In March 2026, the Care Quality Commission (CQC) published draft, sector specific assessment frameworks as part of its Better regulation, better care reforms. One of the most significant for the health and care system is the draft framework for primary care and community services, which is intended to replace elements of the Single Assessment Framework introduced in 2024.
The return to sector specific regulation has been broadly welcomed. The CQC has said that separate frameworks are designed to provide greater clarity, consistency and relevance, while retaining the familiar five key questions – safe, effective, caring, responsive and well led – and removing numerical scoring in favour of key lines of enquiry and detailed rating characteristics.
However, for general practice, the detail of the draft framework raises important practical and policy questions.
A return to sector specific regulation
Under the draft primary care and community services framework, the CQC proposes to:
- Reintroduce key lines of enquiry, framed as structured questions.
- Set out clear descriptions of what outstanding, good, requires improvement and inadequate care look like.
- Make judgements directly at key question level rather than through aggregated scores.
The stated aim is to make assessments more proportionate and intelligible, and to better reflect how services operate in practice.
Early concerns from primary care
Commenting on the draft framework in Pulse, Professor Azeem Majeed, professor of primary care and public health at Imperial College London, welcomed the move back to a sector specific approach but warned that some expectations appear to go beyond what many GPs would consider their “core role”.
His concerns are closely linked to three areas where the draft framework sets particularly high expectations: care transitions, population health, and innovative technology and artificial intelligence.
Care transitions and shared responsibility
Care transitions feature prominently in the draft framework, particularly under the safe systems, pathways and transitions key line of enquiry. To achieve an outstanding rating, the framework states that care plans for transitions, referrals and discharge should be co produced with people and those close to them, kept under continuous review, and include appropriate support for carers.
While continuity of care is a core strength of general practice, the framework risks blurring lines of accountability where transitions depend heavily on capacity, processes and decision making elsewhere in the health and care system. This is one of the areas where Professor Majeed cautioned that regulatory expectations may not fully reflect the realities facing GP practices.
Population health and tackling inequalities
The draft framework also embeds a strong population health focus across several key questions. Higher ratings are linked to the use of population level data to identify and address health inequalities, and to sharing learning beyond individual practices and neighbourhoods.
This aligns with wider NHS policy direction, including neighbourhood health and integrated care. However, it also raises questions about the extent to which individual GP practices can be held accountable for population level outcomes without corresponding powers, resources or system wide data access.
Innovative technology, AI and access to care
Perhaps most strikingly, the draft framework explicitly links the use of innovative technology, including artificial intelligence and online services, with the highest regulatory ratings.
Under timely and equitable access, outstanding care is described as including where: “innovative technology, including artificial intelligence and online services, is used to ensure people have timely access to care, treatment and support.”
This represents a significant shift. While digital tools already play a growing role in primary care, tying outstanding ratings to the use of AI raises important questions about digital exclusion, clinical governance and proportionality, particularly for practices serving older or more deprived populations.
Why engagement matters now
The draft primary care and community services framework is open for consultation until 12 June 2026, and the CQC has invited feedback on whether the proposals are practical, proportionate and focused on improving outcomes for people who use services.
For GP practices, primary care networks and community providers, this consultation is a critical opportunity to:
- Highlight where expectations rely on system level support rather than individual practice control.
- Comment on the balance between innovation and equity.
- Shape how population health and care transitions are reflected in future inspections.
Read the draft assessment frameworks and consultation and respond to it here.
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