The CQC will rate practices at four levels:
- Level 1: Rate every population group for each key question. Inspectors will consider evidence that relates to individual population groups, and practice-level evidence that relates to all people using the service.
- Level 2: An aggregated rating for each population group.
- Level 3: An aggregated rating for each key question.
- Level 4: An aggregated overall rating for the practice as a whole.
The diagram below shows how this should work in practice.
Ratings at four levels for GP practices (Source: CQC)
The CQC is currently reviewing its approach to aggrgating population group ratings and will be updating this guidance.
How the CQC decides on a rating
When awarding ratings for the five key questions and six population groups the inspection teams will review the evidence gathered against the key lines of enquiry. See CQC inspection explained: What will the CQC assess? for more on this.
In deciding a rating the inspection team will ask:
- Does the evidence demonstrate a potential rating of good?
- If yes – does it exceed the standard of good and could it be outstanding?
- If no – does it match the characteristics of requires improvement or inadequate?
The CQC says inspection teams will use a set of principles when rating providers to ensure consistent decisions. However, inspectors may use professional judgement to depart from these principles, for example when the concerns identified have a very low impact on people who use services or where the CQC is confident that the service will address concerns or where action has already been taken.
When the CQC is aggregating ratings all five questions and all six population groups are weighted equally.
There is more information about how the CQC aggregates its ratings to produce an overall population group rating, an overall key question rating and an overall service level rating here.
After a practice has been inspected the CQC will produce a report, which will be published on its website.
Practices will receive a copy of the draft report, which will include their ratings. If they practice is unhappy it can 'challenge the factual accuracy of reports' and also 'challenge the completeness of the evidence on which the ratings are based'. Practices will have 10 working days to review draft reports and submit comments to the CQC.
Practices can only request a review of their ratings if the inspector did not follow the process for awarding them properly. The practice must tell the CQC they wish to do this when the report is published. If the CQC does not agree to review the ratings the practice cannot request another review of ratings from the same report.
What happens to inadequate practices?
Practices rated 'inadequate' overall are placed in special measures immediately and expected to make 'significant changes to improve their services'.
Services rated inadequate for a key question or a population group will be inspected within six month. If there is still a rating of inadequate for a population group or key question the practice will be placed in special measures.
Practices in special measures will be re-inspected within six months. If the practice has made sufficient improvement the CQC will remove it from special measures. If sufficient progress has not been made the CQC can either propose to cancel its registration or vary its terms of reistration. There will then be a further inspection within six months and if progress has not been made the practice's registration will be cancelled.