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CQC proposes move to risk based regime

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The Care Quality Commission has proposed moving to a more risk based regulatory regime.

  • Providers rated good and outstanding would be inspected less often
  • ‘Co-regulation’ including ‘self-assessment’ by providers would play a part
  • David Behan said he wouldn’t describe plans as ‘light touch’


But the chief executive of the regulator, David Behan, told LGC’s sister title HSJ the changes would not be a return to “light touch” regulation. 

In a report to be published today, the watchdog will set out a number of options for health and care regulation between 2016 and 2021. These include reducing the frequency of inspections for high performing services and getting providers to self-assess their quality.

David Behan

The phrase ‘light touch’ has ‘unhelpful’ connotations, David Behan said

Last week HSJ reported that the CQC has been asked to model the effects of cuts to its central government funding of 25 and 40 per cent.

In an exclusive interview ahead of the report’s release, Mr Behan said the changes would make the regulator “more efficient and more effective” so it could operate in a “context of having less resources”.

Mr Behan said that measures to improve the regulator’s effectiveness and efficiency would include inspecting “good” and “outstanding” services less frequently.

The regulator has not yet decided exactly what the frequency of inspections should be, but Mr Behan said it had previously intended to revisit high performing services after two years and it “may well push that out”. However, he said “inadequate” providers would probably continue to be inspected every six months.

Mr Behan said the CQC would pioneer a new approach of “co-regulation”, with providers sending in “self-assessments of how they think they’re doing”, which the watchdog would then “verify”.

This would encourage providers to take “more responsibility for ensuring that they can demonstrate the quality of what they do”, he said.

Along with making the current model more efficient, Mr Behan said the second part of the CQC’s strategy would be about the organisation “doing things differently” by assessing quality in areas and across pathways.

While this would involve the CQC using its powers under the Health Act 2008 to look at the commissioning of services, Mr Behan said it had no plans to start inspecting or rating clinical commissioning groups.

“We’ve not been given a role to assess the quality of CCG’s… there’s nobody asking us to do that,” he added.

Mr Behan said the changes were not a shift from intensive inspection back to a “light touch” approach.

Earlier this year, chief inspector of general practice Steve Field told HSJ the CQC should consider whether to move to “encouraging improvement and having a more light touch”.

Mr Behan said: “I don’t see what we’re doing here as a pendulum swinging.

“[When] 80 per cent of all GPs are assessed as being good or outstanding, the argument isn’t that you go round and [inspect] them all again using exactly the same methodology.

“Is that a good use of the money that is in the system if you’re actually finding out something that you already know? I would argue it’s not.

“I see this… as a development from the baseline that we’ve got in place.”

Mr Behan said he would not be using the phrase “light touch”, which had “unhelpful” connotations, and that the new approach was about regulation being “proportionate to the risk”.

He also said the CQC would improve its use of data and be “much more risk based” in its approach to registering services.

The registering of “low risk” services, such as two merged general practices, would become less burdensome, allowing the CQC to focus on more “high risk” services, such as a merger of mental health providers, he said.

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