 2026) will inform the final version. 

• Practices will not be inspected under the new KLOEs until rollout is confirmed. 

This clarity helps practice managers avoid preparing for a framework that isn’t yet in use. 

Click here to download a staff handout for your team

The KPIs CQC Is Monitoring in 2026 

Under the continuous‑assessment model, CQC is tracking a defined set of performance indicators across the six evidence categories. These KPIs now shape ratings, trigger targeted activity, and influence ICS‑level assurance. 

Access KPIs 

• Same‑day urgent care availability 

• Time to third next available appointment 

• Telephone response times 

• Digital triage safety and turnaround 

• Continuity for complex patients 

• Equity of access for deprived groups 

Patient Experience KPIs 

• GP Patient Survey trends 

• Friends & Family Test feedback 

• Complaints themes and resolution times 

• Negative feedback spikes (treated as risk triggers) 

Safety KPIs 

• Safeguarding documentation completeness 

• Medicines management compliance 

• Safety alerts acted on promptly 

• Remote consulting safety 

• ARRS role supervision 

• AI/digital tool governance 

Workforce & Governance KPIs 

• Mandatory and role‑specific training compliance 

• Clinical supervision records 

• Turnover and vacancy rates 

• Locum usage and continuity impact 

• Currency of governance documents 

• Accuracy of risk registers 

Population Health KPIs (ICS‑linked) 

• Long‑term condition outcomes 

• Screening and immunisation uptake 

• Health inequalities indicators 

• Frailty and complex care metrics 

• PCN DES delivery 

Digital Maturity KPIs 

• Portal responsiveness and evidence uploads 

• Digital triage audit trails 

• Online access usability 

• Interoperability with ICS systems 

• Use of data for proactive care 

These KPIs now form the backbone of CQC’s continuous monitoring and are the most reliable indicators of regulatory risk or improvement. 

Final Thoughts 

The CQC changes of 2026 are not just regulatory tweaks — they represent a fundamental shift in how quality is measured, how risk is identified, and how GP surgeries are held accountable within the wider NHS system. 

For practice managers, this is both a challenge and an opportunity: 

• A challenge because the bar is higher, the scrutiny is continuous, and the expectations are broader. 

• An opportunity because the new model rewards proactive governance, strong patient experience, and alignment with ICS priorities. 

This is the new regulatory landscape — and those who adapt early will be the ones who shape what “good” looks like in the years ahead. 

References 

1. Slatewick (2026) — CQC Compliance for GP Practices: What the Single Assessment Framework Means for Primary Care Confirms continuous assessment, portal‑based evidence, and that GP practices remain under the SAF during 2026. 

2. Pulse Today (2026) — CQC reveals how it intends to assess GP practices in new draft framework Confirms draft GP‑specific KLOEs, consultation timeline, and expectations around continuity, AI governance and population health. 

3. ProPolicyForge (2026) — CQC’s New Sector-Specific Assessment Frameworks: What the 2026 Pilot Means for Your Service Confirms June–October 2026 pilot, SAF still applies, and draft framework does not yet affect ratings.