The CQC recently conducted a post-implementation review of three sets of regulations made under the Health and Social Care Act 2008, specifically:
- Care Quality Commission (Registration) Regulations 2009
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
- Care Quality Commission (Reviews and Performance Assessments) Regulations 2018
The consultation consisted of questions, with respondents prompted to answer strongly agree, agree, disagree or strongly disagree and provide comments on their response. The full Londonwide LMCs’ response can be read here.
The key requests and recommendations from our responses are:
- The CQC should be as accountable for its processes as the providers it regulates, and the regulations should incorporate this very important component within their scope, to avoid inconsistency and unfair treatment of registered providers.
- There should be greater coherence and cohesion between the CQC regulatory framework and the commissioner contract management framework. Particularly in cases where a provider is instructed to start/stop a particular piece of activity by its commissioner and given a completely contradictory instruction by its regulator.
- Ratings should focus on areas that are proven risks to patient safety and not on areas that are just perceived to be so by a member of the inspection team. Inspectors should rate providers only against the mandatory standards set out and not factor in whether they are undertaking good practice or ‘nice to dos’ which are not actual requirements.
- Where local commissioners are managing CQC registration suspensions there should be more consistency between different commissioning localities. This would not only be fairer to practices but would make it easier to provide training and guidance to them.
- The creation of a fast-track registration process for interim/caretaking by new providers would improve the chances of keeping practices open when existing contract holders leave a contract.
- The duty of candour requirement as currently implemented means many practices fear punitive action from their regulators or commissioners if they do share mistakes. A better approach would be a no-blame, learning culture that enables the provider in question to reflect, address any issues appropriately and engage with their affected patient(s) without fear of punishment.
- More could be done to mitigate the impact of the inspection process given the incredibly high pressures practice teams are working under due to the mismatch between demand and capacity in general practice. This is with regard to both workload pressures and the stress on practice staff created by an inspection. Adjustments could include:
- Flexibility when key partners or managers of a practice are on leave or unavailable on the day that an inspection is scheduled and agree to reschedule inspection dates accordingly.
- Making it easier to re-rate practices rather than waiting for a subsequent scheduled inspection, particularly where practices have undertaken remedial work and believe they no longer fall into the “requires improvement” or “inadequate” categories.