Changes to the CQC Regime

The outcome of CQC consultation has now been published and there have been changes to its regulatory regime.

The multiple provider handbooks will now be replaced with two CQC assessment frameworks for all providers, one for healthcare and one for adult social care. The NHS Trusts will seek to implement the new assessment frameworks from this month, whilst the adult social care providers and GPs will have until November 2017. The independent sector providers will have until 2018/19 to implement the new frameworks.

In addition, there will be a new monitoring, inspection and ratings regime for NHS Trusts which will entail a well-led assessment and at least one core service inspection each year. It is expected that this will also be implemented this month by the NHS Trusts. There may be similar changes brought in for other providers including independent sector providers, following further CQC consultations this year.

The New Assessment Frameworks

The 5 Key Questions within the current provider handbook will remain unchanged (are services safe, effective, caring, responsive and well-led), however there are various revisions and additions to the existing Key Lines of Enquiry and Prompts.

In order to assist providers with updating systems and processes which may be aligned to the existing assessment frameworks, the CQC has published versions of the frameworks with the changes clearly marked. These versions can be accessed by clicking on healthcare and/ or social care.

New CQC Regime for NHS Trusts

The key points in the new CQC regime for NHS Trusts are as follows:

CQC Monitoring

The CQC will monitor NHS Trusts and decide which core services to inspect and when by using the new ‘CQC Insight’ system, but will initially seek to focus on existing data collections available nationally.

The new, annual Provider Information Requests (PIRs) will also be implemented, and the first batch of NHS Trusts that are identified on a risk basis and/or those not inspected in the last 12 months will receive a new-style PIR in the second half of this month, with targeted inspections likely to follow in the following 6 months after a PIR request. There will also be quarterly relationship management meetings with Trusts, which will help inform the CQC’s regulatory planning.

CQC Inspection

The CQC will be going ahead with its plan for NHS Trusts to have a well-led assessment and assessment of at least one core service each year after receiving extensive support for the proposals relating to the nature and frequency of inspections.

Following the CQC’s internal regulatory planning meetings, the Trusts will be informed of the timing of the well-led assessments. The CQC has specified that the scope/depth of these well-led inspections may vary according to the nature of the individual Trust.

In respect of core services, the CQC will inspect each year:

  1. All core services rated ‘inadequate’;
  2. Half of those rated ‘requires improvement’;
  3. a third of those rated ‘good’;and
  4. a fifth of those rated ‘outstanding’.

The CQC will address the concerns expressed in the consultation that long gaps between inspections for some core services may well prevent Trusts from being able to demonstrate improvements and some core service inspections will be triggered by information suggesting that the quality of care has improved.

A consultation on the monitoring and inspection regime changes for the adult social care and primary medical care sectors has commenced, and there will be a similar consultation during 2017/18 on the proposed changes to how independent sector providers are regulated and rated.

CQC Ratings

There were also concerns from those who responded to the CQC’s consultation for the need to improve transparency about how ratings are arrived at.

The CQC has committed to setting out clearly in each report how it reached the rating of ‘outstanding’, ‘good’, ‘requires improvement’ and ‘inadequate’ for each question, including factors considered and how this impacted on the CQC’s decision-making.

The next consultation

The CQC has launched a further consultation about the number of issues relevant to all sectors, including how providers are registered, new models of care/complex care providers and proposals for provider-level assessments. In addition it will also propose regulatory regime changes for adult social care and primary medical care (closing date 8 August 2017), with a third consultation in relation to CQC regime changes for independent sector providers expected later in 2017/18.

The first tranche of new-style information requests will be sent out to NHS Trusts this month and it is anticipated that the first of the ‘next phase’ NHS Trust inspections will take place between September and November 2017 and be fully embedded by Spring 2019.

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