Taking a GP Practice to Outstanding
The Care Quality Commission (CQC) uses a four-point rating scale to assess GP practices and other health and care services.
CQC Rating Scale
1. Outstanding ⭐⭐⭐⭐
Definition: Exceptionally high quality care
Consistently exceeds expected standards
Innovative, proactive, and patient-centred
Strong culture of learning, improvement, and leadership
Often demonstrates best practice that others could follow
👉 Think: “Going above and beyond in multiple areas”
2. Good ⭐⭐⭐
Definition: Meets expected standards
Safe, effective, and well-run
Patients receive reliable, high-quality care
Systems and processes work as they should
👉 Think: “Doing what should be done, consistently well”
3. Requires Improvement ⭐⭐
Definition: Not consistently meeting standards
Some areas of concern or inconsistency
Potential risks to quality or patient experience
Improvements needed to reach “Good”
👉 Think: “Okay in parts, but gaps need addressing”
4. Inadequate ⭐
Definition: Fails to meet minimum standards
Significant concerns about safety, quality, or leadership
Potential risk to patients
Urgent improvements required
👉 Think: “Serious problems that must be fixed quickly”
How Ratings Are Applied
CQC gives ratings at multiple levels:
Per domain (Safe, Effective, Caring, Responsive, Well-led)
Overall practice rating (based on a combination of domains)
Key Points
Most GP practices are rated Good
To achieve Outstanding, evidence must show consistent excellence and innovation
Well-led often has a strong influence on the overall rating
Patient experience heavily impacts Caring and Responsive
Bottom line
The scale moves from unsafe and failing (Inadequate) to consistently exceptional (Outstanding), with Good as the expected standard.
Moving from Good → Outstanding with the Care Quality Commission isn’t about doing more of the same—it’s about demonstrating consistent excellence, innovation, and impact, especially in how patients are involved and services are improved.
Here’s what that looks like in practice, with a focus on PPGs and patient engagement.
1. The Key Shift: From “Working Well” to “Leading Practice”
Good = systems work, patients are satisfied
Outstanding = the practice is proactive, innovative, and demonstrably improving outcomes, often beyond its own patient list
👉 CQC is asking:
“Is this service just good—or is it exceptional and making a wider difference?”
2. What Outstanding Looks Like by Domain
A. Caring → From Respectful to Truly Person-Centred
Good:
Patients feel listened to and treated with respect
Outstanding:
Care is consistently personalised and compassionate, even for complex needs
Staff go above and beyond for vulnerable patients
Strong evidence of tailored approaches for different groups
PPG Role:
Patients help design how care is delivered (e.g. communication methods, accessibility)
B. Responsive → From Reactive to Proactive
Good:
Practice responds to feedback and improves access
Outstanding:
Anticipates patient needs before problems arise
Uses data + patient insight to redesign services
Demonstrates measurable improvements (e.g. reduced inequalities, better access)
PPG Role:
Co-designing access models (not just commenting on them)
Leading or supporting outreach to underserved groups
C. Well-led → From Engagement to Co-Production Leadership
Good:
Active PPG
Regular feedback mechanisms
Outstanding:
Embedded culture of co-production
Patients are partners in governance and decision-making
Clear evidence that patient input directly shapes strategy and services
PPG Role (critical here):
Involved in:
Service redesign projects
Practice priorities
Evaluating impact of changes
👉 This is often where practices differentiate themselves.
3. What CQC Specifically Looks for at “Outstanding”
A. Innovation
New approaches to access, communication, or care delivery
Creative engagement methods (beyond standard meetings)
Example:
Digital + community-based engagement led by PPG members
B. Impact (Not Just Activity)
Clear evidence that changes made a difference
Strong evidence:
“PPG helped redesign access → call wait times reduced by 40% → patient satisfaction increased”
Not enough:
“We meet regularly with our PPG”
C. Inclusion and Reducing Inequalities
Aligned with NHS England priorities:
Engaging underserved groups
Adapting services for:
Carers
Ethnic minorities
Digitally excluded patients
Outstanding practices:
Can show targeted improvements in access or outcomes
D. Continuous Learning Culture
Feedback is constantly gathered, reviewed, and acted on
Staff and patients are both involved in improvement
4. What Makes a PPG “Outstanding-Level”
A typical (Good) PPG:
Meets regularly
Discusses issues
Provides feedback
An Outstanding-level PPG:
Co-designs services
Represents diverse communities
Influences real decisions
Helps deliver improvements (not just suggest them)
Works beyond the practice (e.g. with PCN or community groups)
5. Practical Examples That Impress CQC
PPG co-designs a new appointment system that improves access for working patients
Targeted engagement leads to increased uptake of screening in a deprived group
PPG helps redesign communication for non-English speakers
Practice demonstrates a clear “feedback → action → measurable outcome” cycle
Collaboration with local partners to address wider determinants of health
6. Common Gap: Why Practices Stay at “Good”
Engagement is passive, not collaborative
PPG exists but has limited influence
Changes are made, but impact isn’t measured or evidenced
Little focus on inequalities or underserved groups
7. Simple Formula for Outstanding
To move to Outstanding, practices need to show:
Patient Voice + Co-Production + Measurable Impact + Innovation + Inclusion
Bottom Line
From a Care Quality Commission perspective:
Good = patients are listened to
Outstanding = patients shape the service and improve outcomes
PPGs are one of the strongest ways to demonstrate this—if they are used as true partners, not just a forum.
Kevin Minier
Email: onestopcarers@gmail.com
22nd April 2026