CQC preparation
The Care Quality Commission (CQC) is changing how it assesses GP practices. This page sets out what has been confirmed, what is still to come, and the practical things that make a CQC assessment go well. It will be updated as CQC publishes more.
Current position
CQC has confirmed it will drop scoring and move to sector-specific frameworks, including one for primary care and community services. Draft frameworks were consulted on until 12 June 2026 and piloted from June to October 2026, with CQC due to finish evaluating the pilots in November 2026. No start date has been announced yet. In the meantime CQC is still assessing practices, using its current single assessment framework (the five key questions and quality statements). Lower-risk practices rated Good or Outstanding may get a shorter assessment of 10 quality statements.
What CQC is assessing now: the 10 + 2
Since March 2026 CQC’s Returning to Good and Outstanding programme has been running shorter, focused assessments that look at 10 of the 34 quality statements.
The programme applies to NHS in-hours GP practices that:
- are rated Good or Outstanding, with the last report published between 2017 and 2022
- are considered lower risk, with no ongoing regulatory action
What to expect:
- A site visit and in-person interviews with key staff, with at least 5 working days’ notice.
- Standard or enhanced: a standard assessment does not routinely involve a GP specialist adviser. Since July 2026 CQC may instead carry out an enhanced assessment, which adds clinical searches and record reviews by a GP specialist adviser or a CQC clinical pharmacist, and 2 more quality statements. CQC tells you which type when it announces the assessment.
- Escalation: if the rating looks wrong, either because of concerns or significant improvement, CQC may move to a full assessment of all quality statements with GP specialist advisers.
See CQC: Returning to Good and Outstanding.
What is changing
Confirmed by CQC
- No more scoring: ratings will be a professional judgement by the inspection team, informed by evidence, not a sum of scores.
- Ratings at key question level: CQC will no longer make formal judgements below the five key questions: safe, effective, caring, responsive and well-led.
- Key lines of enquiry return: they replace the quality statements and set out what inspectors will look at.
- Rating characteristics return: each sector framework will describe what outstanding, good, requires improvement and inadequate look like.
- Four sector frameworks replace the single assessment framework. GP practices fall under primary care and community services, which CQC may split in two.
Still to come
- The final primary care framework and its key lines of enquiry.
- Results of the pilots (June to October 2026), due to be evaluated in November 2026.
- A go-live date, and how practices will move across from the current approach.
- CQC’s full consultation response, promised during 2026.
Who’s who
- Chief Inspector of Primary and Community Services: Professor Bola Owolabi (since July 2025).
- Chief Executive: Emily Miles (from October 2026).
- Chair: Kay Boycott (interim). Baroness Julia Neuberger is the Government’s preferred candidate.
How practices are being assessed now
Assessments are continuing under the current framework while the new one is piloted: CQC had completed over 9,800 assessments across all sectors by August 2026, and is prioritising services whose ratings are oldest. Inspections carry on during industrial action; if this causes you a problem, contact your local inspection team. A typical GP assessment combines remote work with a short site visit:
- Clinical searches: a GP specialist adviser runs searches on your clinical system remotely, with your consent. These typically cover DMARD and other high-risk drug monitoring, action on MHRA and patient safety alerts, potential missed diagnoses, medication reviews, monitoring of long-term conditions, and DNACPR or ReSPECT records. See CQC GP mythbuster 12.
- Clinical record reviews: the adviser reads a sample of records to check what was documented, including safety-netting, consent and follow-up.
- Interviews: usually remote, with clinical and non-clinical staff, leaders and sometimes the patient participation group.
- Site visit: an inspector and specialist advisers check premises, recruitment and HR records, infection control and emergency equipment.
Using AI scribes (ambient voice technology)?
Record reviews look at what is in the notes, whoever or whatever drafted them. NHS England’s guidance on AI scribing products expects the clinician to review and approve every note before it is saved. Have a clinical safety assessment (DCB0160) and a DPIA in place, check a sample of AI-drafted notes in your record audits, and make sure patients are told the tool is being used. CQC has set out what it expects of providers using AI and is looking at using AI in its own regulatory work.
What CQC’s latest State of Care says about GP practices
CQC’s annual report (23 October 2026) has a few points worth knowing before an assessment:
- Ratings so far: of 1,202 practices assessed under the new framework since January 2024, 87% are good, 3% outstanding, 9% requires improvement and 1% inadequate. CQC says it has prioritised practices where its data suggested more risk.
