What Workforce Wellbeing Evidence Might Be Useful for CQC Well-led?

Workforce wellbeing evidence can support a GP practice's CQC Well-led assessment by showing how leaders understand staff experience, identify workforce concerns and use that information to make decisions. Useful evidence may include staff feedback, records of management discussions, speaking-up arrangements, workforce risk assessments and examples of improvements made following employee concerns.

CQC considers feedback from staff and leaders, alongside organisational processes, when assessing several Well-led quality statements for primary health services.

However, collecting a staff survey or maintaining a wellbeing policy does not automatically demonstrate effective leadership. The evidence needs to reflect how the practice actually operates.

For Practice Managers, the most useful approach is to connect workforce information with decisions, responsibilities and subsequent review.

This can help demonstrate that employee wellbeing is considered through routine governance rather than treated as a separate exercise undertaken when an assessment is expected.

• Which CQC Well-led quality statements relate to workforce wellbeing?

  Workforce wellbeing is relevant to several Well-led quality statements, particularly those concerning organisational culture, leadership, freedom to speak up and governance.

  Importantly, Workforce wellbeing and enablement is itself a quality statement under the Caring key question, not Well-led. Nevertheless, the way a practice manages workforce concerns may provide information relevant to both areas.

  CQC's evidence categories for primary health services identify staff and leader feedback, together with organisational processes, as relevant to the following Well-led statements:

  Shared direction and culture

  This concerns the organisation's approach to its purpose, values, engagement and inclusive working culture.

  For GP practices, relevant workforce information may help explain whether employees understand organisational priorities and feel included in decisions affecting their responsibilities.

  Capable, compassionate and inclusive leaders

  This concerns leadership capability, integrity, openness and understanding of the environment in which services are delivered.

  Evidence might show how practice leaders recognise workforce pressures and respond to concerns raised by employees.

  Freedom to speak up

  This concerns whether employees feel able to raise concerns and believe they will be heard.

  Written reporting procedures may be relevant, but so is evidence of how those arrangements operate.

  Workforce equality, diversity and inclusion

  This considers how providers work towards a fair and inclusive culture.

  Relevant information may include arrangements for addressing discrimination, promoting fair opportunities and understanding differences in staff experience.

  Governance, management and sustainability

  This concerns accountability, effective management systems and the use of information about organisational risks and performance.

  Workforce pressures affecting service delivery may need to be considered through these arrangements.

  Learning, improvement and innovation

  This concerns how organisations learn and improve.

  Examples of operational changes made following staff feedback may contribute useful evidence.

  These statements are not separate instructions to create a different wellbeing document for each area. Much of the relevant information should arise naturally through existing management activities.

• What staff feedback could provide useful evidence?

  Staff feedback can help demonstrate whether practice leaders have a reliable understanding of employees' working experiences.

  CQC's evidence category covering feedback from staff and leaders includes staff surveys, employee discussions, interviews, information provided by leaders and speaking-up concerns.

  For GP practices, useful information could come from annual surveys, shorter targeted questionnaires, team meetings or individual discussions.

  The method matters less than whether it provides credible insight.

  For example, a workforce survey might identify concerns about communication between reception and clinical colleagues.

  A Practice Manager could examine whether the issue reflects unclear procedures, inconsistent instructions or difficulties introduced by a recent operational change.

  The survey findings would demonstrate that employees had provided information about their experience.

  Records of the subsequent review could help show how management considered that information.

  However, staff feedback needs interpreting.

  A high overall wellbeing score does not necessarily mean that employees have no concerns. Similarly, a lower score may reflect a temporary period of organisational change rather than a longstanding management problem.

  Practice Managers should consider:

  • Whether findings are consistent with previous feedback.

  • Whether particular concerns recur over time.

  • Whether employee participation has changed.

  • What operational circumstances may explain the responses.

  • Whether employees have appropriate opportunities to clarify concerns.

  • How management has used the information.

  CQC may also obtain feedback directly from staff. Written reports should therefore describe actual working arrangements rather than present an idealised account.

  A practice's evidence is more credible when the management records and employees' experiences tell a consistent story.

• How can practices evidence that staff are able to speak up?

  Useful evidence of speaking-up arrangements should demonstrate that employees know how to raise concerns and that management responds appropriately.

  A policy can explain the available routes, but it cannot establish on its own that employees feel confident using them.

  This is particularly relevant in general practice, where staff may be reluctant to raise concerns involving a senior colleague or GP partner.

  Practice Managers should consider whether employees have an alternative route when approaching their immediate manager is inappropriate.

