The CQC – What you need to know
All healthcare organisations that provide regulated activities have to register with the CQC. Here’s a little background along with advice on who is affected and how to apply for registration.
The Care Quality Commission (CQC) came into effect on 1 April 2009. It was established by the Health and Social Care Act 2008 to regulate the quality of health and social care. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 came into force on 1 April 2015. Providers must meet the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009.
All healthcare organisations that provide regulated activities need to register with the CQC. For primary care dental services, registration was required from 1 April 2011.
Regulated activities include:
- Treatment of diseases, disorder or injury
- Diagnostic and screening procedures
- Surgical procedures
It is illegal and therefore a criminal offence for any primary care dental service to carry out any regulated activities unless it is registered with the CQC.
If you are already registered with the CQC as a provider or manager, it is important that you read and consider the Regulations and the guidance, as it will help you to understand what you need to do to meet the regulations.
You are responsible for meeting the regulations and deciding how to do this.
After registration, providers are monitored by the CQC and must comply with any conditions of registration.
The CQC shares information with other organisations and in particular has a Memorandum of Understanding with the General Dental Council and another with the Parliamentary and Health Service Ombudsman (PHSO).
The Social Care Act 2008 (Regulated Activities) Regulations 2014 introduce the new fundamental standards, which describe requirements that reflect the recommendations made by Sir Robert Francis. The regulations enable the CQC to pinpoint more clearly the fundamental standards below which the provision of regulated activities and the care provided to people must not fall, and to take appropriate enforcement action where necessary.
The Regulations require a provider to operate an effective and accessible complaints procedure and to investigate any complaint and take necessary and proportionate action.
If the CQC request complaints information this must be provided within 28 days.
Fit and proper person requirement
The provider must not appoint or have in place within the practice anyone who is:
- Not of good character,
- Who does not have the qualifications, competence, skills and experience which are necessary for the relevant office or position or the work for which they are employed,
- Not able by reason of their health, after reasonable adjustments are made, of properly performing tasks which are intrinsic to the office or position for which they are appointed or to the work for which they are employed,
- Has not been responsible for, been privy to, contributed to or facilitated any serious misconduct or mismanagement (whether unlawful or not) in the course of carrying on a regulated activity or providing a service elsewhere which, if provided in England, would be a regulated activity.
Also see Guidance on the Fit and Proper Persons Requirement for Directors regulations.
Duty of candour
The duty of candour sets out what providers must do to make sure they are open and honest with people when something goes wrong with their care and treatment.
When a provider is meeting the duty of candour patients should expect:
- A culture within the service that is open and honest at all levels.
- To be told in a timely manner when certain safety incidents have happened.
- To receive a written and truthful account of the incident and an explanation about any enquiries and investigations that the service will make.
- To receive an apology in writing.
- Reasonable support if they were directly affected by the incident.
If the provider fails to do any of these things, the CQC can take immediate legal action against that provider. For more information, please see the CQC's Guidance on the Duty of Candour regulations.
Read more on duty of candour here
Since December 2014, the CQC has been testing a new approach to the inspection of dental practices, using specially trained inspectors accompanied by dental advisors. In line with the CQC's other inspections, reports focus on whether services provided are safe, effective, caring, responsive and well led. Unlike other regulated sectors, primary care dental services will not be given a rating in 2015/16.
The CQC’s new inspection regime introduces the acronym KLOE, which stands for key lines of enquiry. The inspectors will use a standard set of KLOEs that directly relate to the five key questions – are services safe, effective, caring, responsive and well-led?
The KLOEs are:
- Safe track record
- Learning from incidents
- Monitoring safety and responding to risk
- Medicines management
- Cleanliness and infection control
- Staffing and recruitment
- Dealing with emergencies
The KLOEs are:
- Promoting best practice
- Management, monitoring and improving outcomes for people
- Working with other services
- Information sharing
- Consent to care and treatment
- Health promotion and prevention.
The KLOEs are:
- Respect, dignity, compassion and empathy
- Care planning and involvement in decisions about care and treatment
- Patient/carer support to cope emotionally with care and treatment.
The KLOEs are:
- Responding to and meeting people’s needs
- Access to the service
- Tackling inequity and promoting equality
- Listening and learning from concerns and complaints.
The KLOEs are:
- Leadership, openness and transparency
- Governance arrangements
- Management lead through learning and improvement
- Practice seeks and acts on feedback from users, public and staff
- Systems to monitor and improve quality and improvement.
What action can the CQC take?
Where concerns are identified, the CQC states that its response will be proportionate and depend on the potential impact on service-users.
Where there has been a breach of regulations CQC may use its enforcement powers in the following ways:
- Issuing warning notices telling a provider that they are not complying with a condition of registration or any other legal requirement CQC thinks is relevant.
- Civil law enforcement action may be taken to protect patients from harm by improving the care given to patients, or make it safer. The CQC states that this will normally be by imposing or changing a condition of registration; or suspending or cancelling registration.
- Criminal law proceedings may be used where the CQC wants to hold a registered person to account for causing harm to patients, or for failing to meet their statutory obligations. Criminal proceedings may result in a fixed penalty notice being served, a caution or prosecution, where a court may convict a registered person resulting in a fine and/or imprisonment.