Registering with the CQC: social enterprises
Social enterprises are changing the community services landscape by providing an innovative way of delivering NHS health and social care.
As a new social enterprise (SE), however, navigating the regulatory landscape can be challenging, as there are many different issues to consider. One of which is registration with the Care Quality Commission (CQC) - the health and social care regulator in England. The purpose of this article is to provide some practical assistance on registering with CQC and the obligations on an SE provider once registered.
CQC is a regulatory body which is in place to ensure that health and social care bodies, both private and public (the NHS) in England, protect and promote the safety and welfare of people who use health and social care services. It does this through assessing registered providers against regulations and outcomes which set out the expected standards of quality.
The starting point for any SE provider is to take note of the fact that it is an offence not to be registered with the CQC. That is, of course, if registration is required; the onus is on the provider to determine this themselves. Additionally, although the previous provider of the service, such as the PCT or a local authority, were CQC registered, the registration is non-transferable to a new entity. In short, a new provider such as a new SE must make its own application for registration to the CQC.
“The starting point for any SE provider is to take note of the fact that it is an offence not to be registered with the CQC.”
The CQC registration regime is based on the need for a legal entity to be registered for any “regulated activity” it undertakes. There are currently fifteen “regulated activities” listed within the Health and Social Care Regulations - and their definitions are broad. Therefore, most providers carrying on health and social care functions are likely to sit within one of the definitions. Examples of the regulated activities listed are “personal care”, “treatment of disease, disorder or injury” and “surgical procedures”. Each provider is registered once for each of the regulated services it provides across all of its services. As SEs come in all shapes and sizes, the question of whether registration is required or not is not always easy.
“Each location from which a ‘regulated activity’ is undertaken must be identified and will be made a condition on the CQC registration.”
To complicate matters further, there are certain community services which are currently exempt from registration - although they will be registerable in April 2012 or 2013. The services currently exempt include the NHS primary medical services, as long as the primary medical services are the main or only services provided. If this is not the case, an SE will not need to register them until April 2013 but they will need to apply to register for the other community services provided in the meantime. Providers of the NHS GP out-of-hours services who carry on regulated activities will be legally required to be registered with CQC in April 2012, however.
The question of location is also important. Each location from which a “regulated activity” is undertaken must be identified and will be made a condition on the CQC registration. An SE is also likely to require a CQC registered manager.
If registration is required, the next step will be to complete an application form - which can be found on the CQC website - and pay an application fee. Different fees are applicable to different types of provisions. SEs will then be asked to provide key information and documentation to prove that they are able to meet the regulations.
The CQC states that it aims to register all new providers within 12 weeks. However, this timescale will of course depend on whether the application form is completed comprehensively and if the CQC is given all of the required information with the form. The CQC can also ask for further information during the application process if it requires said information in order to draw conclusions as to whether or not the provider can meet the regulations. It will also undertake a site visit in most cases in its assessment of a new application. This in itself can be problematic. It may be that the premises have been CQC registered in the past (again, when a PCT or a local authority were the registered provider of the services) but from the time they are “taken over” by an SE, the premises may no longer be CQC compliant. This raises problems in relation to whose responsibility it is to ensure that the premises are fit for purpose, and thought will need to be given as to how best to address this issue so as to mitigate risk.
“If the CQC has no current concerns, it states that it will only physically review each location of a registered service once every two years.”
Another illustration of the complexity of the premises issue is when a situation arises in which the relevant premises are owned by a third-party other than the commissioner. For example, an SE may be providing services in a prison whose buildings may fail the CQC test. Again, thought will need to be given as to how best to deal with the situation in order that the level of care provided to service users is not jeopardised, whilst at the same time ensuring that the SE is able to provide the care and are therefore able to achieve its own CQC registration.
In addition, the proposed registered manager will also be interviewed as part of the application process. Once registered, an SE’s ongoing obligations from a CQC perspective are of course to ensure that it meets the essential standards of quality. The CQC will collate information about a service from those receiving care, from the provider and any other relevant body. If the CQC has no current concerns, it states that it will only physically review each location of a registered service once every two years. However, if concerns are raised, then review visits will be more frequent. Most visits will be unannounced. In the event of non-compliance with the essential standards of care, CQC has a number of enforcement options at its disposal: issuing a warning notice, prosecuting a provider, taking action to impose a condition on a registration, or in the most serious cases, taking action to cancel a registration. Once registered, there will be an annual application fee to pay.
Therefore, a good starting point for SEs in terms of understanding the registration process is to visit the CQC website, which is helpful in terms of identifying what needs to be done both to achieve and maintain CQC registration. It is also essential to determine early who is processing the application form within the CQC. Establishing good communication with the CQC and having a main contact there from the outset will help an SE understand what information and further information is required, if any, all of which will contribute to the steady progression of the process. This smooth running will be all the more relevant if your services are currently exempt as you look to obtain your CQC registration in time for the April 2012 deadline.
Cendrine Le Blanc and Siwan Griffiths are both Capsticks associates.
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