The CQC Is Rewriting the Rulebook for Primary Care — Here's What's Changing

The Care Quality Commission has published a draft assessment framework specifically for primary care and community services, marking a significant shift in how GP practices will be inspected and rated. After widespread criticism of the single assessment framework introduced in 2024, the regulator is going back to sector-specific frameworks — and the new draft introduces some notable changes in what "good" looks like for general practice.

Here's what practices need to know.

Why the framework is changing

The single assessment framework, rolled out in early 2024, was intended to simplify regulation by creating one framework for all health and social care services. In practice, it didn't work well for primary care. The 34 quality statements were criticised for being overly complex, the scoring system lacked transparency, and the one-size-fits-all approach failed to account for the realities of general practice.

Independent reviews — including those led by Dr Penny Dash and Professor Sir Mike Richards — highlighted serious flaws, and the CQC has since acknowledged that the approach needs a fundamental rethink.

The result is four new sector-specific draft frameworks, one of which is dedicated to primary care and community services. The consultation is open until 12 June 2026, with the final framework expected to be published in summer 2026 and implementation beginning toward the end of the year.

What's structurally different

The new framework keeps the five key questions — Safe, Effective, Caring, Responsive, and Well-led — but makes several structural changes:

Key lines of enquiry are back. The quality statements introduced under the SAF are being replaced with structured questions that describe what the CQC will be looking for during assessments. These function similarly to the old KLOEs that practices were familiar with before 2024.

Rating characteristics return. The draft reintroduces detailed descriptors for each rating level — Outstanding, Good, Requires Improvement, and Inadequate — for every key line of enquiry. The current SAF only described what "good" looks like. Having all four levels spelled out gives practices a much clearer picture of where they sit and what they need to demonstrate.

Scoring is being removed. The complex numerical scoring system introduced with the SAF is gone. Ratings will instead be based on rounded professional judgement across each key question.

The themes that matter most for general practice

Beyond the structural changes, the content of the framework introduces some notable shifts in emphasis.

Equity is everywhere

This is probably the single biggest thematic change. Previously, equality and diversity requirements sat mainly under Well-led and parts of Caring. In the new framework, equity is woven into virtually every key line of enquiry across all five domains.

Under Safe, practices need to show they're identifying safety risks that affect particular groups. Under Effective, clinical outcome data should be reviewed to identify disparities across different characteristics. Under Responsive, services must identify digitally excluded patients and offer alternative access routes. Under Well-led, workforce equity and anti-discrimination are assessed in detail.

This means practices will need to demonstrate equity considerations not as a standalone policy, but as something embedded in day-to-day clinical and operational decision-making.

Population health management is now a core expectation

The framework explicitly requires services to use population health data to support prevention, improve outcomes, and reduce health inequalities. This goes beyond individual patient care — it asks practices to think at population level about who they're reaching, who they're missing, and what they're doing about the gap.

For practices already engaged in proactive recall and long-term condition management, this validates the approach. For those who aren't, it raises the bar on what "good" looks like.

AI gets a specific mention

Perhaps the most surprising inclusion: artificial intelligence is explicitly referenced in three places across the framework.

Under Safe environments, the technology used to deliver care — including AI — must be shown to be suitable for its intended purpose, secure, and used properly. This is a governance requirement: practices using any AI-driven tools will need to demonstrate they've assured themselves of their fitness for purpose.

Under Effective (delivering evidence-based care), staff at Outstanding-rated services are expected to identify and implement innovative approaches to care delivery, with AI in clinical care pathways given as a specific example.

Under Responsive (timely and equitable access), innovative technology including AI is referenced as a route to ensuring timely access to care.

This is a notable step from the regulator — acknowledging AI not just as something to be governed, but as something that can actively improve care quality.

Digital inclusion is explicitly in scope

The framework names digital exclusion as a specific consideration under timely and equitable access. Services need to identify people who may be digitally excluded and offer alternative ways of accessing care. This applies to everything from appointment booking to patient communications and recalls.

Technology assurance becomes assessable

"Digital systems / technology assurance" is now an explicit scope area under Safe environments. Practices will be asked about the governance, safety, and suitability of the digital tools they rely on — not just physical premises and equipment. This is new territory for primary care inspections.

Chronic condition follow-up is specifically named

The framework calls out "the follow-up of chronic conditions" as an example of internal pathways that need to be rigorous and safe. This makes proactive long-term condition management not just good practice, but a specific area an inspector might ask about.

The timeline

The draft framework is currently in consultation, with responses invited until 12 June 2026. CQC plans to pilot the framework with selected providers over summer 2026, publish the final version in summer 2026, and begin implementation toward the end of the year.

The CQC is also on track to complete 9,000 assessments by September 2026, representing a significant acceleration in inspection activity. Many practices that haven't been inspected for several years will receive assessments under the new framework.

What practices should be doing now

The specific wording of individual KLEs and rating descriptors may shift following consultation, but the direction of travel is clear. The themes of equity, population health, digital inclusion, and technology governance reflect broader NHS policy and are unlikely to change significantly.

Practices don't need to panic — the underlying legislation hasn't changed and the fundamental standards remain the same. But the framework does raise expectations around how practices evidence proactive, population-level, equitable care. Those already doing this work will find it easier to demonstrate. Those who aren't may want to start thinking about it before inspections under the new framework begin.

We'll be publishing a follow-up piece looking at how specific primary care tools and approaches map to the new framework requirements. If you'd like to stay updated, get in touch.