At A Glance

  • CQC is moving closer towards registration and inspection under the badge of the service provided rather than on a provider-by-provider basis
  • When there is collective responsibility, care providers need to know where the lines of accountability stop and start
  • Where services are changing the CQC should be informed at the earliest possible stage. The CQC does not want to be seen as a barrier to innovation and so it is imperative to involve local CQC relationship managers

Why this area is important

The current model of Care Quality Commission (CQC) registration is provider-led: whichever organisation provides the regulated activity is the entity which is registered to provide the service and be inspected.

In future, where multiple provider organisations come together in an integrated care pathway centred on ‘the patient’, the vital question will be who becomes the provider entity for the purpose of regulation and inspection by the CQC.

Providers want to know how regulation is going to work where you have a GP, an acute provider, a community care provider, and an independent sector provider – either individually or as a combined ‘entity’ organisation subject to CQC regulation – coming together to provide a seamless service which will, as a whole, require regulatory scrutiny under the CQC regime.

Key issues

Some Vanguard sites road testing integrated services have settled on creating separate legal entities into which all relevant providers on a specific pathway would fall. They effectively become a single provider entity under the inspection purview of the CQC, and registered in that form.

The CQC is mindful that regulation should not hold up the pace of change. Its ‘Shaping the Future’ strategy document sets out that registration arrangements should be a help rather than a hindrance to integration.

The CQC wants, in future, to register providers collectively under the badge of the service that they are providing, rather than on a provider-by-provider basis, a process known as ‘registration by location’. For example, if one clinic comprises primary care providers and independent sector providers all in one place, it makes more sense to regulate that place of care delivery, rather than all the providers separately.

But integrated care providers urgently need to know who is going to be carrying the regulatory can for any regulatory breaches along that care pathway; where the lines of accountability may have become blurred. If there is some form of collective responsibility, how is it going to be enforced and where do the lines of accountability stop and start?

If something goes wrong under the ‘registration by location’ regime, is there a way to ring-fence that regulatory pain within that service? Or, where these providers are also providing services elsewhere, will enforcement activity bite back on general business and potentially have a detrimental effect on reputation and other income streams?

Providers are willing participants in integration but they fear that a registration and inspection regime that might impinge on other parts of their businesses would be unhelpful and provide a disincentive to further collaborative work; quite the opposite of the intended outcome of increased innovation and integration in how services are delivered.

Potential solutions

The CQC is working with NHS Improvement and NHS England on a solution to this dilemma. It has a designated person at each of the Vanguard sites to better understand how the regulatory landscape needs to change.

Providers in Vanguard sites need to be in close and regular communication with these local contacts. Those not in Vanguards or Pathfinders need to bring in the CQC at an early stage to discuss inspection issues around any innovations or service changes.

We have seen this approach working very effectively where providers want to do things that differ from normal practice. It is better to consult with the CQC registration team at the ideas stage, rather than wait and try to register something that is entirely new and may not neatly fit into the current CQC provider ‘boxes’.