The CQC has extensive enforcement powers which, if exercised, can have a major impact on your dentist provider registration.   These powers can be taken on notice or, if urgent, on an emergency basis. 

The CQC can serve a: 

Notice of Proposal (NOP) to: 

• Cancel your registration 
• Suspend your registration 
• Vary your registration by removing a location (and effectively cancel its registration) 
• Vary your registration to stop you from doing something, such as not accepting new patients 
• Vary your registration to make you do something, such as provide action plans to the CQC 

Ridouts can help you to draft representations to the NOP setting out why the proposed action should not be taken. 

Notice of Decision (NOD) to: 

• Cancel, Suspend, or Vary your registration which confirms a Notice of Proposal already issued. 
• Suspend or Vary your registration on an urgent basis under section 31 of the Health and Social Care Act 2008.  This means the decision takes effect immediately, and dental practices should comply or face committing a criminal offence.  Such action can result in services having to cease immediately. 

Ridouts can help you to appeal the Notice of Decision to the First-Tier (Care Standards) Tribunal. 

Magistrates’ Court Order: 

• Cancelling a provider’s registration on an urgent basis, which takes effect as soon as the order is made. 

Ridouts can help you to appeal the order to the First-Tier (Care Standards) Tribunal. 

Such action can be highly damaging, reputations can be tarnished, dental practices can be prosecuted for failing to comply with conditions of registration and businesses can be lost. 

Ridouts can work with you to build a robust response to these types of action. 

Letter of Intent 

The CQC may issue a Letter of Intent to dental practices.  These are used as a pre-cursor to the above types of action.  These letters ask the dental practice to respond within a short timeframe (often 24 hours or less) to assure the CQC that suitable action is being taken to mitigate perceived risk. 

Ridouts can help you by: 

• Assisting with responses to Letters of Intent to provide reassurance to the CQC that enforcement action is not required; 
• Advising on the strength of the case contained within Notices of Proposals (“NOPs”) and Notices of Decision (“NODs”); 
• Drafting comprehensive responses to NOPs and NODs and identifying supportive evidence;  
• Appealing NODs to the Tribunal; including drafting witness statements, attending case management hearings and preparing bundles for disclosure; 
• Representing dentists at emergency closure hearings in the Magistrates’ Court. 

Following a site visit inspection the Care Quality Commission will produce an inspection report recording its findings.   

Negative findings, including breaches of regulations, can have a negative effect on a practice and information can be passed on to other bodies such as NHS England Area Teams or the General Dental Council. 

Dental practices have a short period of time to make factual accuracy comments.  If you do not make representations, you will be deemed to accept the findings. 

Inspections can lead to other enforcement action.  This can happen immediately or following a succession of reports showing non-compliance. 

Dental practices can suffer reputational, staffing and financial damage as a result of an inaccurate inspection report. 

Ridouts can help you to challenge the factual accuracy of the report.  We will work with you to gather evidence and put together as robust response as possible.   

Ridouts can help you by: 

• Drafting factual accuracy comments submissions; 
• Collating evidence in support of factual accuracy comments; 
• Pre-action protocol letters and complaints where comments to inspection reports have not been thoroughly or properly considered. 

The CQC can ask a dental practice to provide it with information and documentation under Section 64 of the Health and Social Care Act 2008 if it considers it necessary or expedient to have for the purposes of any of its regulatory functions.  This is a wide remit and failure to comply with a request under Section 64 is an offence punishable with a fine. 

The request for information is usually because the CQC has a concern about the practice.  It is therefore important for a dental practice to consider how that information is presented to the CQC to assure the CQC, whilst complying with the request.   It is also important to understand what information is being supplied and how this may impact the dental practice should the CQC use it to take action against it. 

Ridouts can help by: 

• Assisting Dentists to determine what falls within the scope of the request; 
• Compile the requested information and present it in an appropriate format; 
• Advising Dentists what the request might mean for possible future action. 

Ridouts puts on training events for the sector and our lawyers are often asked to speak at external events too.  (You can watch past events here and sign up to our mailing list to be kept informed of events here).   

We also provide tailored in-house training to you and your staff, offering practical advice on key health and social care topics. 

We will liaise with you in order to tailor the session to you particular needs. Our team is will explain issues in both a clear and practical way.  

