The Care Quality Commission has fundamentally restructured how it inspects GP practices. The Single Assessment Framework, introduced in late 2023 and now fully operational, replaces the previous key lines of enquiry with a new evidence-based model. For practice managers and partners, the shift is not cosmetic. It changes what evidence CQC collects, when it collects it, and how ratings are determined.
Under the old model, a GP practice could reasonably expect a scheduled inspection every few years, with a defined inspection window and a predictable set of questions. The Single Assessment Framework moves to continuous assessment, where CQC draws on multiple evidence sources between formal inspections. Your rating can change without a site visit.
The five key questions remain unchanged: is the service safe, effective, caring, responsive, and well-led? What has changed is the evidence framework beneath them. CQC now uses quality statements under each key question, replacing the old key lines of enquiry and prompts. Each quality statement describes what good care looks like, and inspections assess against these statements using six evidence categories.
CQC assesses whether the practice protects patients from avoidable harm and abuse. The quality statements cover safety systems, learning from incidents, safeguarding, infection prevention and control, medicines management, and staff recruitment. For GP practices, the most common triggers for concern under "safe" are inadequate significant event analysis, poor medicines reconciliation, incomplete DBS checks, and gaps in immunisation cold chain records.
This covers clinical outcomes, evidence-based practice, and staff competence. CQC looks at how the practice monitors clinical performance, uses guidelines and pathways, and ensures staff maintain their skills. QOF achievement is relevant here, but CQC is more interested in how the practice responds to clinical variation than in raw QOF scores. If your QOF exception reporting is high, expect questions about why.
Patient experience is central. CQC draws heavily on the GP Patient Survey, Friends and Family Test results, complaints data, and its own patient interviews during inspection. A practice with persistently low patient satisfaction scores will face scrutiny regardless of clinical performance. The national GP Patient Survey response rate averages around 30 per cent, and practices with overall experience ratings below the national average are flagged automatically.
Access to appointments is the dominant issue. CQC assesses whether patients can access care when they need it, whether the practice responds to the needs of its population, and whether complaints are handled effectively. The NHS complaints regulations require written acknowledgement within three working days and a formal response within an agreed timeframe. Many practices fail on this basic procedural requirement.
Governance, leadership, and culture. CQC examines whether the practice has a clear management structure, whether leaders understand their responsibilities, whether there is a culture of learning and improvement, and whether governance systems are effective. For partnerships, this includes clarity about partner responsibilities, locum governance, and decision-making processes.
The Single Assessment Framework draws evidence from six categories. Understanding these categories is essential because CQC now collects and analyses evidence continuously, not just during site visits.
The practical implication is that CQC forms a view of your practice between inspections using data it receives from NHS England, ICBs, patient surveys, and national prescribing datasets. A practice that looks fine on the day of an inspection but has concerning trends in its prescribing data or patient survey scores will be rated accordingly.
Clinical governance is the single area where most practices either pass comfortably or fail badly. There is very little middle ground. CQC expects documented evidence of:
CQC inspection does not exist in isolation from the NHS contract. Many compliance requirements overlap, and failure in one system often predicts failure in the other. The Quality and Outcomes Framework, enhanced services (DES and LES), and the Investment and Impact Fund all generate evidence that CQC considers during assessments.
Practices that struggle with QOF achievement rarely have isolated coding problems. Low achievement usually indicates systemic issues with chronic disease management, recall systems, or clinical capacity, all of which CQC will explore. Similarly, failure to deliver enhanced services to contracted levels raises questions about practice capability and resource management.
CQC expects all GP practice staff to maintain up-to-date training in defined areas. The specific requirements depend on role, but for clinical staff the mandatory training list includes:
| Training area | Required level | Renewal frequency |
|---|---|---|
| Safeguarding adults | Level 3 (clinical staff) | Every 3 years |
| Safeguarding children | Level 3 (clinical staff) | Every 3 years |
| Basic life support | All staff | Annual |
| Anaphylaxis | Clinical staff | Annual |
| Information governance | All staff | Annual |
| Fire safety | All staff | Annual |
| Infection prevention and control | All staff | Every 2 years |
| Equality and diversity | All staff | Every 3 years |
| Mental capacity and consent | Clinical staff | Every 3 years |
| PREVENT (counter-terrorism) | All staff | Every 3 years |
Tracking 10 to 15 training requirements across 15 to 30 staff, each with different renewal dates, is a genuinely complex administrative task. A single lapsed BLS certificate discovered during an inspection can move a practice from Good to Requires Improvement under the "safe" domain.
The Local Authority Social Services and NHS Complaints (England) Regulations 2009 set out the statutory requirements for complaints handling. GP practices must acknowledge complaints within three working days and respond within a timeframe agreed with the complainant. CQC checks not only that complaints are answered but that the practice demonstrates learning from complaints and makes changes to practice as a result.
Common failures include: no written complaints policy, no evidence of complaints review at practice meetings, no documented learning or action plans, and no analysis of complaint trends. CQC will ask to see a complaints log and will select individual cases to review in detail.
Under the Single Assessment Framework, CQC uses a risk-based approach to determine inspection timing. Practices rated Good or Outstanding with no concerning intelligence may go several years between site visits. Practices rated Requires Improvement are typically re-inspected within 12 months. Practices rated Inadequate are placed in special measures with a six-month re-inspection timeline.
Between scheduled inspections, specific triggers can prompt an earlier visit or a focused inspection on a single key question. Common triggers include:
The key point is that you cannot predict when CQC will next look at your practice. The evidence is flowing to CQC continuously, and a concerning data point can trigger scrutiny at any time. The only viable strategy is continuous compliance, not inspection preparation.
Significant event analysis, training matrices, complaints handling, clinical audit tracking, and CQC inspection preparation. Built for primary care teams who want to stay ahead of the Single Assessment Framework.
Learn more at slatewick.co.ukCompliance tools for regulated industries. Built with the tools of tomorrow, guided by the values of yesterday.