An outstanding CQC rating means a GP practice has been assessed as performing exceptionally well, and it is deliberately difficult to achieve: only 8% of GP practices in England held an outstanding rating as at 1 August 2025, according to CQC’s State of Care report published in October 2025. The rating requires at least two of the five key questions to be rated outstanding and three to be rated good, with strict rules preventing a single weak area from being masked by strong performance elsewhere.
We work with GP partnerships on governance and CQC-related matters, and we are often asked what genuinely separates a good rating from an outstanding one. This post sets out how the rating is actually calculated and what CQC’s own published inspection findings show outstanding practices doing differently.
Why Outstanding Is Hard to Achieve by Accident
Under CQC’s single assessment framework, each of the five key questions (safe, effective, caring, responsive and well-led) is scored from a set of quality statements, themselves built up from scored evidence categories. A key question reaches the outstanding threshold at 88% or above. But CQC’s scoring rules include a specific safeguard: if a key question’s overall percentage sits in the outstanding range, the rating is still capped at good if even one relevant quality statement scored only 1 or 2 out of 4. In other words, a practice cannot average its way to outstanding while carrying a genuine weak spot; every area assessed within that key question has to hold up.
At the overall practice level, an outstanding rating additionally requires at least two of the five key questions to be individually rated outstanding, with the remaining three rated at least good. We explain the full scoring mechanics, including how evidence categories and quality statements combine, in our companion post on the CQC single assessment framework for GP practices.
What Outstanding Practices Actually Do, According to CQC’s Own Findings
CQC’s State of Care 2024/25 report, published in October 2025, includes real, anonymised examples drawn from its own inspection reports that illustrate what an outstanding rating for a specific key question looks like in practice. These are worth reading closely because they show the standard is about substance, not paperwork.
One practice rated good overall and outstanding for caring was found to be, in CQC’s words, “exceptional at responding to people’s immediate needs”, with patients describing rapid responses to both online triage requests and telephone contact, and the large majority of patients seen on the same day they made contact.
A second example, also rated good overall with an outstanding caring assessment, showed staff actively using population health registers to identify people with learning disabilities, long-term conditions, palliative care needs, and caring responsibilities, then tailoring services accordingly, including small group sessions to support people with a learning disability through breast screening, and outreach to the LGBTQ+ community, asylum seekers, travellers and carers. The same practice had set up and run its own heart failure clinic, assessing 602 patients during 2023/24 and reducing pressure on secondary care as a result.
Leadership and Culture as the Common Thread
Across CQC’s inspection findings, leadership, management and governance are consistently identified as the factor most closely associated with a good or outstanding rating. In CQC’s published case examples of well-led general practice, a recurring feature is a “no blame” culture in which staff understand their own role in supporting and promoting change, rather than a culture where problems are hidden for fear of individual blame. Practical markers CQC has highlighted include structured recognition of staff contribution, genuine integration with wider community and specialist services, and evidence that feedback from staff and patients actually changes how the practice operates, rather than being collected and filed.
Access and Responsiveness Matter, But Context Matters Too
CQC’s current findings are candid that access remains a significant pressure point across general practice nationally, with only around half of patients nationally describing telephone contact with their GP practice as easy, and marked variation by deprivation, ethnicity and disability. Practices that have improved their responsiveness rating tend to show measurable change, such as materially reduced call wait times following a specific intervention, alongside genuine attention to digital exclusion, since CQC has flagged that online booking systems introduced without care can create new barriers for autistic patients, older patients, and people with certain long-term conditions. An outstanding responsive rating is not simply about offering more channels to contact the practice; it is about evidencing that those channels actually work for the practice’s specific population.
What Separates Good from Outstanding: A Practical Summary
| Key question | What “good” typically shows | What CQC’s outstanding examples show |
|---|---|---|
| Caring | Patients treated with courtesy and involved in decisions about their care | Measurable, fast response to patient contact, and proactive use of population registers to identify and support specific groups (learning disability, palliative care, carers, LGBTQ+ patients) |
| Responsive | Reasonable access arrangements broadly in place | Evidenced improvement in access (for example, verified reductions in call wait times), with explicit attention to digital exclusion for vulnerable groups |
| Effective | Care generally follows current guidance | In-house services (such as a dedicated long-term condition clinic) that demonstrably improve outcomes and reduce reliance on secondary care |
| Well-led | Clear governance structures exist on paper | A genuine “no blame” culture, staff recognition embedded in practice, and evidence that feedback changes how the practice actually operates |
| Safe | Systems in place to manage risk and safeguarding | Systems actively tested, audited and demonstrably acted upon, not just documented |
What This Means for Your Practice
An outstanding rating is achievable, but CQC’s own scoring rules mean it cannot be reached by strong performance in some areas covering for a genuine gap in another. The practices CQC highlights as outstanding tend to share a pattern: they can evidence outcomes, not just policies, and their leadership culture supports staff in raising and fixing problems rather than concealing them. For the underlying registration and structural points every practice needs to have right before working towards a rating like this, see our pillar post on CQC registration and compliance for GP practices.
If your practice would like an independent governance review ahead of an assessment, or support responding to a rating you believe doesn’t reflect the evidence, get in touch with our healthcare team or call us on +44 207 566 1188. You can also reach us at info@gurvelegal.com. Our regulatory compliance team regularly supports GP practices preparing for and responding to CQC assessments.
