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Practice Registration - Care Quality Commission and GPs

Zahra Shah provides details on what being registered with the CQC will entail for general practice.

To maintain registration with the CQC, practices will have to demonstrate their ability to maintain 16 essential standards of quality and safety
To maintain registration with the CQC, practices will have to demonstrate their ability to maintain 16 essential standards of quality and safety

Under recent legislation that applies to all regulated health and adult social care services, all 8,500 GP practices in England will be required to register with the Care Quality Commission (CQC).

This applies regardless of whether they provide solely private, solely NHS services or a mixture of both.

Under the Health and Social Care Act 2008, the CQC took over from the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission, as the new single regulator for health and social care in England.

According to the coalition government's NHS White Paper, the CQC's role will be strengthened and it will become 'an effective quality inspectorate' across both health and social care.

When do we need to register?
Whether yours is an NHS GP practice - including single-handed, a partnership, or a private sector or GP-owned company contracted to provide general practice - or you are a private GP who provides some NHS primary care medical services, you will need to be registered from 1 April 2012.

If your practice is part of a co-operative or federation - for example, to provide out-of-hours services or enhanced services - the co-operative or federation will need to be registered if it is a separate legal entity, as well as each practice.

What happens if we miss the deadline?
The CQC will expect the practice to meet the registration timescales. Otherwise, the practice must at least show it has systems and processes in place that mean it is on track to register within a very short period of time.

If the practice does not register, providing services (including normal NHS GP services) that are within in the scope of the new framework will be illegal.

To maintain their registration, practices will need to demonstrate an ongoing ability to meet all 16 essential standards of quality and safety - see below.

Practices must meet these 16 standards:
  • Care and welfare of people who use services.
  • Assessing and monitoring the quality of service provision.
  • Safeguarding from abuse people who use services.
  • Cleanliness and infection control.
  • Management of medicines.
  • Meeting nutritional needs.
  • Safety and suitability of premises.
  • Safety, availability and suitability of equipment.
  • Respecting and involving people who use services.
  • Consent to care and treatment.
  • Complaints.
  • Records.
  • Requirements relating to workers.
  • Staffing.
  • Supporting workers.
  • Co-operating with other providers.

What happens if we fail to comply?
The CQC recognises that minor lapses in performance can occur in any practice. It will 'take a view', depending on various factors such as the seriousness of the non-compliance, its impact on service-users and the time that it is reasonable to allow the GP practice to remedy the particular shortfall. The CQC has a much wider range of enforcement powers than its predecessor regulators (see box).


These include:

  • Issuing warning notices, where care quality falls below the requirements in the essential standards of quality and safety. Where the failure is continuing, the warning notice will state what action must be taken to comply, together with a timetable for rectifying the failure.
  • Imposing financial penalty notices, in lieu of prosecution. The CQC can take further action if the fine is not paid and the breach is not made good.
  • Suspending registration. The CQC can close down a practice temporarily if people's rights and safety are at risk until all compliance issues are resolved.
  • Imposing, varying or removing conditions with immediate effect, if a person is exposed to a risk of harm.
  • Cancelling registration. In very serious cases, a service could be closed down.
  • Prosecution. This could happen if a GP practice does not register to run services but continues to provide them.

Practices may also face unannounced spot checks - and be liable for a fine if they refuse to allow in the inspectors. However, practices that join the RCGP accreditation scheme will not be inspected.

The CQC's former chief executive Baroness Barbara Young said: 'If you have College accreditation, we will say that is enough for us, we will not require any further information. Our philosophy has to be not collecting data if it has been collected already ... and not inspecting if we do not think there is a problem.'

How much will it cost to register?
All GP practices will be charged an annual fee to fund the cost of registration from 2012.

The CQC will fully consult on annual payments later this year. It is unclear how much the annual fee will be, although the CQC has said that any fees that apply to GPs will be proportionate. Despite this, the GPC has opposed all plans to make practices pay to register with the CQC. The concern for GPs is that fees of thousands of pounds could threaten practice viability.

What can we do now to prepare for registration?

GP practices should check their internal reporting and audit systems, consider what evidence they already hold/need to create, be aware of activities in other sectors (for example, social care and independent healthcare providers) as they come into the new registration system, and check the CQC website for latest information on registration.

Zahra Shah is associate at solicitors Fox Williams LLP, www.foxwilliams.com.

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