- What lay behind poorer ratings: persistent staffing gaps, which led to heavier workloads, staff falling behind on required training and longer waits. Keep training records current and show how you cover gaps.
- What CQC praised: continuity of care and longer appointments where needed, learning disability registers and annual health checks with reasonable adjustments, and practices leading neighbourhood (for example frailty) work.
Getting ready: practical checks
These apply whatever framework is in place. Most come from CQC’s own GP mythbusters, which set out what inspectors expect.
Safe
- High-risk medicines: monitoring is up to date for drugs such as DMARDs, DOACs, lithium and valproate, with shared care arrangements in place. Run your own searches first, recall patients who are overdue and review repeats issued without monitoring. Expect CQC to run the same kind of searches.
- Safety alerts: patient safety alerts are received, actioned and recorded, such as the current penicillin and penicillamine allergy review.
- Emergency medicines and equipment: checked regularly, with the checks recorded, including expiry dates, oxygen, and defibrillator pads and battery.
- Record access: staff only open records with a professional need, smartcards are not shared, and access is reviewed. Remove system access promptly when staff, locums and students leave.
- Safeguarding, chaperones and infection control: training current, policies known by staff.
Effective
- Clinical records: good coding and clear safety-netting, checked by regular note audits. Check that diagnoses in hospital letters are coded.
- Hospital letters and results: a clear process for discharge summaries and medication changes, and urgent suspected cancer referrals tracked and followed up if not acknowledged.
- Clinical supervision: in place for ARRS and other non-GP clinicians, with a named supervisor, a clear escalation route and a record of case reviews.
Caring and responsive
- Access: how patients contact the practice, how requests are triaged and how you know it is working, for example call answer times and abandoned calls. Make sure patients who cannot use online access have another way in.
- Reducing inequalities: learning disability and serious mental illness health checks, carers’ register, reasonable adjustment flags, and patients’ preferences recorded in long-term condition reviews.
- Complaints: handled, learned from and shared.
Well-led
- Governance: significant events, duty of candour and quality improvement, with learning shared.
- Staff: recruitment checks, DBS, training records and appraisal.
- Digital and AI tools: clinical safety assessed (DCB0160), a DPIA in place and the supplier’s DTAC checked before using tools such as AI scribes.
- Shared care after private diagnoses: a clear practice policy on requests to prescribe after private assessments, such as for ADHD. See Templates & letters.
- Notifications: statutory notifications sent to CQC when required.
Useful CQC links and tips
- Check an inspector is genuine: people have posed as CQC inspectors. Real inspectors carry a photo ID badge with CQC’s warrant on the back. If unsure, ring CQC to check before letting them in. See how to check an inspector’s identity.
- GP mythbusters to read first: 12 (clinical searches and record access), 84 (high-risk medicines), 92 (anticoagulant monitoring) and 96 (covert administration of medicines). All on the GP mythbusters page.
- What good looks like: CQC learning from practice: GP examples, including a Midlands practice tackling digital exclusion.
- Controlled drugs: CQC annual controlled drugs update.
- Children and young people’s gender care: NHS England guidance for primary care, including record keeping.
- How the new approach is being tested: CQC’s monthly updates on improving how it works, for example August 2026.
- Coming up: CQC’s annual State of Care report on 23 October 2026. Have your say on CQC’s dementia care guidance by 5pm, 30 October 2026.
- Stay up to date: sign up to CQC’s email updates for GP practices on its subscription page, or follow CQC’s WhatsApp channel. BLMC also summarises CQC news for practices.
Had a CQC assessment? Help other practices prepare
We are collecting practices’ experience of recent CQC assessments so we can share what CQC is actually looking at. If you have been assessed in the last year, tell us:
- which type of assessment it was, and what notice you had
- which searches, records or documents CQC asked for
- what went well, what surprised you and what you would do differently
Email birmingham.lmc@nhs.net. Do not include any patient details. We will only share tips anonymously. See also CQC news from BLMC, and look up any practice’s rating on the CQC website.
Sources: CQC initial response to Better regulation, better care (March 2026); CQC March 2026 update; CQC executive team; CQC Returning to Good and Outstanding; CQC provider bulletins, March to September 2026; CQC GP mythbusters; NHS England guidance on AI-enabled ambient scribing. Last updated 25 October 2026. General guidance, not legal advice.