1. Our next phase of regulation: A more targeted, responsive and collaborative approach1 1

2. Our purpose
The Care Quality Commission is the independent regulator of health and adult social care in England.
We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.
Strategy Slides - 24 May MASTER

3. Monitor, inspect and rate
Our current model of regulation
Register
Monitor, inspect and rate
Enforce
Independent voice
We register those who apply to CQC to provide health and adult social care services
We monitor
services, carry out expert
inspections, and judge each service, usually to give an overall rating, and conduct thematic reviews
Where we find poor care, we ask providers to improve and can enforce this if necessary
We provide an independent voice on
the state of health and adult social care
in England on issues that matter to the
public, providers and stakeholders

4. Key findings
CQC’s first inspection programme of all GP practices in England provides an unprecedented view of general practice…
We found the best care where it is clearly evidenced that a practice has:
strong leadership, management and governance,
an understanding of everyone’s responsibilities in the practice team (skills mix),
a clear knowledge of the needs of patient groups and
a supportive local health economy.

5. Interim findings
89% of GP practices we have inspected are providing a good or outstanding standard of care
Source: CQC – 1 March 2017

6. Overall picture of quality in general practice( 6
Source: CQC – 1 March 2017

7. Consultations on our proposed changes to inspections
Closed 8 Aug
nextphase
20 December 2016 – 14 February 2017
New care models and complex providers
Cross sector changes to assessment frameworks
Updated guidance for registration of learning disability services
Changes to Hospitals inspection methodology
12 June – 8 August 2017
Changes to Adult Social Care regulation
Changes to Primary Medical Services regulation
Clarifying how we define registered providers and improving the structure of registration
Updating guidance on Fit and Proper Person Requirements
Closed
Winter 2017
Changes to Independent Acute inspection methodology
Following the publication of our strategy, we have been going through a complex series of consultations. This is the current state
We have recently been consulting on changes to the way we regulate primary care services in future. Our latest consultation closed on 8 August
We will be reporting on responses to our latest consultation in late October when we will publish new guidance and methodology taking into account the views that we have received.
A joint consultation on Use of Resources with NHS Improvement is expected in Winter 2017

8. The purpose of the consultations
How we propose to update our approach and our assessment framework to reflect the changing provider landscape
Three consultations on these changes: Winter 2016/17, Summer 2017 and Autumn 2017.
more integrated approach that enables us to be flexible and responsive to changes in care provision
more targeted approach that focuses on areas of greatest concern, and where there have been improvements in quality
greater emphasis on leadership, including at the level of overall accountability for quality of care
closer working and alignment with NHS Improvement and other partners so that providers experience less duplication
Our strategy for 2016 to 2021, set out four strategic priorities, which are to:
Encourage improvement, innovation and sustainability in care
Deliver an intelligence-driven approach to regulation
Promote a single shared view of quality
Improve our efficiency and effectiveness.
Consultation 1 looked in further detail about how we propose to update our approach and our assessment framework to reflect the changing provider landscape which was aimed at achieving;
A more integrated approach that enables us to be responsive to changes in care provision
A more targeted approach that focuses on areas of greatest concern, and where there have been improvements in quality.
A greater emphasis on leadership, including at the level of overall accountability closer working and
Alignment with other partners so that providers experience less duplication 
The consultation that has just closed focussed on how we will regulate adult social care and primary medical services, and the changes we want to make to how we register providers.

9. Timing
20 October: Publish response to consultation, new guidance and methodology, 1 November: Introduction of the new assessment framework, with aligned Key Lines of Enquiry 2018: Introduce new system of provider information collections and annual regulatory reviews.
Whatever the outcome of the consultation – we expect to phase in any changes gradually. We anticipate that the first of these changes will come into effect in November with the introduction of the new assessment framework, which will guide our inspections.
New assessment framework: The previous 11 separate frameworks for healthcare services have been merged into one. We have also aligned, as much as possible, the wording of our Key Lines of Enquiry and prompts between the two assessment frameworks.
In the New Year we expect to introduce a new system of provider information collections and annual regulatory reviews.
In line with our commitment to reduce the demand on GP practices we are working with the GMC, NHSE and other regulators to streamline these requests, avoid duplication and share information. For the same reason CQC will not introduce this new process until our new digital systems are in place during 2018.
In the meantime our current schedule of inspections to the end of March will continue as planned - giving priority to practices previously rated Requires Improvement or Inadequate as well as those Good and Outstanding practices who had early inspections. We will also inspect in response to information that highlights concerns or risks.

10. Testing our methodology
As part of our consultation around how we regulate primary medical services, we are also testing and piloting changes with GPs and urgent care providers
Four inspection teams – one in each region
Testing will be alongside our current methodology and with the permission of the provider
Will not affect rating
Opportunity for co-production
We are very keen to ensure that we are working in collaboration with GPs – so we have been testing our new approach with some volunteers.
We will work with organisations representing GPs to develop this process.
SUBJECT TO CONSULTATION

11. Key changes - register Registration Improvement Programme includes:
improving existing processes – including a simpler process for low risk registration changes such as change of partners
ensuring we stay up to date with emerging models of care. Asking the right questions at registration
ensuring we are able to register new models at the guiding mind level
SUBJECT TO CONSULTATION

