In this report, you'll find the high level trends and themes from the last three months of our analysis of CQC GP Practice Inspection Reports. Here you can see what most commonly led to practices being awarded Outstanding, Requires Improvement, and Inadequate. You can also see the trends broken down by Key Question, and some thoughts on practical implications for GP practice and PCN managers.

Period reviewed: April, May and June 2026
Reports covered: April: 1 Outstanding and 3 Requires Improvement reports; May: 1 Outstanding and 1 Requires Improvement report; June: 1 Outstanding, 1 Requires Improvement and 2 Inadequate reports.

Executive summary

Across the quarter, the clearest pattern is that Outstanding practices are repeatedly praised for proactive, data-led, population-health work, especially around long-term conditions, preventive care, targeted outreach and measurable quality improvement. These practices are not simply delivering core services well; they are redesigning workflows, using digital tools, working with partners and proving impact through audits, uptake data and reduced unplanned care.

By contrast, the most common themes in Requires Improvement and Inadequate ratings are: weak governance, poor risk oversight, unsafe or inconsistent medicines management, staffing/training gaps, poor follow-up of results/referrals/tasks, weak safeguarding systems and poor learning from incidents or complaints. In the most serious examples, the same issues had been found previously but had not been resolved.

Trends from the “Outstanding” rating reports

1. Proactive identification of risk and unmet need comes up repeatedly

A strong recurring theme is that Outstanding practices are actively finding patients who need help, rather than waiting for them to present. This appears in all three months. Examples include identifying previously undiagnosed conditions, using frailty and risk stratification, proactive hypertension detection, CKD and diabetes missed-diagnosis audits, and long-term condition search/recall systems.

For managers, the practical lesson is clear: CQC values proactive case-finding when it is systematic, auditable and linked to patient outcomes. Outstanding examples included

• increased long-term-condition reviews over three years,
• housebound LTC reviews,
• hypertension register growth,
• improved CKD testing and
• systems to identify missed diagnoses.

2. Digital tools are praised when they directly improve access, monitoring or safety

Another frequent positive theme is the intelligent use of digital systems. Outstanding practices used digital flags for patients needing longer appointments or interpreters, dashboards showing outstanding monitoring needs, automated texting and booking links, a triage dashboard showing frailty scores and recent contacts, and a one-click internal clinical communications hub.

Note that CQC’s praise is not simply for “using technology”. The technology is valued where it reduces missed monitoring, supports safer triage, helps staff identify needs quickly, improves access, or helps patients complete multiple tasks in one visit.

3. Outstanding practices show measurable quality improvement, not just good intentions

CQC frequently praised practices that could show before-and-after evidence. One Outstanding practice had two-cycle audits on antibiotics, pneumococcal vaccination in people with learning disabilities, and gestational diabetes follow-up, with clear improvements in uptake and monitoring. Another Outstanding example was regular missed-diagnosis audits and showed sustained improvement in CKD blood testing. A third example demonstrated improvements in vaccination uptake, hypertension detection and screening processes.

For GP and PCN leaders, this suggests that documented improvement cycles are a differentiator. CQC appears to give particular weight to examples where practices can show: the problem identified, the action taken, the impact measured, and the learning shared or sustained.

4. Health inequalities work is a major Outstanding theme

Across the quarter, Outstanding comments repeatedly involved practices adapting services for specific population groups. Examples included:

• targeted outreach in deprived communities,
• use of interpreters or specific-language calls,
• health checks at a mosque,
• Safe Surgery registration,
• support for people with learning disabilities,
• housebound patients,
• frail patients,
• pregnant women in deprived communities,
• patients at higher risk of diabetes or hypertension.

This is a strong message for PCNs: CQC is looking for practices that understand their population and design services around real local barriers, not just generic access models.

5. Partnership working is a frequent marker of Outstanding care

Outstanding examples often involved work with PCNs, ICBs, local hospitals, community providers, charities, Age UK, Mind, bereavement services, research partners, ambulance services, universities or local community organisations.

The best examples were not token partnerships. They produced tangible outputs:

• frailty pilots,
• grief counselling clinics,
• first-contact mental health support,
• ultrasound-guided injections closer to home,
• paramedic placements,
• research recruitment and
• PCN-wide training.

6. Outstanding Well-led comments often focus on culture, staff development and sustainability

In April and June, Outstanding Well-led comments repeatedly referenced staff development, succession planning, staff newsletters, clear roles, open culture, training practices, PCN-wide education, environmental sustainability, greener prescribing and leadership pathways such as an Associate Partner Scheme.

