Intended for healthcare professionals


Do we need the inspector to call?

BMJ 2018; 363 doi: (Published 30 October 2018) Cite this as: BMJ 2018;363:k4491
  1. Helen Crisp, independent consultant
  1. Crisp QI, London, UK
  1. helen.crisp{at}

Inspection visits need to be intelligent, responsive, and proportionate

Inspection and regulation by the Care Quality Commission (CQC) has limited effect on the performance of NHS England providers, research by the King’s Fund and University of Manchester has concluded.1 Few studies have demonstrated whether inspections improve quality of care. A systematic review on the subject identified only two papers that met the inclusion criteria: a study of South African hospital accreditation and an evaluation of inspections related to hospital acquired infections by the CQC’s predecessor, the Healthcare Commission.2 Neither showed a relation between the inspection process and any increase in quality.


Inspection also costs, in terms of both regulatory infrastructure and the time and resources spent by providers to prepare for inspections, which is reported as a perceived distraction from patient care.1 General practitioners have repeatedly commented on the disproportionate cost of preparing for CQC inspections since these were introduced for general practices in 2013,3 and the 2018 annual conference of the Royal College of GPs supported a motion that: …

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