Managing partner Adrian Down says it’s time for the CQC to shelve meaningless one-word ratings and report on practice performance in a more detailed and supportive way

Following the tragic death of headteacher Ruth Perry, who took her own life following an Ofsted inspection at her school, the debate around single-word assessments has gained momentum.  

Ofsted, the schools’ regulator, recently announced a move away from ‘reductive’ one-word ratings (such as ‘good’ or ‘inadequate’) acknowledging the mental and emotional toll this can take on school leaders.

This decision has reignited discussions in other sectors, including ours, where the CQC assessments for GP practices operate in a similar manner.

As a GP practice manager, with 20 years of experience and several as a partner, I love what I do and take pride in the quality of care we provide our patients.

But I would be lying if I said the pressures of CQC assessments – particularly the single-word ratings – hasn’t weighed heavily on me and other colleagues with the same role.

This assessment style, despite being widely adopted, has no strong evidence of genuinely improving care standards. Instead, it leaves healthcare professionals feeling demoralised, undervalued, and subjected to a system that fails to appreciate the complexities of patient care.

The problem with single-word ratings

The CQC uses a system of ratings to evaluate the quality of care provided by practices, hospitals, and care homes. These ratings are broken down into four categories: outstanding, good, requires improvement, and inadequate.

While single-word ratings might aim to simplify information for patients, they can be misleading and unfair for the healthcare professionals on the receiving end.

Much like Ofsted’s one-word judgments in education, a single-word rating by the CQC does little to reflect the nuances, challenges, and real efforts that go into running a GP practice.

Imagine this: a practice that serves a large population, some with complex social and health needs, might be rated as ‘requires improvement. What that rating doesn’t tell you is that this practice is almost certainly underfunded, understaffed, and struggling with administrative burdens, all factors that contribute to the challenges they face but may have little to do with the quality of care being provided.

In these situations, a single-word assessment doesn’t just fail to convey the bigger picture; it can actively harm a practice’s reputation and morale.

The psychological toll

The tragedy of Ruth Perry, whose school was being downgraded to inadequate, sheds light on the immense pressure single-word assessments can place on individuals in leadership positions. The parallels between education and healthcare are striking.

Practice managers will be acutely aware of how stressful a CQC inspection can be. The preparation that goes into ensuring compliance with standards is immense, and the stakes are incredibly high. One negative word – just one – can overshadow years of dedication and hard work.

While practices can appeal the findings, the initial impact of a lower rating can be devastating, particularly for those already struggling to cope with the demands of the healthcare system.

There is also a risk that these ratings encourage a box-ticking culture. Practices may prioritise compliance over patient-centred care, not because they believe it will improve outcomes, but because they are fearful of receiving a negative rating. This can lead to a loss of focus on what truly matters, which is delivering quality care to patients.

No evidence of improving standards

One of the most frustrating aspects of the CQC’s current assessment system is that there is little evidence to suggest it improves care standards in a meaningful way. Ratings often fail to accurately reflect the quality of care delivered by GP practices. In many cases, as far as I can see, practices rated as ‘good’ or ‘outstanding’ have no demonstrable improvements in clinical outcomes for patients compared with those rated as ‘requires improvement’.

So, if these ratings aren’t driving improvements, why are we continuing to rely on them?

A more nuanced approach

The CQC, like Ofsted, should rethink its use of single-word assessments. Instead of boiling down the complexities of healthcare provision into one word, there should be a more comprehensive and supportive approach.

Inspections should focus on understanding the individual circumstances of each practice, the challenges they face, and the steps they are taking to overcome them. Commissioners should change their mindset so ‘requires improvement becomes ‘requires support’.

A more detailed narrative report, rather than a single rating, would provide both healthcare professionals and the public with a clearer understanding of a practice’s strengths and areas for development. Furthermore, the CQC should offer constructive support to practices that are struggling – whether that means unlocking additional resources, training, or guidance.

One-word assessments are condescending for patients. They assume that our own healthcare is so unimportant to most of us that we would not read a more complex document to learn about the right provider of care to us and our families. 

I believe the CQC should follow in Ofsted’s footsteps and abandon these reductive assessments in favour of a system that truly supports and uplifts healthcare professionals while ensuring the best outcomes for patients.

As someone who has spent two decades managing a GP practice, I can say with certainty that the CQC’s one-word assessments do little to improve care standards.

It’s an issue that has now been taken up by the Institute of General Practice Management, which has outlined its concerns to health secretary Wes Streeting and is now awaiting a response.

It’s time for change.

Adrian Down is managing partner at Caythorpe & Ancaster Medical Practice, Lincolnshire and a regional representative at the IGPM. The views expressed here are Adrian’s own and do not necessarily reflect those of his practice partners