For managers, the message is that Outstanding leadership is evidenced through systems that build capacity, not just through individual leaders being well regarded.

Trends from the “Requires Improvement” and “Inadequate” tables

1. Weak governance is the most consistent cross-cutting problem

The most recurring negative theme is poor governance. Across the quarter, CQC repeatedly criticised practices for ineffective oversight of risk, incidents, clinical tasks, staff training, recruitment, premises safety, prescribing, complaints, meetings and improvement actions.

• In several cases, systems existed in theory but did not work in practice. Examples included policies not followed,
• action plans not updated, meetings not held,
• clinical governance meetings not taking place,
• poor auditing, and
• leaders unable to demonstrate oversight of key risks.

2. Medicines optimisation is one of the most frequent and serious risk areas

Medicines issues appear repeatedly and often with high-risk implications. These included failure to act on MHRA alerts, unsafe prescribing combinations, poor monitoring of high-risk medicines, medication reviews coded but not actually completed, prescribing errors, unclear prescribing responsibility, poor monitoring of DMARDs, ACE inhibitors, DOACs, methotrexate, azathioprine, gabapentinoids and benzodiazepines, and unsafe vaccine storage or cold chain arrangements.

For practice managers, this is one of the clearest operational priorities: high-risk medicines monitoring, safety alerts, repeat prescribing, medication review quality and emergency medicines checks need visible, auditable oversight.

3. Backlogs in documents, results, referrals and diary dates are a repeated warning sign

Several low-rated reports described serious backlogs: unactioned tasks, unprocessed documents, pathology results not reviewed, referrals awaiting processing, paper records awaiting digitisation, diary dates not actioned, delayed test results and patients having to chase outcomes.

These issues are highly relevant for PCNs because they often reflect a combination of workforce pressure, unclear ownership, weak escalation routes and insufficient administrative resilience. The risk is not simply poor admin; CQC links these backlogs to delayed care, missed monitoring and potential patient harm.

4. Safeguarding weaknesses are common and often basic

Safeguarding concerns appeared in April, May and June. Recurring issues included

• unclear or inaccurate safeguarding leads in policies,
• safeguarding registers not properly maintained,
• household members not linked,
• safeguarding alerts missing,
• lack of audits for children not brought to appointments or A&E attendances,
• gaps in safeguarding training and
• poor follow-up of vulnerable children or adults.

The recurring lesson is that CQC expects safeguarding to be live, coded, audited and understood by all staff, not simply covered by a policy.

5. Staff training, recruitment and supervision gaps are frequent

CQC repeatedly highlighted incomplete training, missing recruitment checks, absent references, missing proof of identity, DBS concerns, lack of chaperone training, out-of-date fire/sepsis/basic life support training, unsafe locum onboarding, unclear staff competencies and lack of appraisals.

The especially concerning examples were where staff were working beyond competence, reception staff were completing clinical triage without formal training, or locum GPs were not properly inducted.

6. Premises, infection control and emergency preparedness are common Safe-domain failures

Low-rated reports repeatedly included problems with Legionella, fire risk assessments, emergency lighting, fire drills, visitor sign-in, emergency equipment, out-of-date consumables, missing emergency medicines, incomplete anaphylaxis kits, inadequate IPC audits, poor cleaning arrangements, dirty cords, unsafe mop storage and lack of landlord oversight.

This matters for practice managers in leased premises: CQC still expects the provider to have assurance that landlord-held checks and actions are completed. “The landlord holds the records” was not treated as sufficient assurance.

7. Poor learning from incidents and complaints is a major theme

Several reports criticised practices for not learning from significant events, prescribing errors, complaints, patient feedback or repeated CQC findings. Examples included recurring prescribing errors with no effective action, significant events not formally recorded, complaint responses not clinically reviewed, complaints not managed in line with policy, and learning not embedded into daily practice.

For managers, the key message is that CQC is looking for a closed-loop learning system: identify, record, review, act, share, audit, and evidence impact.

8. Leadership culture and freedom to speak up are decisive in Inadequate reports

The most serious reports described toxic culture, conflict between clinical leaders, staff feeling frightened to speak up, concerns ignored, poor wellbeing support, lack of succession planning, no shared vision and confusion over which leader or process staff should follow.

