CQC Scraps Scoring: What the 4 New Sector-Specific Inspection Frameworks Mean for Care Homes, Dental Practices and GP Surgeries

The Care Quality Commission has published four new sector-specific inspection frameworks and abolished the numerical scoring system used across all provider types. If you run a care home, GP surgery, dental practice or mental health service, your existing compliance preparation is now out of date. The consultation window closes 12 June 2026 — 74 days to respond. Pilots begin summer 2026, with full rollout in H2 2026 and into 2027.

This guide breaks down exactly what's changed, why your previous Good rating doesn't guarantee Good under the new criteria, and what you should be doing before inspectors arrive.

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What's Changed: The Four New Frameworks

Until this week, all CQC-registered providers were assessed against a single overarching framework using numerical scoring (e.g. 4/7 for Safe, 6/9 for Responsive). That system is gone.

CQC has replaced it with four separate frameworks, each tailored to the specific regulated activity:

Framework	Who It Covers
Adult Social Care	Care homes (residential and nursing), domiciliary care, supported living
Primary Care	GP surgeries, dental practices, opticians, community pharmacies
Mental Health	In-patient and community mental health services
Hospitals	NHS and independent acute hospitals

Each framework has its own Key Lines of Enquiry (KLOEs), structured inspection questions, and — critically — its own definition of what Good and Outstanding look like.

The old system rated you numerically across all provider types. The new system asks very specific, sector-shaped questions about your specific service.

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Why Numerical Scoring Has Been Abolished

Under the old framework, a care home could receive a score of 4 out of 7 for Safe and argue that this represented strong performance in some areas offsetting weakness in others. Numerical aggregation allowed providers to 'average out' risks.

The new system uses rating characteristics instead of scores. Each KLOÉ outcome is described qualitatively — what Good looks like, what Requires Improvement looks like — in language specific to that sector.

What this means in practice:

• You cannot offset a weakness in one area with strength in another
• Inspectors apply sector-specific evidence standards, not generic ones
• The bar for Outstanding in a care home is explicitly different from Outstanding in a dental practice

CQC's published rationale: "Numerical scoring did not adequately communicate the complexity of inspection findings to the public or reflect the real-world risks in individual service types."

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The Burrow Down Paignton Case: How Good Becomes Inadequate

On 27 March 2026, CQC published its latest inspection report for Burrow Down, a 13-resident care home in Paignton, Devon.

The home had previously been rated Good. It fell to Inadequate.

The failings recorded included:

• A diabetic resident experiencing 29 unsafe blood glucose readings with no clinical escalation
• Systematic failures in medication management documentation
• Leadership failures at registered manager level

The leadership failure aspect carries criminal liability risk. Under the Care Act 2014, a registered manager can face personal prosecution for systemic failures — not just the registered provider.

This case is being used by CQC as an illustration of exactly the kind of failure the new frameworks are designed to capture. Under the old numerical system, headline scores could mask individual clinical risks. Under the new characteristic-based system, a single unmitigated clinical risk can determine the overall rating.

If your home received Good in 2024, that rating was awarded under a different standard. You do not know what Good looks like for you under the new framework until you read the adult social care Key Lines of Enquiry.

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What's Actually in the New Frameworks

Adult Social Care KLOEs

The adult social care framework focuses heavily on personalisation and clinical oversight:

• Evidence of person-centred care planning reviewed at regular intervals
• Escalation protocols for clinical deterioration — with documented timescales
• Staff competency assessments, not just training records
• Leadership: registered manager visibility in quality oversight, not just operational management

Key shift: The old Safe domain included prompts about medicine management. The new KLOÉ asks specifically about clinical monitoring systems — whether the home can demonstrate that abnormal results trigger a documented escalation pathway within a defined timeframe. Burrow Down's 29 unescalated blood glucose readings would fail this directly.

Primary Care KLOEs

For GP surgeries and dental practices:

• Patient access and waiting time evidence (referral patterns, appointment availability data)
• Clinical governance: documented case review, significant event analysis, learning logs
• Infection prevention: not just a policy but observational evidence during inspection
• Patient feedback: Friends & Family Test and formal complaint data are now explicitly evidential

Key shift: Under the old framework, a dental practice could present a full set of policies and receive credit. The new primary care KLOEs require evidence that the policies are applied in practice — inspection includes clinical observation, staff interview, and patient record sampling.

