The Care Quality Commission is to pilot assessing whole health systems as part of a move towards a more place based approach to regulation.

  • CQC will pilot inspecting whole systems in Northern Lincolnshire and Greater Manchester
  • Chief inspector of general practice Steve Field says the regulator will still look at individual providers
  • CQC will not carry out extra inspections as part of the pilot

North Lincolnshire and parts of Greater Manchester will be the pilot areas, in what the CQC’s chief inspector of general practice called “the most important thing [the CQC is] doing at the moment”.

However, Steve Field insisted the regulator would not stop inspecting individual provider organisations.

In an exclusive interview with HSJ, he said: “The future has to be looking at place, but there is always going to be a role for looking at the provider within the place.”

Professor Field said the two regions were selected for the pilot because the CQC had already inspected their individual provider organisations.

“We’re not going to increase the burden on hospitals or GPs,” he said. “We’re using the inspections we’ve already done and we’re adding a data review of that.”

Steve Field

Inspecting whole health systems would ‘not increase the burden on hospitals or GPs’, Steve Field said

However, the regulator would use its powers to look at commissioning within one of the areas - north Lincolnshire - if it is signed off by ministers. Ministers are currently considering a request for the CQC to use those powers, outlined under section 48 of the Health Act 2012, to request information from local authorities and clinical commissioning groups.

There has been a push politically towards inspecting commissioners. Health secretary Jeremy Hunt has proposed ranking CCGs’ performance, using quality and performance indicators to create a “points” score for a group’s overall performance. Asked by HSJ whether the CQC should have the power to inspect commissioners, Professor Field said the organisation “needs to see what’s happening now that [NHS England has] devolved responsibility for commissioning primary care to [some] CCGs”.

He added that “there have been discussions about local authorities [and] whether they should be regulated and looked at by [the CQC]”, but “we don’t officially have a view on local authorities or CCG commissioning and our role in that”.

Within Greater Manchester, the CQC will focus on Salford and Tameside. Professor Field said the CQC “wanted to look at Salford specifically” because it has one of only two acute trusts in England to have been rated “outstanding” by the regulator, as well as the first two GP practices to be rated “outstanding”.

He added: “Within its catchment area there are also practices that aren’t as good, but we wanted to see what was happening there. Tameside has a different sort of hospitals, it’s had different challenges.”

Tameside Hospital Foundation Trust was one of the 14 trusts investigated by NHS England’s medical director Sir Bruce Keogh in 2013 because of high mortality rates. It is one of 13 hospital trusts currently in special measures.

He said north Lincolnshire was “interesting because there’s no big city there” so there was a question about how GP practices link up with district general hospitals and social care.

The CQC will produce a report on the outcomes of the pilot, but it will not assign a rating to the health systems, Professor Field said.

He said the work was “the most important thing [the CQC is] doing at the moment because it’s taking CQC into a new place… it’s joining up social care as well as hospitals, as well as GPs, as well as mental health”.

“It is really important that health and social care services are encouraged to deliver new services in new ways. That means CQC needs to facilitate these new ways of working,” he added.

“In the future we’ll be looking at those joined up organisations.”  

CQC to assess whole health systems