The CQC clinical searches run against your live clinical system, and every line they return is a real patient with a real gap in their care. You cannot prepare for them by tidying a folder.
If an assessment is coming, this is the part that most reliably produces findings, and the part practices underestimate, because it looks like a technical job. The work it generates is clinical time.
This article covers what the searches are, the four areas they test, why practices that know all about them still fail them, and how to size the work the output creates before an assessor sizes it for you.
What the searches are and where they came from
CQC has developed a suite of clinical searches with Ardens, now used routinely at GP practice assessments. The reference material is at ardens.org.uk/cqc, and CQC’s position on access and methodology is set out in GP mythbuster 12: Accessing medical records and carrying out clinical searches.
Two facts about them define the problem. The searches and their business rules are available free of charge to all GP practices. They are also already on your clinical system: EMIS Web via the Ardens Portal, SystmOne via organisation groups, and Vision, made available by Cegedim Healthcare. Version 3 updates DOAC monitoring and adds new bisphosphonate usage searches. There is no paywall and nothing to procure. You can run at your own practice, today, the same searches an assessor will run at you.
The design principle matters more than the mechanics. The searches focus on areas of clinical importance that reflect the profession’s own agreed shared view of quality. They are, broadly, what a careful clinical pharmacist or GP would look at anyway if they had the time.
The searches are part of the Safe key question, which maps to Regulation 12 (safe care and treatment), the regulation with the most recorded breaches in GP practices. The pillar on how practices get back to Good covers the wider framework. What matters here is volume: CQC completed 4,308 assessments by the end of 2025 and aims to deliver 9,000 by the end of September 2026.
The four areas the searches cover
Most of the searches concentrate on four areas, and each one asks a different question about your practice.
Safe prescribing asks whether you are prescribing things that should not be co-prescribed, or should not go to this patient at all. It tests your decision support, and whether anyone acts on it.
Monitoring of higher-risk drugs covers ACE inhibitors and ARBs, amiodarone, DOACs, lithium, and the DMARDs (azathioprine, leflunomide, methotrexate). Related evidence areas include anticoagulant monitoring, controlled drugs and levothyroxine. This family tests whether your monitoring is a system or a habit. We have written separately on what a working high-risk drug monitoring system looks like.
Long-term condition management asks whether your LTC cohorts are actually reviewed, or coded as reviewed. This is where QOF chasing and clinical care diverge most visibly.
Identification of potential missed diagnoses looks for patients whose data implies a diagnosis nobody has made. The results are there, the pattern is there, and no one has joined them up. Practices are least prepared for this family, because it finds an absence in the record.
What a hit on a search actually means
The searches are designed to identify potential significant risk, and they often have a degree of tolerance built in, for example in the intervals for monitoring medicines. The thresholds are not set at the guideline date. There is deliberate slack in them.
A patient the search returns is therefore already past the point where reasonable allowance has been made. Arguing that the search is too strict is not available to you, and offering that argument tells an assessor something about your governance you did not intend to say.
Why practices fail them
Follow the logic through. The searches are free, already installed, and the business rules are published. CQC will run them at your assessment whatever you do. Every practice can see exactly what the regulator will see, at no cost. That leaves one barrier standing: the clinical capacity to work the output.
The recorded findings bear this out. They include gaps in monitoring of patients on high-risk medicines, incomplete Ardens searches, and missing documentation of medication review discussions. Read the middle one carefully. Incomplete searches means somebody started this work. They ran the searches, they saw the list, and the list sat there, because the clinical time to work it did not exist. What those gaps become on a report is covered in the medicines breaches behind a Requires Improvement rating.
Run the searches on your own practice
Run them before anyone else does. If you take one thing from this post, take that. You will see what an assessor will see, while you still have room to do something about it.
Then resist the obvious next move, which is letting the searches become your governance. CQC’s guidance is that practices should establish their own independent governance systems and should not rely solely on the searches for compliance preparation. Ardens says the same of its own product. When the regulator and the supplier agree on the limits of a tool, that is worth reading twice.
If the only time your methotrexate cohort gets reviewed is when somebody runs the CQC search, then your monitoring depends on the search. An assessor works that out in about ten minutes of conversation about your recall processes.
Working the output
The output is a list of patients. Each one needs triage, then clinical action, then a record of both. Triage separates the patient eight weeks past a methotrexate FBC from the one whose last result was abnormal and unacted on. Clinical action is the review, the call, the test request. For CQC’s purposes, an undocumented medication review discussion is a review that did not happen.