Mental Health KLOEs

For in-patient and community mental health services:

• Physical health monitoring for patients on long-term psychiatric medication
• Safe patient observation frameworks with documented staff-to-patient ratios
• Crisis pathway clarity — can staff demonstrate exactly what happens when a patient deteriorates?

Hospital KLOEs

Hospitals face the most significant change: surgical outcome data and mortality review are now explicitly weighted KLOÉs, not contextual evidence.

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The Consultation Closes 12 June 2026

CQC has opened a formal consultation on the new frameworks. The deadline is 12 June 2026.

This matters for two reasons:

1. You can respond. If the specific KLOÉs for your sector don't reflect the realities of your service type, this is your window to say so formally. CQC has changed frameworks in response to consultation before (the rollout of the Single Assessment Framework was delayed and modified after provider feedback in 2023-24).

2. Reading the consultation documents tells you exactly what you'll be inspected against. CQC publishes the draft KLOÉs as part of the consultation. If you haven't downloaded them yet, do it today. This is your preparation guide.

The consultation documents are available on cqc.org.uk.

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Why Existing Prep Guides and Toolkits Are Now Obsolete

If your compliance team, registered manager or quality lead is working from any toolkit, self-assessment guide, or preparation checklist that was written before March 2026, it is based on the old framework.

Specifically:

• Any guide using numerical scoring (e.g. "score yourself 1-5 against these prompts")
• Any self-assessment based on the old five key questions without sector-specific KLOÉs
• Any policy package that doesn't include the new escalation pathway requirements for your sector

The rollout timeline:

• Pilots: Summer 2026 — CQC will test the new frameworks with selected providers
• Full rollout: H2 2026 / early 2027 — all inspection activity moves to new frameworks

If you are in the pilot cohort (CQC will contact you), inspection under the new framework could begin as early as July 2026.

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What You Should Do Before June 12

1. Download the Relevant Framework Document

Go to cqc.org.uk, navigate to the consultation section, and download the framework for your service type. Read the KLOÉs specific to your sector. Highlight anything your current policies or practices don't cover.

2. Map Your Evidence Against the New KLOÉs

The new frameworks describe what Good looks like in concrete terms. Audit your current evidence against each KLOÉ:

• Do you have a documented escalation protocol with defined timeframes?
• Can you evidence clinical monitoring systematically (not just individual entries)?
• Is your patient/resident feedback data captured, analysed and acted on?

3. Update Your Registered Manager's Risk Awareness

The Burrow Down case is a direct illustration of criminal liability at registered manager level. Every registered manager needs to understand that under the new characteristic-based system, individual clinical failures cannot be masked by aggregate performance.

4. Respond to the Consultation

Even a brief response (two or three paragraphs) identifying any KLOÉs that are impractical or unclear for your service type contributes to improving the final framework. This is particularly relevant for smaller providers who operate across multiple registered categories.

5. Brief Your Staff

The new KLOÉs place greater weight on staff interviews as evidence. Inspectors will ask staff directly about escalation pathways, quality oversight processes, and leadership. Your staff need to know what Good looks like in your sector — not just what they're supposed to do, but why, and how it connects to CQC's framework.

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Key Dates Summary

Date	Event
March 2026	CQC publishes four sector-specific frameworks
12 June 2026	Consultation response deadline
Summer 2026	Framework pilots begin
H2 2026 / early 2027	Full rollout — all inspections under new frameworks

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TL;DR — Key Takeaways

• CQC has published four separate frameworks for adult social care, primary care, mental health and hospitals
• Numerical scoring is abolished — replaced by rating characteristics describing what Good/Outstanding looks like in your specific sector
• A Good rating under the old framework does not mean Good under the new one
• The consultation closes 12 June 2026 — download the relevant KLOÉ document now
• Burrow Down (Good → Inadequate, 27 March) illustrates how quickly a previously compliant home can fall under heightened clinical scrutiny
• Pilots start summer 2026; full rollout H2 2026 / early 2027

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Stay Ahead of CQC Framework Changes

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