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CQC is rated well but 'requires improvement', says review

GPs have less access to support to help improve services

Adrian O'Dowd

Thursday, 27 September 2018

A national evaluation of the healthcare regulator the Care Quality Commission (CQC) has concluded that it has provided a better inspection regime than the previous system it replaced, but says it could do better.

A joint report* published today by The King’s Fund and Alliance Manchester Business School at the University of Manchester details their research carried out between 2015 and 2018 into the CQC.

The work involved examining the CQC and its approach to inspection (introduced in 2013) to see how it was working in four sectors – acute care, mental health care, general practice and adult social care – in six areas of England.

It combined a literature review, qualitative fieldwork, analyses of national data on provider performance, ratings and activity, and 170 interviews with a range of staff from health and social care provider organisations, CQC, patient and public groups and other organisations such as Healthwatch, NHS England and CCGs.

The authors overall conclusion was that the CQC’s “Ofsted-style” inspection and rating regime was a significant improvement on the system it replaced, but it could be made more effective.

Despite the praise, the report highlights a number of areas for improvement in CQC’s approach to regulation and cautions that the focus on inspection and rating may have crowded out other activity which might have more impact.

It recommends that CQC focus less on large, intensive but infrequent inspections and more on regular, less formal contact with providers, helping to drive improvement before, during and after inspections.

The evaluation found significant differences in how CQC’s inspection and ratings work across the four sectors it regulates.

Acute care and mental health care providers were more likely to have the capacity to improve and had better access to external improvement support than general practice and adult social care providers.

Support for acute and mental health care providers could come from national bodies such as NHS Improvement and NHS England, and although GPs had access to some oversight from CCGs and NHS England, and access to the RCGP’s peer support programme, in reality, many practices did not seem to access much support.

The report recommends CQC thinks about developing the inspection model in different ways for different sectors, taking into account these differences in capability and support.

The researchers also analysed data on GP, A&E and maternity services to see if CQC inspection and rating had an impact on key performance indicators.

For general practice, they examined whether prescribing behaviours changed after inspection and rating, using data from 6,600 practices on prescribing indicators relating to antibiotics, hypnotics and non-steroidal anti-inflammatory drugs.

Results showed that in the six months after practices were inspected, prescribing behaviour generally improved slightly for practices rated “inadequate” or“requires improvement”, but worsened slightly for those rated “good” or “outstanding”.

The authors said that the CQC was now implementing a revised strategy for regulation which addressed some of the issues raised in the report.

Ruth Robertson, report author and senior fellow at The King’s Fund said: “Over the past few years, the CQC has completed a herculean task by inspecting and rating every hospital, general practice and adult social care provider in England.

“Although we heard general support for their new approach, we also uncovered frustrations with the process, some unintended consequences and clear room for improvement.

“We found that CQC’s approach works in different ways in different parts of the health and care system. When CQC identifies a problem in a large hospital there is a team of people who can help the organisation respond, but for a small GP surgery or care home the situation is very different.”

Kieran Walshe, report author and professor of health policy and management at Alliance Manchester Business School, said: “CQC has already taken some of our findings into account in developing their approach to regulating health and social care.”

CQC chief executive Ian Trenholm said: “We welcome the findings of this report on the regulatory model we introduced in 2013, the recommendations it offers and the support it gives to the changes we have already made and are continuing to make in line with our strategy.”

*Impact of the Care Quality Commission on provider performance: Room for improvement? The King’s Fund & University of Manchester, 27 September 2018.

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