CQC fundamental standards and quality statements, explained for private GPs

CQC standards in brief

The CQC fundamental standards are the legal minimum every registered service in England must meet, set out in regulations 9 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The CQC judges how well you meet them through five key questions (safe, effective, caring, responsive and well-led) and, under its current single assessment framework, 34 quality statements that replaced the old key lines of enquiry (KLOEs).

So when people ask “what are the 5 CQC standards?”, they usually mean the five key questions. The standards themselves are the regulations. The key questions and quality statements are how the CQC assesses and rates you against them.

The CQC fundamental standards (regulations 9 to 20A)

The CQC describes the fundamental standards as “the standards below which your care must never fall”. When it registers a service, it checks the service is likely to meet them. They sit in Part 3, Section 2 of the 2014 Regulations. Regulation 8 requires every registered person to comply with regulations 9 to 20A when carrying on a regulated activity.

Regulation	What it requires	What it means for a private GP
9: Person-centred care	Care that meets the person’s needs and preferences	Assessment and plans agreed with the patient, recorded in the notes
9A: Visiting and accompanying	Visiting in care homes, hospitals and hospices	Rarely relevant to a consulting-room service
10: Dignity and respect	Privacy, equal treatment and support for independence	Private consulting space, chaperones, respectful communication
11: Need for consent	Consent before care or treatment	Recorded consent, including for children and patients who may lack capacity
12: Safe care and treatment	Risk assessment, competent staff, safe medicines, infection control	Prescribing controls, results handling, emergency medicines, infection prevention and control
13: Safeguarding	Protection from abuse and improper treatment	Safeguarding policy, a named lead, training and referral routes
14: Nutrition and hydration	Enough to eat and drink while receiving care	Rarely relevant to an outpatient GP service
15: Premises and equipment	Clean, suitable, secure and maintained premises and equipment	Cleaning schedules, equipment servicing and calibration, fridge checks
16: Complaints	A system to receive, investigate and act on complaints	A published procedure, a complaints log and the learning from each one
17: Good governance	Systems to check and improve quality and safety, manage risk, keep records and act on feedback	Audits, a risk register, governance reviews and accurate records
18: Staffing	Enough qualified staff, with training and supervision	Training matrix, appraisal and cover for absence
19: Fit and proper persons employed	Safe recruitment and pre-employment checks	Identity, DBS, GMC or NMC registration, references and indemnity on file
20: Duty of candour	Openness with patients when things go wrong	A duty of candour process and records of when you used it
20A: Display of ratings	Display your CQC rating	Rating shown at your premises and on your website once you have one

Good governance (regulation 17) ties the rest together. It requires systems that make sure you meet all the other requirements, and you must send the CQC a written report on how you do this within 28 days if it asks. Our guide to clinical governance in private practice covers what that looks like day to day.

The five key questions

The CQC asks the same five questions of every health and care service it rates. Is it:

• safe
• effective
• caring
• responsive to people’s needs
• well-led?

The key questions are not separate legal standards. Each quality statement under them links to the regulations the CQC considers when it makes a judgement.

From KLOEs to the single assessment framework

Until 2023 the CQC assessed services using key lines of enquiry (KLOEs), prompts and ratings characteristics, with separate frameworks for different sectors. It published its single assessment framework on 18 July 2022, and started using it in its South region from 21 November 2023, with a small number of early adopter assessments, before expanding to all providers on a risk-informed schedule. The CQC’s guidance now says the quality statements “have replaced our previous key lines of enquiry (KLOEs), prompts and ratings characteristics”, and that it is using the new approach across England.

The framework kept the five key questions and the four ratings (outstanding, good, requires improvement and inadequate). It added 34 quality statements, written as “we statements” from the provider’s point of view, and six evidence categories.

CQC quality statements, with example evidence for a private GP

The quality statements below are the CQC’s current titles. Private GP services come under the CQC’s “independent doctors” group, and its evidence guidance for that group lists every statement except environmental sustainability under well-led. The evidence examples are our suggestions for a small private GP service, not a CQC list.

Key question	Quality statements	Example evidence a private GP would keep
Safe	Learning culture; safe systems, pathways and transitions; safeguarding; involving people to manage risks; safe environments; safe and effective staffing; infection prevention and control; medicines optimisation	Significant event log with learning; results and referral tracking; safeguarding training certificates; chaperone records; emergency medicines and equipment checks; infection control audit; recruitment files; prescribing audit and high-risk drug monitoring
Effective	Assessing needs; delivering evidence-based care and treatment; how staff, teams and services work together; supporting people to live healthier lives; monitoring and improving outcomes; consent to care and treatment	Records audit; how you keep up with NICE guidance; a completed clinical audit cycle; letters to the patient’s NHS GP and what you record when a patient declines sharing; consent records
Caring	Kindness, compassion and dignity; treating people as individuals; independence, choice and control; responding to people’s immediate needs; workforce wellbeing and enablement	Patient feedback and what you changed; privacy arrangements; interpreter access; clear fee information before care starts; staff support and supervision records
Responsive	Person-centred care; care provision, integration and continuity; providing information; listening to and involving people; equity in access; equity in experiences and outcomes; planning for the future	Complaints procedure and log; appointment availability and out-of-hours advice; accessibility and reasonable adjustments; signposting when you cannot meet a need
Well-led	Shared direction and culture; capable, compassionate and inclusive leaders; freedom to speak up; workforce equality, diversity and inclusion; governance, management and sustainability; partnerships and communities; learning, improvement and innovation (plus environmental sustainability, not listed for independent doctors)	Statement of purpose; governance meeting notes or a solo governance log; risk register; policy review schedule; speaking-up route; duty of candour records; statutory notifications; business continuity plan

