Daniel Vincent · Harmony CQC · July 2026
At our most recent Inspection Readiness Audit Workshop, twenty-five practices pulled up their live mandatory training figures and RAG-rated them against what an inspector would expect to see.
Four rated green.
And into the anonymous free-text box, three separate practices — independently, within minutes of each other — typed some version of the same three words:
“Partners all red.”
Every practice manager in the country just nodded. So before we go any further, let me say the thing out loud: if your training gap wears a GP partner’s name, you are not failing. You are normal. And the fix isn’t what most practices think it is.
The question nobody can answer quickly
Here’s what the live workshop exercise actually exposed — and it’s subtler than “people haven’t done their training.”
I asked practices to pull their live completion percentage. Not last quarter’s report. Not the number from the last partners’ meeting. The number, now.
Watch what happened in the room’s own words: “not consistent with staff categories.” “A mix of 100% and very low.””Will double-check the CQC list to make sure we have covered everything.” “I think we may need to look at what we deem mandatory…”
The struggle wasn’t laziness and it wasn’t ignorance. It was that in most practices, the live training figure is genuinely hard to produce — because the thing being measured hasn’t been properly defined. Which courses count? For which roles? Against what list? Until those questions have answers, your training percentage isn’t a fact. It’s a negotiation.
And here’s the truly uncomfortable finding from the room: one practice noticed that their worst percentages were in exactly the subjects the CQC reviews most — sepsis and safeguarding among them. Sit with that for a second. The gaps aren’t randomly distributed. They cluster in the highest-risk, most-inspected subjects, because those are often the longer, harder, more frequently refreshed courses. The place your compliance is weakest is precisely the place an inspector looks first.
Why this matters — and it isn’t the inspection
I want to be careful here, because it’s easy to write about training as a compliance chore. It is not.
Basic life support is on your mandatory list because one day, in your waiting room, somebody’s heart will stop. Safeguarding is on the list because one day a child or a vulnerable adult will present with something that a trained receptionist notices and an untrained one doesn’t. Sepsis training is on the list because sepsis kills quickly and presents quietly. Infection prevention, fire safety, mental capacity, information governance — every one of these earns its place through a specific, foreseeable moment of risk to a real patient or a real colleague.
That is what “mandatory” is supposed to mean: the risk of this person not knowing this thing is one we refuse to carry.
Which is exactly why the modern habit of calling everything mandatory is so corrosive. When twenty-plus courses all wear the same label, the label stops meaning anything. Staff can’t tell the training that stops a death from the training that satisfies a contract. The genuinely critical subjects queue behind everything else — and the percentage that leadership sees blends both into one meaningless number.
The fix: tiers, anchored to the CSTF
The way out is not more chasing. It’s better sorting — and there’s a national reference framework built for precisely this job: the UK Core Skills Training Framework (CSTF).
The CSTF defines the genuinely core subjects for health and care staff and — crucially — maps them by role. It’s the closest thing English general practice has to an authoritative answer to “what actually counts?” So use it as your anchor:
Tier 1 — the CSTF core, your true mandatory list. Basic life support. Safeguarding at the correct level for each role. Infection prevention and control. Fire safety. Information governance. Mental capacity. The subjects where the risk of not-knowing is unacceptable, for the roles where it applies. This is the tier you measure at 100%, always — and because it’s a short, defensible list, 100% becomes achievable rather than theoretical.
Tier 2 — role-based and regulatory. Fire wardens, chaperones, smear takers, lone working, controlled drugs handling. Mandatory for the people whose roles require it, irrelevant to everyone else. Measured per role, not across the whole practice.
Tier 3 — contractual and developmental. The NHS England contractual additions, and everything identified through appraisal and CPD. Important. Tracked. But it does not belong in the same denominator as basic life support, and pretending it does is how a practice ends up “failing” at training while its resuscitation cover is actually complete.
The insight that changes everything, which I say in every coaching session: if you call something mandatory, you are choosing to be measured on it at 100%, for everyone, forever. Choose carefully. A short tier-1 list you can defend and actually achieve beats a long list that guarantees a red number and dilutes the subjects that save lives.
What this looks like when a practice actually does it: Birchwood
Theory is cheap, so let me tell you about our coaching client Birchwood Medical Practice, because their team — led by practice manager Wayne Catchpole — did exactly this rationalisation, and did it faster and better than I would have dared promise.
When we ran the training module together, Birchwood’s mandatory list stood at twenty-eight courses. Twenty-eight things, all wearing the same label, all theoretically required of everyone, all dragging on the same compliance percentage. In the week between two coaching sessions — not a project plan, a week — Wayne drafted a tiered mandatory training policy, checked every line against the CQC’s own mythbuster guidance, merged it with a parallel draft his colleague Steph had built independently, and then reviewed the whole thing three ways with Sara and with Donna, their lead nurse, who brought the clinical eye that made the final document sing. Total input time: about half a day.
