Ratings principles: primary medical services

Our inspection teams use a set of principles when rating services, locations and providers to ensure that we make consistent decisions.

The principles will normally apply but will be balanced by inspection teams using their professional judgement. Our ratings must be proportionate to all the available evidence and the specific facts and circumstances.

Reflecting enforcement action in our ratings

Where we are taking enforcement action we will reflect this in the ratings at the key question level.

1. Where we have identified a breach of a regulation and we issue a Requirement Notice, the rating linked to the key question relevant to the breach will normally be limited to ‘requires improvement’ at best.
2. Where we have identified a breach of a regulation and we take action under our enforcement powers, such as issuing a Warning Notice or imposing a condition of registration, the rating linked to the key question relevant to the breach will normally be ‘inadequate’.

Overarching aggregation principles

The following principles apply when we are aggregating ratings.

3. The five key questions are all equally important and should be weighted equally when aggregating.
4. All ratings will be treated equally when aggregating unless one of the other principles below applies.

Note: We can adjust the following principles for combinations where it is not appropriate to treat ratings equally.

Aggregating ratings

There are too many combinations of ratings and the resulting aggregation to show here. We use the following principles as the basis of the aggregation and use our professional judgement to apply them to the specific combination of underlying ratings.

We will apply the principles shown in the table when aggregating the five key questions to an overall service level.

When using these principles, there will be five underlying ratings in most cases (for the key questions). However, in some circumstances we may not rate for one or more of these. In these instances, the number of underlying ratings may be fewer.

5. The aggregated rating will normally be ‘outstanding’ where at least X number of the underlying ratings are ‘outstanding’ and the other underlying ratings are ‘good’.

6. The aggregated rating will normally be limited to ‘requires improvement’ where at least X number of the underlying ratings are ‘requires improvement’

7. The aggregated rating will normally be limited to ‘requires improvement’ at best where X number of the underlying ratings are ‘inadequate’
8. The aggregated rating will normally be limited to ‘inadequate’ where at least Y number of the underlying ratings are ‘inadequate’.