  Potential supporting evidence includes:

  • Information provided to employees about raising concerns.

  • Clear escalation arrangements for sensitive matters.

  • Relevant staff feedback about confidence in speaking up.

  • Appropriate records showing how concerns have been considered.

  • Management reviews of recurring themes.

  • Examples of improvements following concerns about working arrangements or safety.

  Confidentiality is essential.

  Practices should not disclose identifiable speaking-up reports or individual employment matters merely to demonstrate that concerns have been received.

  A suitably anonymised or summarised account of the issue and management response may be more appropriate, provided individuals cannot be identified indirectly.

  Speaking-up arrangements also need to distinguish between different types of concern.

  A routine disagreement about task allocation may be resolved through ordinary management discussion. A potential patient safety incident or serious allegation may require formal escalation.

  For Well-led, the important question is whether employees have effective routes for raising relevant matters and whether leaders respond appropriately.

• What workforce governance records might be useful?

  Workforce governance evidence can help demonstrate that staffing pressures, employee concerns and organisational risks are considered through appropriate management arrangements.

  The records do not need to be extensive, but they should establish how relevant information reaches decision-makers.

  For example, a practice experiencing persistent administrative vacancies may need to review how remaining responsibilities are managed.

  A workforce review could identify the impact on available capacity, consider the potential consequences for essential tasks and record the decisions made by practice leaders.

  That evidence may be more informative than a general statement that the practice regularly monitors staffing.

  Workforce feedback summaries - How leaders understand employee experience and recurring concerns

  Practice or partner meeting records - Whether significant workforce matters are considered by appropriate decision-makers

  Staffing and capacity reviews - How changes in workforce availability are considered alongside service requirements

  Work-related stress risk assessments - How relevant workplace risks are identified and managed

  Supervision and training records - How employees receive appropriate support for their responsibilities

  Workforce improvement plans - What action has been agreed and who is responsible

  Follow-up reviews - Whether management establishes if improvements have been effective

  These are examples of potentially useful information, not a prescribed CQC document checklist.

  Regulation 17, Good governance, requires providers to operate effective systems for assessing and monitoring quality, safety and relevant risks. It also requires providers to seek and act on relevant feedback to support service evaluation and improvement.

  The regulation does not prescribe one specific workforce wellbeing survey.

  For Practice Managers, the practical question is whether existing governance arrangements provide enough information for leaders to recognise and respond to significant workforce issues.

• How can practices demonstrate that wellbeing concerns lead to action?

  One of the clearest ways to demonstrate effective workforce management is to show the connection between an identified concern, a management decision and a subsequent review.

  This does not mean every staff suggestion must result in a change.

  The practice should be able to explain how significant issues were considered and why particular decisions were made.

  Consider a practice where employees report difficulties obtaining assistance during periods of high patient demand.

  Management might examine staffing arrangements, responsibilities and escalation procedures before deciding whether changes are necessary.

  A useful record could establish:

  • The concern identified through workforce feedback.

  • The information considered when reviewing it.

  • The decision made and who authorised it.

  • The person responsible for any agreed action.

  • The timescale for implementation.

  • How the outcome will be reviewed.

  If the practice cannot introduce the preferred change because of staffing or financial constraints, the record may still show that leaders considered the issue.

  However, explaining a constraint does not remove the need to manage any remaining safety risks.

  The Health and Safety Executive recommends action plans that allocate responsibility, establish realistic timescales and provide a basis for evaluating effectiveness.

  For GP practices, this can often be incorporated into existing management arrangements.

  An improvement plan should be proportionate to the concern. A relatively simple communication issue may need only a brief agreed action, while a significant staffing risk may require more detailed review and partner involvement.

  The evidence becomes stronger when the practice can demonstrate what happened after the original decision.

• How should workload and staffing evidence be interpreted?

  Workload and staffing information may help leaders identify workforce risks, but individual indicators should not be treated as proof of poor wellbeing.

  For example, increasing overtime may suggest pressure on available capacity.

  However, it may also reflect temporary cover arrangements or a specific period of additional work.

  Likewise, sickness absence and turnover can provide useful workforce information without establishing that difficulties are caused by management or working conditions.

  The distinction between temporary demand and sustained organisational pressure is important.

  A practice may experience an unusually busy period without its overall arrangements becoming unsafe or unmanageable.

  If employees regularly cannot complete essential responsibilities within their available hours, management may need to consider whether established processes or staffing arrangements require review.

  Relevant evidence should therefore show how leaders interpret the information, rather than simply record the figures.

