CQC to revisit older Good and Outstanding GP ratings under new focused assessment programme
From March 2026, lower-risk NHS GP practices with historic Good and Outstanding ratings will begin to face focused reassessment under CQC’s new Returning to Good and Outstanding programme.
The programme is designed to give the regulator updated assurance on practices that have not been inspected for several years, with focused assessments centred on 10 non-clinical quality statements rather than a full clinically led review.
The most practical way to prepare is to combine the draft framework themes with a simple readiness review of the records, oversight and day-to-day evidence inspectors are likely to ask for quickly.
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Includes the update at a glance, the main preparation areas, common inspector asks and what practices should get in order now.
What practices need to know now
CQC’s new approach means older Good and Outstanding ratings will no longer sit untouched for long periods without fresh assurance.
In brief
- The programme applies to lower-risk NHS GP practices currently rated Good or Outstanding.
- It is aimed at practices whose last published inspection report was issued between 2017 and 2022.
- Assessments will focus on 10 non-clinical quality statements, include a site visit, and usually give at least five working days’ notice.
- The immediate challenge for practices will be showing that governance, culture, staffing, feedback, access and equity remain strong between inspections.
Why this matters
The Care Quality Commission is preparing to launch a new programme of focused assessments for NHS GP practices rated Good or Outstanding that have not been inspected for several years. Branded Returning to Good and Outstanding, the initiative will run alongside CQC’s usual assessment activity.
This matters because it marks a shift away from the idea that a historic Good or Outstanding rating can simply sit in place for years without fresh assurance. CQC is signalling that lower-risk does not mean permanently out of view.
For practices, the practical point is not just that reassessment is coming. It is that the regulator is focusing more closely on whether the systems, culture and management oversight that underpin quality have actually remained strong over time.
In plain terms, this is less about producing one polished inspection-day performance and more about being able to show that the practice runs safely, consistently and transparently every week of the year.
Who is affected
The programme is aimed at NHS GP practices that currently hold a Good or Outstanding rating and are considered lower risk.
- • The practice currently holds a Good or Outstanding CQC rating.
- • The last published inspection report was issued between 2017 and 2022.
- • The service is considered lower risk.
- • There is no ongoing regulatory activity.
- • The practice is not dormant.
What the assessments will involve
These are not framed as full clinically led reinspections. Instead, CQC is using a narrower and more targeted form of review designed to provide assurance on defined non-clinical themes.
- • The assessment will focus on 10 non-clinical quality statements.
- • It will include a site visit.
- • Practices will usually receive at least five working days’ notice.
- • These visits will not routinely involve a GP Specialist Advisor.
- • CQC may still escalate to a full inspection if concerns are identified or a positive escalation is needed.
10 practical preparation areas
The most useful approach is to treat the likely assessment themes as preparation areas and review the evidence behind each one.
1. Learning culture
Incidents, significant events, complaints learning, speaking up and evidence that concerns are investigated and shared.
2. Safe and effective staffing
Recruitment checks, DBS, induction, appraisals, training matrix, staffing levels, supervision and oversight.
3. Safe environments
Premises, fire, legionella, IPC, equipment checks, emergency kit, cold chain and continuity planning.
4. Workforce wellbeing and enablement
Staff support, wellbeing, workload oversight, reasonable adjustments and evidence that staff voice is heard.
5. Equity in access
Access routes, barriers, phone demand, online options, patient groups facing disadvantage and action taken.
6. Listening to and involving people
Complaints, FFT, PPG feedback, patient voice and evidence that feedback produces visible change.
7. Shared direction and culture
A clear sense of what the practice stands for, how it works and whether staff understand that consistently.
8. Managers and partners
Visible oversight, leadership development, accountability and day-to-day management credibility.
9. Equality, diversity and inclusion
Fair treatment, adjustments, training, recruitment fairness and action on bullying or discrimination.
10. Governance, management and sustainability
Governance meetings, risk registers, policy control, improvement actions and evidence of grip.
Detailed breakdown: what inspectors are likely to test
The value is in translating each preparation area into evidence, records and conversations that can be produced without a scramble.
1. Learning culture
What inspectors are likely to look for
- Significant Event Analysis records from the last 12 months
- Evidence incidents are investigated, actioned and shared with the team
- Learning from complaints, incidents and near misses
- Meeting minutes showing SEA discussion and follow-up action
- Staff confidence in raising concerns without fear of blame
- Freedom to Speak Up arrangements understood by staff
What strong preparation looks like
Every team member, not just the practice manager, should be able to explain how concerns are raised, what happened after the last significant event, and how the practice changed as a result.
2. Safe and effective staffing
What inspectors are likely to look for
- Recruitment files with DBS, references and right-to-work checks
- Mandatory training completion for clinical and non-clinical staff
- Annual appraisal records for all staff
- Supervision and professional support, including documented clinical supervision where relevant
- Induction records for new starters
- Governance arrangements for locums, temporary staff, ARRS and PCN staff
- Clear evidence of staffing levels, skills mix and oversight
What strong preparation looks like
A comprehensive training matrix does a lot of heavy lifting here. One spreadsheet, every person, every training item, every date, with any gaps clearly owned and actioned.
3. Safe environments
What inspectors are likely to look for
- Premises risk assessments and maintenance records
- Fire safety records, drills and staff fire training
- Legionella risk assessments and water flushing logs
- COSHH where relevant
- Equipment servicing, calibration and maintenance records
- Electrical checks, business continuity and infection prevention assurance
What strong preparation looks like
Walk the premises as if you are the inspector. Check fire exits, signage, emergency kit, vaccine storage, fridge logs, room condition, cleaning assurance and maintenance records.