Then do the arithmetic, because this is where practices find out the size of the problem. Realistic time allocations:
- High-risk drug monitoring. 10 to 20 minutes per patient.
- Patient review from a report, which is the activity of working a list from a search output. 10 minutes per patient.
- Patient phone call. 10 minutes.
- Medication review. 15 minutes for 1 to 6 items, 30 minutes for 6 or more.
- Structured medication review. 30 minutes.
- LTC work. 15 minutes for an asthma review, hypertension titration, statin initiation or review, or bisphosphonate initiation. 20 minutes for heart failure, mental health or depression.
Add 10 minutes where a consultation is by telephone. A patient needing translation requires a double appointment. Multiply by your list length. That number is your real preparation timeline, and it is usually the point at which the conversation inside the practice changes.
It is also the number worth talking through with another pharmacist before you build a plan around it. Someone who has worked a search output in a live practice can usually tell you whether your figure looks about right, and which part of the list to start with.
Why massaging the output makes things worse
There is a way to make a search return clean that has nothing to do with clearing the backlog. Recode, backdate, adjust the denominator, exception-report your way to a tidy number.
The patients the searches surface are real. Massaging the output leaves every one of them exactly where they were, and adds a data integrity problem on top of a clinical one. If it comes to light, you are no longer discussing a monitoring gap. You are discussing whether the practice can be trusted about anything else in the record.
Clear the clinical backlog. Do not massage the denominator.
Where extra clinical capacity fits
If the arithmetic produces a number your clinical sessions cannot absorb before your assessment, the free searches have done their half of the job. The half they cannot do is the one that closes the Regulation 12 risk: every patient on that list triaged, actioned and documented.
Virtual Pharmacist delivers fully managed remote clinical pharmacy services to GP practices, PCNs and ICBs. CQC Searches & Preparation is a named service, as is Ardens Searches & Quality Work. The service framework covers the same ground the searches do, including high-risk drug monitoring across DMARDs, lithium, amiodarone and antipsychotics, and bisphosphonate initiation, which version 3 has brought into scope. The service is delivered remotely under Virtual Pharmacist’s clinical governance, and aligned to your practice’s agreed workflow: your protocols, your recall standards, your documentation conventions. Delivery is monitored through clinical activity KPIs, so the backlog burn-down is visible. Every pharmacist is verified on the GPhC register before engagement.
No one can promise you a rating. What a managed service does is make sure the list is worked, the actions are real, and the documentation exists before an assessor reads it.
Frequently asked questions
Do we have to pay for the CQC clinical searches?
No. The searches and their business rules are available free of charge to all GP practices, and they are already available on EMIS Web through the Ardens Portal, on SystmOne through organisation groups, and on Vision, made available by Cegedim Healthcare. The reference material is at ardens.org.uk/cqc.
How long does it take to work a search output?
It depends on the list. Realistic allocations are 10 to 20 minutes per patient for high-risk drug monitoring and about 10 minutes per patient to review a patient from a report, with 15 to 30 minutes for a medication review depending on the number of items. Multiply those figures by your list length and you have the honest starting point for planning.
Can we argue that a search threshold is too strict?
No. The searches are designed to identify potential significant risk and often have a degree of tolerance built in, for example in monitoring intervals, so a patient who appears on the output is already past the allowance the search makes. Raising the argument during an assessment tends to tell an assessor more about your governance than about the search.
Is running the searches enough to prepare for an assessment?
No. CQC’s guidance is that practices should establish their own independent governance systems and should not rely solely on the searches for compliance preparation, and Ardens says the same of its own product. The searches show you where you are today. Your recall and monitoring systems are what an assessor will ask you about.
What if we do not have the clinical time before our assessment date?
Talk to someone about it early. The output does not shrink, and the closer the date gets the fewer sessions there are to put against it. A conversation with an experienced clinical pharmacist about the size of your list and the time it needs is a reasonable first step, whether or not you end up bringing in outside capacity.
Run the searches this week, then answer one question: can you name the clinician who will work the output, and point to the sessions in the diary where they will do it? If you cannot, that is worth talking through with someone who has seen the same output before. Our clinical pharmacists have worked these lists in practices at every stage of the process, including practices already in the middle of an assessment. Contact Virtual Pharmacist to discuss what your practice needs and how a remote, managed service could fit.
