General Practitioners
Whether you run an NHS or private practice, the requirement for GP practices to register with the Care Quality Commission has added an additional layer of complexity to running a successful practice. Balancing and juggling competing demands whilst maintaining high quality patient care can be tough.
The CQC has extensive enforcement powers which, if exercised, can have a major impact on a GP Practice’s registration. These powers can be taken on notice or, if urgent, on an emergency basis.
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 GP 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 GP practice’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 damaged, GP 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 a GP Practice. These are used as a pre-cursor to the above types of action. These letters ask the providers 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 GP Practices at emergency closure hearings in the Magistrates’ Court.
The CQC can ask a GP Practice to provide it with information and documentation (which includes medical records) 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 GP 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 Practice should the CQC use it to take action against it.
Ridouts can help by:
- Assisting GP Practices to determine what falls within the scope of the request;
- Compile the requested information and present it in an appropriate format;
- Advising GP Practices what the request might mean for possible future action.
The CQC can issue a Warning Notice to a GP Practice. This can be on the basis the GP Practice is deemed to have failed to, or is continuing to fail to, comply with a legal requirement. GP 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 GP Provider 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 GP Practice will be deemed to have accepted the findings. The CQC has the power to publish information about Warning Notices and it does so routinely. This can lead to press attention, reputational damage and prompt the interest of other parties such as NHS England or the GMC.
The CQC can issue Fixed Penalty Notices where a GP Practice has failed, amongst other reasons, to comply with relevant legislation. Examples include where a Practice 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 of publication of any notice;
- Supporting GP Practices 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.
Any business falling within the scope of registration must be registered with the relevant regulator. For GP Practices, this includes the Care Quality Commission (“CQC”).
The process of registration can be complicated and lengthy but if a GP Practice prepares itself thoroughly then it should run more smoothly. Our team of specialist lawyers can make sure that this process is as seamless as possible.
Ridouts can help you by:
- Establishing which regulated activities/services you will be providing;
- Guiding you through the application process;
- Reviewing your Statement of Purpose;
- Considering any additional guidance that the CQC might require you to rely upon when applying for registration;
- Assisting with the registration of your manager;
- Making sure that all relevant applicants have applied for the relevant enhanced DBS checks;
- Reviewing the completed application before submission;
- Advising in the event of CQC refusing to register a service.
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.
Following site visit inspections the Care Quality Commission will produce an inspection report recording its findings. This includes rating a service. These reports are published and GP Practices must display their ratings.
Negative findings, breaches of regulations or ratings of ‘Requires Improvement’ or ‘Inadequate’ can have a negative effect on a service. Equally a GP Practice may be expecting a rating of ‘Outstanding’ but receives ‘Good’ and wishes to make representations about this.
GP Practices have a short period of time to make factual accuracy comments and challenge the ratings made. 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.
GP 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 and the rationale behind the judgements. 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;
- Challenging ratings;
- Rating Reviews ;
- Pre-action protocol letters and complaints where comments to inspection reports have not been thoroughly or properly considered.
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