Any individual, partnership or organisation providing a regulated activity in England must be registered with the CQC. This means that GP practices and independent consulting doctors are required to be registered with the CQC. Online primary care services in England which deliver a regulated activity by online means (via text, sound, images or other digital forms to deliver care and treatment to patients) are also required to be registered with the CQC. Examples include providers that deliver healthcare consultations via video link and providers prescribing medicines in response to online forms.
CQC registration applications
Completing registration application forms can be quite an onerous task. Providers are required to complete a comprehensive application form detailing the kind of service that they wish to provide, where it will be provided and who will be the registered manager, amongst other things.
As with everything, preparation is key. Before completing the CQC registration forms, it is important to understand the commercial structure of your business as different structures such as partnerships have different legal implications. At Ridouts, we can help providers to understand these implications.
By law, health and social care providers in England are required to register with the CQC for each of the regulated activities that are carried out. Regulated activities are listed in Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Not all regulated activities will be relevant to the service being provided, so providers need to carefully determine which ones are relevant to the service they are providing. Providers also need to provide details of the locations where the regulated activities will be carried out. Again, this is something that the team at Ridouts can assist with.
What happens when a provider submits its registration application forms?
Once providers have submitted their registration application, CQC will review it and check for missing documents or incomplete information. CQC calls this process ‘validation’ and in its guidance for providers last updated in March 2021, it states that, “If your application is incomplete or is invalid for some other reason, then it will be rejected (i.e. returned to you) with a letter explaining why.” Following the validation process, the application is allocated to and assessed by a registration inspector. In a recent registration matter that Ridouts assisted a provider with CQC stated that, “The coronavirus (COVID-19) pandemic has changed the way we work. And we’ve had to prioritise applications that help to deliver DHSC’s response to the coronavirus. This is causing delays to allocations. It may take up to 14 weeks for your application to be allocated to an inspector.”
Once the registration application has been assessed by an inspector, the CQC either issues a Notice of Decision (“NOD”) to register or a Notice of Proposal (“NOP”) to refuse registration.
What happens if CQC refuses a registration application?
The CQC might issue a NOP if it considers that the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 will not be complied with. For example, concerns might relate to staffing arrangements or the layout of the proposed premises.
If a provider is issued with a NOP it does not mean that this is the end of the journey. A NOP is only a proposal to refuse registration and providers have 28 calendar days in which to make written representations to the CQC setting out why the NOP should be withdrawn and registration granted.
Once the CQC has considered a provider’s NOP representations it will notify the provider of its decision and issue a NOD. If the CQC upholds the NOP and refuses to grant registration, providers have the right to appeal to the First-Tier Tribunal.
Ridouts can assist providers with drafting representations to a NOP and appealing a NOD and has extensive experience of doing this.
There are various difficulties that can arise in relation to CQC registration. A recent case relating to a digital healthcare provider and some of the difficulties that it experienced with CQC registration is considered below.
Recent CQC registration case
Due to the advancements in technology, more digital healthcare providers are entering the health and social care sector but this is still a relatively new area and so the issue of the CQC registration can be complex.
It was recently reported in HSJ that a digital paediatric and maternity service was providing care without being registered by the CQC. It was reported that the provider had been, “providing consultation services with clinicians since its launch seven months ago, while awaiting registration approval from the CQC” and that the provider, “… said the CQC had unofficially told it that it could provide services while its registration was pending. The CQC declined to comment on this specifically, but told HSJ that providers carrying out a “regulated activity” needed to first have their registration formally approved.” This case highlights potential issues that can occur.
If a provider realises that they have inadvertently been carrying out a regulated activity without being registered, they should stop providing services and seek specialist legal advice immediately. Taking action quickly to address the issue can help to mitigate against potential criminal enforcement action or prosecution by the CQC.
This article sets out the reasons why it is important for providers to determine if they require registration with the CQC. Sometimes it can be difficult to determine if a regulated activity is being carried out and therefore if the CQC registration is necessary. Advice from specialist lawyers can assist with this and help protect providers from prosecution or imprisonment.
At Ridouts we have wide experience in preparing a service for registration and are able to help navigate the maze of regulation by supporting you every step of the way. If providers need any advice or assistance please contact us using the email address firstname.lastname@example.org or by calling 0207 317 0340.