How we determine your aggregated ratings: primary medical services

Using professional judgement

To ensure that we make consistent decisions, we follow a set of ratings principles and apply professional judgement when rating at key question level. Our ratings must be proportionate to all available evidence and the specific facts and circumstances.

Before we start an inspection we will identify whether a service is delivered by a provider that we would usually rate at provider level, for example an NHS trust. If it is, the ratings approach for NHS trusts would apply at the provider level, in addition to service level rating.

If we identified concerns in the inspection we’ll consider the following criteria and use our professional judgement to decide whether to depart from applying the ratings principles – particularly where we need to aggregate ratings that range from inadequate through to outstanding:

• The extent and impact of the concerns on people who use services and the risk to quality and safety, taking into account the type of setting. If concerns have a very limited impact on people, it may reduce the impact on the aggregation of ratings.
• Our confidence in the service to address the concerns, or where action has already been taken.

We can’t predict what future models of care and configurations of services will look like. To enable us to be flexible and respond to change, we will base our approach to aggregation for future models of care on these principles. 

Where a rating decision is not consistent with the principles, we will record the rationale clearly in the inspection report and the decision will be reviewed using internal quality control and consistency processes.

Updating ratings

Any previous ratings for population groups will be removed after inspections completed after October 2021.

After we have published an inspection report, you must display your updated ratings in relevant locations and on your website. This is to meet Regulation 20A.

Where there is a change of ownership or address at an existing location, our website and internal systems will continue to display the provider’s ‘regulatory history’ (rating and inspection report under a previous provider).