Many of our clients have noted that the training provided by Ridouts, particularly in respect of preparing for inspection, has proven very beneficial to them and has enabled staff to fully understand the inspection process and empowered them to do themselves and their service justice. 

Ridouts can help you by: 

• Providing bespoke training sessions and materials that are delivered by knowledgeable professionals with wide experience in the sector; 
• The opportunity to interact with a legal professional on a number of issues pertinent to the running of a health and social care service; 
• The ability to deliver training in house or at a location of the provider’s choice. 

The CQC can issue a Warning Notice to dentists.  This can be on the basis the provider is deemed to have failed to, or is continuing to fail to, comply with a legal requirement.  Dental practices are given the opportunity to make representations about why a Warning Notice should be withdrawn or not be published. Warning Notices are a first step towards the CQC prosecuting a dental practice in respect of certain regulations and can be an indication of enforcement action to come. 

If representations are not made to a Warning Notice then the dental practice will be deemed to have accepted the findings. The CQC has the power to publish information about Warning Notices and routinely does.  This can lead to press attention and reputational damage. 

The CQC can issue Fixed Penalty Notices where a dental practice has failed, amongst other reasons, to comply with relevant legislation. Examples include where a service does not have a registered manager or where it has failed to make relevant notifications as per the regulations. Each individual breach can attract a fine of up to £4000, which can escalate. 

In respect of Fixed Penalty Notices the CQC has a duty to publish information once the fee has been paid. Again, press interest can lead to reputational damage. 

Ridouts can help you by: 

• Challenging the accuracy of any Warning Notice or Fixed Penalty Notice; 
• Making submissions as to the public interest value in publication of any notice; 
• Supporting Dentists with advice on how to manage the public relations issues relating to press interest in a notice; and 
• Drafting representations as to the validity of fixed penalty notices using documentary evidence and any mitigating factors. 

When purchasing or selling a health and social care business you’re not just dealing with bricks and mortar.  All are subject to regulation, contracts and multi-stakeholder interest.  There are many aspects which can help assess the health and value of the business. 

Ridouts can help prepare a dental practice for sale.  We can spot issues which may cause concern for purchasers allowing vendors to eliminate the problem ahead of time, or prepare an explanation which could comfort purchasers. 

We can organise and arrange documents for a disclosure room, be the central point of contact to field information requests and negotiate warranties. 

We can also advise the vendor on whether a purchaser concerns are valid and what impact these may have on the business for the purchaser moving forward which may impact the price the purchaser is willing to pay. 

Ridouts also act for purchasers. We help to identify regulatory issues that may affect the value of the business and therefore the appropriate purchase price.  We can provide a report to the purchaser and provide warranties to insert into the Sale and Purchase Agreement (where there is a share sale) or the Business Purchase Agreement (where there is an asset sale). 

The team have experience of undertaking health and social care regulatory due diligence in relation to the following types of businesses: 

• Dentists 
• Independent hospitals (cosmetic surgery) 
• Non-surgical cosmetic treatments 
• Care homes for adults (Dementia, learning disabled, Acquired Brain Injury, Mental Disorder) 
• Children’s homes 
• Special Schools 
• Foster Agencies 
• Medical Devices 
• Supported Living 

Ridouts is well placed to offer a health and social care regulatory due diligence service which will add value to any acquisition or divestment. 

Health and social care providers who are also registered as dentists often have to deal with a two-pronged attack from their provider regulator, the CQC, as well as from professional regulators, the General Dental Council (GDC).  There is also greater emphasis now on regulators sharing information between bodies. This means that provider regulators and professional regulators are likely to refer matters to each other where appropriate. 

When dealing with any form of disciplinary procedure, things can get difficult and complicated. If you do have to deal with both a professional regulator alongside your provider regulator, Ridouts team of specialist lawyers can advise on both aspects as each is likely to impact on the other. 

Ridouts can help you by: 

• Advising and representing providers faced with GDC proceedings; 
• Challenging, in appropriate cases, that there is no case to answer with the result that the case never reaches a substantive hearing; 
• Help to identify the evidence which a panel is most likely to find persuasive if individuals do attend a hearing; 
• Drafting witness statements and helping to identify which are the most appropriate documents to exhibit; 
• Conducting the advocacy at interim order or substantive hearings; 
• Help conducting appeals against professional regulators in the High Court, if appropriate.