  The relationship with CQC also needs to be understood accurately.

  Workforce wellbeing and enablement sits under Caring, while safe and effective staffing sits under Safe.

  However, where staffing or workload pressures create organisational risks, the way leaders recognise and manage them may also be relevant to Well-led governance.

  Practice Managers should avoid duplicating the same documents unnecessarily across different quality statements.

  An accurate account of the issue, the decision-making process and any improvement may provide useful context for several aspects of an assessment.

• How can practices protect confidentiality while retaining useful evidence?

  Workforce evidence should be proportionate, relevant and handled in a way that protects employees' personal information.

  This can be particularly challenging in small GP practices.

  For example, a survey report separating responses by individual job role may reveal who expressed a particular opinion, even when names have been removed.

  Free-text comments can create similar difficulties where they refer to distinctive responsibilities or incidents.

  Practices should consider whether the information is genuinely anonymous before describing it as such.

  Where employees remain identifiable, data protection requirements continue to apply.

  A sensible approach involves limiting access to detailed responses, avoiding unnecessary personal information and using appropriately aggregated summaries for general workforce reporting.

  Individual grievances, occupational health information and sensitive employment matters should normally be managed through their relevant confidential processes.

  CQC-related evidence does not require every member of the management team to receive unrestricted access to employees' personal information.

  The objective is to demonstrate appropriate oversight while protecting confidentiality.

  Practice leaders should also avoid creating excessive records simply in anticipation of an assessment.

  A concise, accurate management summary may be more useful than extensive documentation that is difficult to maintain or interpret.

• What should a Practice Manager check before a Well-led assessment?

  A Practice Manager preparing to explain workforce governance arrangements may find the following questions useful:

  • Do we understand which Well-led quality statements relate to staff experience?

  • Can we explain how employees contribute feedback and raise concerns?

  • Do we have appropriate information about recurring workforce pressures?

  • Are significant concerns considered by the relevant practice leaders?

  • Can we demonstrate how employee feedback has informed decisions?

  • Are work-related stress and other relevant workforce risks assessed?

  • Do improvement actions have clear responsibilities and review arrangements?

  • Are confidential employment matters kept separate from general workforce reporting?

  • Do staff understand the arrangements described in our policies?

  • Can we explain what has improved, what remains unresolved and how outstanding concerns are managed?

  These questions are intended to support an internal management review. They are not a formal CQC inspection checklist.

  The most useful evidence should already form part of how the practice understands and manages its workforce.

  Common questions about workforce wellbeing evidence and CQC Well-led

  Does CQC require GP practices to conduct annual staff wellbeing surveys?

  CQC does not prescribe a universal annual staff wellbeing survey for GP practices. Surveys may provide useful feedback, but other appropriate methods can also help practices understand workforce experience.

  Is workforce wellbeing assessed under Caring or Well-led?

  Workforce wellbeing and enablement is a quality statement under Caring. However, related evidence may also be relevant to Well-led statements concerning culture, leadership, speaking up, equality and governance.

  Can staff survey results improve a CQC Well-led rating?

  Survey findings can provide relevant information, but there is no survey score that automatically improves or determines a CQC rating. CQC considers the evidence relevant to the assessment.

  What if staff feedback identifies problems that remain unresolved?

  Practice leaders should be able to explain what has been considered, what action is underway and how any ongoing risks are managed. An unresolved issue does not automatically establish regulatory non-compliance, but significant concerns should not be ignored.

  Should practices create a separate CQC workforce evidence folder?

  A separate folder may help organise information, but it is not a prescribed requirement. Accurate records within existing governance systems may be sufficient if they can be located and explained when needed.

• A practical starting point

  GP practices do not need to create a large collection of new workforce documents solely for CQC.

  The priority should be to establish whether existing records provide a reliable account of how leaders understand and respond to staff experience.

  Four actions can help:

  1. Map existing information. Identify where staff feedback, workforce risk assessments and relevant management decisions are already recorded.

  2. Review important gaps. Consider whether the practice can explain how significant workforce concerns reach appropriate decision-makers.

  3. Connect feedback with improvement. Ensure important actions, responsibilities and subsequent reviews are documented.

  4. Check the reality behind the records. Establish whether employees recognise the working arrangements and speaking-up opportunities described.

  Workforce wellbeing evidence is most valuable when it reflects genuine management activity.

  For CQC Well-led, the important question is not how many wellbeing documents a practice can produce. It is whether leaders understand their workforce, recognise relevant risks and use that information to support effective governance and service improvement.