12. Key changes - monitor
Strengthened relationship management – more regular contact with providers and closer working with our national, regional, and local partners
CQC Insight – more timely information about a provider’s performance
Annual provider information collection – what has changed about quality of care provided over the last year
Regulatory planning review – annual review of information we hold on a provider; confirming inspection schedule where no change in quality indicated
You will remember that our strategy for 2016 to 2021spoke about delivering an intelligence-driven approach to regulation
We are carrying out a programme of work through the Regulation of General Practice Programme Board to consider ways in which NHS England, clinical commissioning groups and CQC can work in a more aligned way at regional and local level. We will publish a joint working framework in the Autumn.
Every year we will formally review all of the information we have about a provider. This will ensure that our monitoring and planning decisions are made clearly, consistently and transparently.
Our inspectors will consider whether there have been any changes to the quality of a provider’s care since our last inspection or if the available evidence still supports the rating. This will include reviewing the annual provider information collection, CQC Insight and information from stakeholders.
SUBJECT TO CONSULTATION

13. Key changes - inspection
Subject to consultation – we have proposed changes to the frequency of inspection.
Under the proposals:
Practices rated Inadequate would be re-inspected after six months;
Requires Improvement within 12 months;
Good or Outstanding would move to an inspection interval of up to five years, although every year we will inspect a proportion.
Our consultation envisaged that the frequency and scope of each inspection will be based on the current level of concern that we have about a service, or their potential for improvement.”
The GP Forward View committed CQC to move to a maximum interval of five yearly CQC inspections for good and outstanding practices, as outlined in CQC’s strategy for
It also said: CQC will consult on changes to its regulatory model with the aim of reducing the regulatory burden for practices that deliver good or outstanding care.
Good or Outstanding would move to an inspection interval of up to five years – with a proportion inspected every year.
Note: This would also depend on an annual review of the information we hold on a provider.

14. Key changes – inspect
Scope – comprehensive inspections for providers rated Inadequate or those not inspected before. For providers rated Good and Outstanding there will be a range of regulatory responses to ensure comprehensive assessment of practices – focus of these influenced by Insight
Inspection team – continue to use specialist advisors in the inspection process. We will use experts by experience more efficiently, for example by gathering evidence using telephone calls pre-inspection rather than on the site visit
Notice periods – increased flexibility including short notice and unannounced
Emphasis – more on the quality of care provided including population groups and conditions; less on policies and risk assessments
Inspection intervals – providers rated Inadequate every six months; Requires Improvement within 12 months; rated Good or Outstanding up to five years with a proportion inspected each year.
Scope – comprehensive inspections for providers rated Inadequate or have not inspected before. For the providers rated Good and Outstanding there will be a range of regulatory responses to ensure comprehensive assessment of practices – focus of these influenced by Insight
Inspection team – continue to use specialist advisors in the inspection process. We will use experts by experience more efficiently, for example by gathering evidence using telephone calls pre-inspection rather than on the site visit
Notice periods – increased flexibility including short notice and unannounced
Emphasis – more on the quality of care provided including population groups and conditions; less on policies and risk assessments
SUBJECT TO CONSULTATION

15. Provider information collection
For Good and Outstanding providers the PIC will underpin our monitoring of changes in the quality of care (both positive and negative):
An annual online information collection to replace the existing provider information return
We will ask providers for information every year, rather than as part of inspection preparation, and encourage them to keep it up to date
PIC will give practices an opportunity to champion the quality of care they are providing
Central to it all is the PIC – which is now being developed. Every year we will formally review all of the information we have about a provider.
We are working closely with NHS England and the GMC to align our information requests and develop more integrated systems so that we reduce unnecessary duplication.
The Regulation of General Practice Programme Board was formed with the purpose of coordinating and improving the overall approach to the regulation of general practice ... with the aim of reducing demands on GP practices that deliver good or outstanding care
What will PIC include?
It will give providers an opportunity to give us their view of the quality of care that they are providing
What has changed about quality of care provided since last year
What plans they have to improve
Examples of good practice
How they provide effective and responsive care to each population group
In line with our commitment to reduce the demand on GP practices CQC will not introduce this new process until our new digital systems are in place during We are working with the General Medical Council, NHS England and other regulators to streamline these requests, avoid duplication and share information. We will work with organisations representing GPs to develop this process.
What sort of questions might we ask?
TBC – but as examples
Please give examples of how learning from significant events has improved the quality of care (Safe)
Please give examples of how the practice provides effective care for older people, describing any specific improvements in outcomes (Effective)
Please give examples of any innovative practice undertaken in the last 12 months (Well Led)
SUBJECT TO CONSULTATION

16. Key changes – rate and report
Content – significantly shorter summary report supported by an evidence table
Publishing reports – commitment to publishing 90% within 50 days of the inspection
Updating ratings – only changed on the basis of evidence from inspections (not as a result of regulatory planning review); six month limit for aggregating ratings dropped
Population groups – we are proposing rating population groups for only Effective and Responsive domains. This is to make rating and aggregation simpler and to better reflect where people are providing good care for particular groups in the ratings.
We currently inspect and rate the quality of care for each of the six population groups against each key question and provide aggregated ratings for each population group, each key question, and for the practice overall.
We want to simplify this by reducing the overall number of ratings we give. During our full programme of inspections in general practice over the last three years, we have learned that the most significant differences in quality between the population groups are in the effective and responsive key questions
We are proposing that we:
Continue to give an overall rating and a rating for all key questions at practice level
• Ratings for effectiveness and responsiveness for all population groups
SUBJECT TO CONSULTATION

17. In summary: Less frequent inspection for most
Closer working relationship with named lead at CQC
Reduced burden re data collection
More proportionate action - not only inspection
Focus on outcomes
A simpler process for low risk registration changes
More timely information about a provider’s performance
SUBJECT TO CONSULTATION

18. The phased approach
Current schedule of inspections will continue, based on:
Practices rated Requires Improvement or Inadequate
Good and Outstanding practices who were inspected early
Information of concern
1 November:
Introduction of the new assessment framework,
Aligned Key Lines of Enquiry,
Increased focus on monitoring and local relationships
April 2018
New system of Provider Information Collections
Annual regulatory reviews
Shorter report
New inspection frequencies