CQC releases public feedback on regulation consultation and changes to the rating of trusts and GP practices

The Care Quality Commission (CQC) has published public responses to its strategy consultation, which was launched to find out public views on its proposals for how to become a more responsive regulator.

Its proposals, which are intended to enable the organisation to ‘assess and rate services more flexibly’, update ratings more often, and make them easier to understand, were followed by a second formal public consultation that took place from January to March 2021.

Respondents were able to share their views on the proposed changes via a web form, email, or post.

Focus groups and interviews were held to highlight and platform the voices of those that are ‘seldom-heard’, such as carers, people with learning disabilities or autism, people who have experienced mental health services, those with a sensory impairment, older people with long-term conditions, and members of the public whose first language is not English.

The CQC also reached out to Local Healthwatch, voluntary sector organisations, CitizenLab and health and care providers, to engage people and encourage responses.

A total of 566 responses were collated and independently analysed by Traverse Ltd, with areas of consultation including: assessing and rating quality; reviewing and updating ratings; changing the way of rating GP practices and NHS trusts; and measuring impacts on equality.

In a summary of its ‘key themes from responses’, the CQC says that “responses indicated broad overall support across all proposals”. Specifically highlighted were:

  • ‘Strong support’ for using a ‘wider range of regulatory approaches to assess quality’, rather than relying on full on-site inspections, to enable a more ‘efficient and proportionate regulatory approach’.
  • ‘Strong support’ for ‘reviewing and updating ratings’ or judgements of quality, more flexibly, instead of having a fixed schedule of inspections, to allow CQC to be ‘more responsive to changes’ and provide ‘more accurate and reliable ratings’.
  • Support for changes to rating GP practices and NHS trusts, with ‘many respondents’ believing it will make ratings simpler and easier to understand.

Respondents also raised ‘concerns’ and ‘queries’ over the following:

  • A more flexible approach leading to fewer on-site inspections, which some thought could ‘undermine the importance of seeing care being delivered’ and how this informs judgements on the quality of care.
  • The ‘reliability and availability of data and information’ that the CQC will use to change ratings and how it will be collected.
  • That the potential for a simpler ratings process for GP practices and NHS trusts could result in a ‘loss of detailed information’.

The CQC then went on to outline its proposed changes, the questions it asked respondents, and a selection of curated responses to illustrate the range of opinions, as well as ‘next steps’.

On changing the rating processes for GP practices – which includes stopping ‘providing separate and distinct ratings for the six population groups when rating GP practices’ – of the 414 respondents, 61 per cent either ‘fully’ or ‘mostly’ supported the approach, while 24 per cent asked ticked the ‘don’t know’ option and five per cent ‘indicated that they did not support the approach at all’.

The next steps outlined for this area were that, as the CQC is ‘encouraged by the level of support’, it will: stop providing separate ratings for the six population groups from October 2021, while ratings of GP practices will be focused on whether practices are ‘safe, effective, caring, responsive and well-led’, with an overall rating provided.

While it will also ‘engage with providers and stakeholders’ to ensure its approach reflects ‘how providers are delivering person-centred care and acting to address inequalities’.

For NHS trusts, the proposal was to ‘remove aggregation for NHS trust-level ratings’ and develop its current approach to ‘assessing the well-led key question for a trust’. Of 420 respondents, 56 per cent either ‘fully’ or ‘mostly’ agreed with the proposal. While 24 per cent chose the ‘don’t know’ option and five per cent ‘did not support the approach at all’.

Next steps in this section are set to see changes implemented by spring 2022. The CQC says it will: work with providers, partners and key stakeholders to develop its assessment approach; work with NHS England and NHS Improvement to ‘align’ its approach and ‘ensure links with the System Oversight Framework; and ‘review and develop’ its framework and approach to rating and reporting in line with wider changes.

Overall, the CQC added that it intends to “publish information that explains clearly how we’re regulating and rating services as we develop our approach, so that everybody understands the changes we’re making following our consultation.”

To read the full report, click here.