4. Workforce wellbeing and enablement
What inspectors are likely to look for
- Evidence staff wellbeing is actively supported, not just written into policy
- Staff feedback routes and examples of action taken
- Reasonable adjustments and flexible working arrangements
- Workload and wellbeing discussed at management level
What strong preparation looks like
Staff should be able to say how supported they feel, who they would go to if they were struggling and whether the practice responds realistically to workload pressure.
5. Equity in access
What inspectors are likely to look for
- Access performance and patient survey evidence
- Understanding of barriers facing different patient groups
- Telephone demand, online routes and appointment structure
- Action taken where access is weak or inequitable
What strong preparation looks like
If access scores are weak, have the improvement plan ready before the question lands. Practices are stronger when they can show they understand the causes and have already responded.
6. Listening to and involving people
What inspectors are likely to look for
- Complaints policy that is current and accessible
- Complaints log with outcomes, timescales and actions
- FFT, PPG activity and wider feedback routes
- Examples of learning from complaints being shared
What strong preparation looks like
Strong complaints handling is not the absence of complaints. It is a clear, fair and timely process with visible learning and action.
7. Shared direction and culture
What inspectors are likely to look for
- A clear practice vision or strategy known to staff
- Values that are visible and understood
- Evidence of shared direction across clinical and non-clinical staff
- Staff involvement in how the practice works
What strong preparation looks like
Staff should be able to say what the practice stands for and how they know. A short, lived strategy is much more credible than a polished document no one remembers.
8. Managers and partners
What inspectors are likely to look for
- Leadership roles clearly defined and understood
- Managers and partners who are visible, accessible and supportive
- Development, appraisal and accountability for management roles
- Evidence oversight is active rather than assumed
What strong preparation looks like
Inspectors may take particular interest in the practice manager’s own development, support and appraisal as well as the partners’. If development only exists for clinicians, that gap will show.
9. Equality, diversity and inclusion
What inspectors are likely to look for
- Equality and diversity policy that is current and known to staff
- EDI training and awareness
- Reasonable adjustments for staff and patients
- Evidence bullying, harassment and discrimination are addressed
- Fair and consistent recruitment processes
What strong preparation looks like
The practice should be able to show that it understands both workforce and population diversity, and that this produces visible action rather than just policy wording.
10. Governance, management and sustainability
What inspectors are likely to look for
- Named governance lead and regular governance meetings
- Current risk register with owners and actions
- Policy index and review control
- CQC notifications, information governance and continuity planning
- Clear management of risk, performance and improvement
What strong preparation looks like
Governance is the backbone section because it ties together incidents, complaints, staffing, access, policy control, premises, risk and improvement. If governance is weak, everything else starts to look less convincing very quickly.
Things practices should watch closely
Recent preparation advice is most useful where it translates broad themes into the evidence inspectors often ask for immediately.
- HR records and recruitment files, including DBS, references, right-to-work and gaps in CV history.
- Training records and matrix detail, including mandatory, role-specific and refresher training.
- Staff immunisation records and occupational health assurance where relevant.
- Complaints and significant events, including whether they are documented, discussed, shared and reflected in minutes.
- Meeting minutes and governance records showing learning, action tracking and oversight.
- Health and safety records, including fire, legionella, IPC and wider premises assurance.
- Emergency drugs and equipment, including expiry checks, accessibility and routine assurance.
- Core policies, especially recruitment, DBS, prescribing and medicines governance.
- ARRS and PCN staff assurance, including supervision, mentoring and safe embedding in the practice.
- Staff development evidence, including appraisals, mentoring, supervision and progression.
- Reception and triage observations, including safe escalation and deteriorating patient recognition.
- Prescription and building security, including script security, records storage and confidential information control.
- DNACPR recording and review processes, including documentation and follow-up assurance.
- Reasonable adjustments for patients and staff, and evidence they are applied in practice.
- Learning disability reviews and recall systems, including annual review follow-up.
- Cold chain and vaccine storage, including monitoring, record keeping and escalation when temperatures go out of range.
- Appointment types and access routes, including whether they align with patient need and staffing capacity.
- Staffing levels and workload pressure, including whether the practice can evidence safe capacity.
For dispensing practices, medicines governance and dispensing processes may also attract additional scrutiny from a pharmacist inspector.
What to do next
The most useful preparation is not a last-minute document chase. It is a structured review of the evidence inspectors are most likely to test quickly.
- Build a single preparation pack. Include your policy index, training matrix, complaints log, governance minutes, risk register and key safety records.
- Test the evidence, not just the policy. Make sure managers, partners and frontline staff can explain how processes work in practice.
- Write down known gaps and the action plan. A visible improvement plan is stronger than pretending the gap does not exist.
The Practice Connect view
The most important signal in this programme is not simply that CQC is revisiting older ratings. It is that the regulator is testing whether quality can still be evidenced through the everyday machinery of a practice: governance, culture, staffing, access, feedback and equity.
That changes the practical challenge for providers. The strongest position will not be held by practices that can assemble a polished response just before a visit. It will be held by practices that can show visible organisational grip throughout the year.
In that sense, the real shift is from inspection preparation to continuous organisational assurance. For long-rated Good and Outstanding practices, that is probably the point worth taking most seriously.