For a fuller list organised the same way, use our first CQC inspection evidence checklist, and see the private prescribing checklist for medicines optimisation.

The six evidence categories

The CQC groups the evidence it collects into six categories:

1. people’s experience of health and care services
2. feedback from staff and leaders
3. feedback from partners
4. observation
5. processes
6. outcomes

Not every category applies to every statement. For independent doctors, the CQC mostly looks at people’s experience, feedback from staff and leaders, and processes. Observation applies to statements such as safe environments, infection prevention and control, and kindness, compassion and dignity, but not for online primary care. For a solo GP, “processes” usually means your policies, logs, audits and clinical records, so that is where most of your preparation goes.

How ratings work for independent doctor services

Under the current guidance, inspectors score each quality statement they assess from 1 (significant shortfalls) to 4 (exceptional standard). The scores under a key question are turned into a percentage and then a rating: 25 to 38% is inadequate, 39 to 62% requires improvement, 63 to 87% good, and 88% or more outstanding. A score of 1 on any statement limits that key question to requires improvement, even if the percentage is in the good range.

Independent doctors and clinics get a rating for each key question and an aggregated overall rating. The overall rating is normally good if no key question is inadequate and no more than one requires improvement. For a service that has never been rated, the CQC assesses all the quality statements in a key question before it publishes that rating. Once rated, you must display it (regulation 20A).

Don’t expect the first assessment quickly. In May 2026 the CQC listed primary care services registered for a year or more without an assessment among its priorities. See will the CQC want to inspect me?

What is changing in 2026

After Dr Penny Dash’s review of the CQC’s operational effectiveness (full report published October 2024) and other independent reviews, the CQC is rebuilding its approach. This is what its own pages said when we checked on 2 October 2026:

• March 2026: responding to its Better regulation, better care consultation (which closed on 11 December 2025), the CQC said it would bring back sector-specific frameworks, including one for primary care and community services. It said it would replace quality statements with new supporting key lines of enquiry, re-introduce rating characteristics, remove scoring, and make rating judgements directly at key question level.
• June 2026: consultation on the four draft frameworks closed on 12 June. Pilots run from June to October 2026, with final evaluation in November 2026. Pilot judgements have no legal standing and do not affect ratings.
• August 2026: the CQC said it was still testing and piloting the draft frameworks, and planned more sector-specific engagement in the autumn.

In late 2025 the CQC said it planned to start implementing the new frameworks at the end of 2026. Until it does, its May 2026 update tells providers to keep using the current published guidance. The fundamental standards are regulations and are not part of this change, and the five key questions remain in the draft frameworks. Evidence organised by key question will carry over, whatever the final structure underneath.

Keeping your evidence organised

A spreadsheet index mapped to the key questions works for a solo GP. Practices with more staff often use a compliance platform such as QCS or GP TeamNet for policies and training records. A newer option is Practice Control Tower, a CQC readiness register aligned to the single assessment framework and organised by the five key questions. Each requirement has the questions an inspector is likely to ask, your answer, an owner and the evidence, and it flags evidence as stale after about 12 months. It is pre-launch, taking a waitlist, and covers the CQC in England only. Our free CQC inspection readiness scorecard shows where your gaps are.

Wales, Scotland and Northern Ireland

The fundamental standards, key questions and quality statements apply in England only.

• Wales: Healthcare Inspectorate Wales inspects independent clinics against the Independent Health Care (Wales) Regulations 2011, the Care Standards Act 2000 and the National Minimum Standards for Independent Health Care Services in Wales.
• Scotland: Healthcare Improvement Scotland regulates independent clinics, including private GP services. It evaluates them against the National Health Service (Scotland) Act 1978 and its regulations, their conditions of registration and its own Quality Assurance Framework, with a focus on whether services are person-centred, safe and well led.
• Northern Ireland: RQIA inspects against the Independent Health Care Regulations (Northern Ireland) 2005 and the Department of Health’s Minimum Care Standards for Healthcare Establishments (July 2014).

The evidence a well-run service keeps is much the same in every nation. Map it to your own regulator’s standards.