“There is nothing so stable as change” Bob Dylan once said, and how right he was! Change is everywhere, and for some time now the CQC has been making changes to how they monitor GP practices. Only last week I was writing the final sections of the CQC Handbook, thinking I’d cracked it and then, hello, what’s this? Ah, it’s my old friend change!

We’ve had the transitional monitoring approach (TMA), the transitional regulatory approach (TRA) and didn’t I recently highlight how similar the ‘new’ monitoring approach was to the ARR? Well, there were so many similarities that the CQC has decided to cast the ARR adrift and sink it like a stone!

Quick recap so far, the TMA, TRA and ARR have gone, as has the Provider Information Collection (PIC). The TLAs (three letter abbreviations) are gone and the sole survivor is the ‘new’ monitoring approach. Unlike its predecessors, the ‘new’ monitoring approach isn’t worthy of a TLA and is simply referred to as ‘the monitoring approach’.

The changes don’t stop there! Let me take the ratings system to a whole new level. Four levels to be precise!

Level 1 – Rate every population group for the effective and responsive key questions

Level 2 – Aggregated rating for each population group

Level 3 – A rating for each key question

Level 4 – An aggregated overall rating for the practice as a whole

Hopefully this image helps provide some clarity.

To determine the aggregated rating of a service provider, the CQC use a set of ratings principles and applies professional judgement. You can read more about the ratings principles here.

Whilst this overhaul wasn’t completed under the radar, and yes it can be argued that the CQC has advised us all that they are changing their strategy and how they monitor and regulate service providers, these latest changes, the banishing of the ARR and PIC weren’t exactly promulgated and just like new or updated mythbusters, we find them as we scan the horizon for new information.

Should we welcome aboard the monitoring approach and the pre-inspection provider information request? Oh, didn’t I tell you, the pre-inspection provider information request is where the CQC may ask you for information prior to inspecting. Sounds familiar doesn’t it, is this the return of the PIC – just not as we know it?

The monitoring approach the CQC is taking has received mixed feedback with some practice managers thinking the remote approach is ideal, less intrusive and less time consuming. However, for me, I can’t help thinking it could be more intrusive. Let me explain.

The monitoring approach is multifaceted, they may need to gather additional information; this means they may need to speak with the registered manager and others, but rather than this taking place annually, it could in fact take place monthly, which could result in lengthy MS Teams calls with your local inspector. Couple this with the potential requests for information and this too could increase the duration of the calls. You might then have a 24-hour deadline to submit evidence!

That said, it’s not all doom and gloom, there is one positive that I can see and that is the surfacing of relationship holders. Your local CQC inspector or inspection manager will be designated as your relationship holder, and they will become your first point of contact with the CQC. The aim of the introducing the relationship holder is to develop and maintain a positive working relationship whilst enabling the CQC to have a better understanding of your practice.

We’ve certainly sailed the many seas of CQC change and if there is now to be a lull in the action, one thing is for sure, we’ll need to remain vigilant for any further changes that are currently lurking below the surface, ready to emerge.

So, it seems apt to quote Bob Dylan once again:

Come gather ‘round people

Wherever you roam

And admit that the waters

Around you have grown….. For the times they are a-changin’

The good news is, to help you navigate the CQC, we will soon be launching the CQC Handbook, which is crammed full of useful and essential information.

Until the next wave of changes.

Phil