This suggests that when inspections move from Requires Improvement to Inadequate, the issue is often not isolated process failure but a leadership and culture failure that prevents problems being surfaced and fixed.

Trends by CQC Key Question

Safe

Safe is the most common source of serious concern in the RI/Inadequate tables. The repeated issues are safeguarding, emergency medicines and equipment, IPC, premises risk assessments, staff training, recruitment checks, significant event learning, medicines safety alerts and unsafe workflows.

The strongest practical takeaway is that practices need reliable evidence for the basics: safeguarding registers and alerts, emergency kit checks, fire and Legionella assurance, IPC audits, staff training compliance, recruitment files, medicines safety alerts and safe prescribing monitoring.

Effective

In the Outstanding reports, Effective is where CQC most often praises proactive long-term-condition management, care planning, evidence-based treatment, audits, prevention and monitoring. Outstanding practices used year-of-care models, missed diagnosis searches, CKD improvements, hypertension detection projects, screening and immunisation work, and structured recalls.

In the RI/Inadequate reports, Effective concerns often mirror Safe concerns: patients not assessed holistically, overdue monitoring, weak recall systems, failure to follow guidance, poor medication reviews, poor coordination between teams and lack of evidence that consent or preferences were properly considered.

Caring

There were fewer Outstanding Caring comments in your quarter’s reports than for Effective, Responsive and Well-led. Where Caring was criticised, it was often connected to wider operational pressure: rushed appointments, poor privacy at reception, rude or impersonal interactions, patients feeling dismissed, lack of compassion in responses, and staff not being enabled to provide the standard of care they wanted.

A useful management conclusion is that Caring is not only about individual staff attitude. CQC links it to access systems, privacy arrangements, appointment length, workload, culture and whether staff are supported to deliver compassionate care.

Responsive

Outstanding Responsive comments frequently involved flexible, equitable access and proactive adaptation to patient needs. Examples included health checks at a mosque, dashboards to complete multiple monitoring tasks in one visit, automated cervical screening invitations, same-day admin or prescribing-clerk appointments, responsive call handling and targeted support for vulnerable groups.

Negative Responsive themes included poor access, e-consult closures, long queues, patients having to take time off work to secure appointments, poor continuity, poor communication of results, complaints not leading to improvement, inadequate accessibility arrangements and weak support for carers or patients with protected characteristics.

Well-led

The contrast in Well-led is very clear. Outstanding Well-led comments describe practices with shared values, staff development, succession planning, partnership working, learning, innovation, environmental sustainability and systems that keep staff informed of guidance and operational changes.

Low-rated Well-led comments repeatedly involve poor governance, weak accountability, lack of transparency, ineffective meetings, no improvement plan, poor succession planning, partnership conflict, failure to act on staff concerns, poor staff wellbeing and lack of embedded learning. In several cases, CQC explicitly linked Well-led weaknesses to ongoing breaches of regulation or repeated failure to improve.

Practical implications for GP practice and PCN managers

What to emulate from Outstanding practices

1. Use searches and dashboards to find risk early: missed diagnoses, overdue monitoring, vaccination gaps, screening gaps and frailty cohorts.
2. Make improvement measurable: use two-cycle audits, baseline data, re-audit and clear outcome measures.
3. Target health inequalities deliberately: design outreach around deprivation, language, housebound status, learning disability, carers, faith settings and local community needs.
4. Use PCN and community partnerships to extend capacity: mental health support, bereavement care, frailty work, training, research and specialist pathways.
5. Show that leadership creates capacity: staff development, succession planning, clear communication, open feedback routes and shared learning.

What to prioritise to avoid RI/Inadequate findings

1. Create an auditable governance dashboard covering training, recruitment, safeguarding, emergency equipment, IPC, premises risks, prescribing safety, complaints and significant events.
2. Treat backlogs as clinical risk, not admin workload: documents, referrals, results, diary dates, prescribing tasks and notes summarisation need ownership and escalation.
3. Review high-risk medicines systems urgently: monitoring, shared care, alerts, repeat prescribing, medication review quality, emergency medicines and vaccine storage.
4. Check safeguarding coding and registers: leads, household links, child/adult registers, alerts, meeting records, audits and training compliance.
5. Evidence learning loops: incidents, complaints, prescribing errors and CQC action plans should all show action, ownership, deadlines, learning shared and re-checking.
6. Do not ignore culture signals: staff fear, poor morale, leadership conflict, lack of support and weak freedom-to-speak-up arrangements are often associated with wider quality and safety failures.