The result, in Wayne’s own words: “We had a list of 28 mandatory trainings last week. This brings it down to about 10 or 11 at the very most if you end up having to do everything. And I know if I cut out all the other rubbish alongside it, I think we’d already be at 100% on the things that really matter.”
Read that last sentence again, because it’s the entire argument of this article coming out of a practice manager’s mouth: the practice was probably already compliant on everything that genuinely mattered — but the bloated list made it impossible to see, let alone prove. Twenty-eight undifferentiated courses hid a practice that was fundamentally sound. Eleven tiered ones revealed it.
And the tiering wasn’t mechanical — it was risk assessment in action. My favourite moment of the whole session was the sepsis debate. Sepsis training wasn’t on Birchwood’s formal mandatory list at all; it was delivered informally through team sessions. Should it be tier 1? The team worked it as a risk question: impact if a member of staff misses it — someone could die. Likelihood of the scenario — sick patients ring the practice all day, every day. High impact, high likelihood: tier 1. That’s the difference between a list you inherited and a list you can defend to an inspector — every item on Birchwood’s tier 1 now has a why attached, in writing.
The policy was one half of Birchwood’s training work this year. The other half is the system underneath it. They are consolidating what used to be scattered matrices — versions living in separate team chats, quietly diverging — into one central skills matrix with proper controls over who can edit and who can view, so there is a single version of the truth. And the matrix tracks more than a tick for “course completed.” Every task, for every person, carries a status: training required → trained, awaiting sign-off → competent — with re-training triggered whenever the underlying procedure changes, and a “champion” level for the people who can teach others.
That distinction — trained versus competent — is the part most practices miss entirely. A certificate says someone sat through the content. Competent says someone watched them do the task, against the practice’s own written standard, and signed it off. One fills a register. The other prepares a person for the moment the training exists for.
And I watched Birchwood run that whole lifecycle on a live issue this summer: a risk identified in the dispensary, logged on the risk register, a procedure written, the fix implemented — and then, in our coaching call, the honest recognition that training and sign-off was the outstanding piece of the loop. That sentence, said out loud, in a room, with a plan attached, is what a mature training culture actually sounds like. Not “we’re at 100%.” Rather: “here is our loop, here is the open box, here is who’s closing it.”
The human factors — and a word about radical candour
Now the part the frameworks don’t cover.
A live training percentage is a moving target by design. Refresher dates roll every single day. A new starter arrives and the denominator changes overnight. Someone goes on maternity leave mid-cycle; someone’s sick the week the BLS trainer visits; the practice’s busiest clinician has protected time that evaporates every time the duty rota wobbles. A practice at 100% today is at 97% next Tuesday through nobody’s fault at all. If your governance treats every dip as a failure, your team will stop showing you the real number — and a flattering false number is far more dangerous than an honest amber.
So build for the human reality: protected time that actually gets protected, refreshers spread across the year rather than stacked into a panic quarter, and a live matrix so the dips are visible in days rather than discovered at the annual report.
And then there’s the hardest human factor of all, the one behind those three anonymous “partners all red” confessions: the person with the training gap is often the person who signs your payslip. Chasing a GP partner on their safeguarding refresher is not an administrative task. It’s an act of professional courage.
This is where I reach for Kim Scott’s idea of radical candour — care personally, challenge directly. Most practices default to one without the other. Ruinous empathy: “I know how busy Dr A is, I’ll leave it another month” — which is how a red ages quietly into a finding. Or the passive-aggressive alternative: the pointed all-staff email that everyone knows is aimed at two people and changes nothing. Radical candour is the practice manager who says, kindly and to the person’s face: “Your sepsis training lapsed in March. I care about you and about the patient in front of you, which is exactly why I’m not letting this slide. Which of these three dates works?”
That conversation is easier to have, incidentally, when the tiering has been done — because you’re no longer nagging about an undifferentiated list of twenty courses. You’re pointing at a short tier-1 list the partners themselves agreed was non-negotiable, backed by a national framework, with the risk spelled out. The system does the confrontation; the human just delivers it with care.
Where to start this week
Pull your training report — the real, live one, however messy. Then ask three questions. Which of these courses are genuinely CSTF tier 1 for each role? What would our percentage be measured against that list alone? And who is going to have the kind, direct conversation with the names at the bottom?
Four greens out of twenty-five practices isn’t a story about lazy teams. It’s a story about undefined lists, invisible systems, and conversations nobody wants to have. All three are fixable — Birchwood went from twenty-eight to eleven in a week — and every one of them is cheaper to fix this summer than to explain in an inspection.
Daniel