First things first – do you need to register?
Quick tip
It’s the provider of care that registers with CQC, not the individual places where care takes place or individual GPs.
For example...
A GP partnership with three practices only needs to complete one application – they include details for each practice on that single application.
All NHS primary medical services working under one of the following contracts or agreements must register.
- General Medical Services (GMS)
- Personal Medical Services (PMS)
- Alternative Provider Medical Services (APMS)
- NHS Act 2006 Section 3 (contracts with the Secretary of State)
You don’t need to register if…
The scope of registration
…you don’t provide primary medical services yourself. For example, if your premises are used by other people who are responsible for providing those services.
…you’re already registered with us. If you need to add medical services to your current registration, call us on 03000 616161 to find out how.
If you're still not sure if you should register, read The scope of registration.
Registration for private practice
All of the services you provide should be included in your registration – this means services you provide privately as well as NHS services.
Is your private practice a separate legal entity from your NHS practice?
If you provide any regulated activities as a private service that is a separate legal entity from your NHS services (e.g. an individual who provides services separately from his partnership) you’ll need to register them in a separate registration application.
Do you provide private services but your main services are NHS services?
Providers of medical services whose main or sole purpose is NHS primary medical care have to register by April 2013.
Please note: if your sole or main purpose is not the provision of NHS primary medical services, you should have already registered with CQC.
Private practice exemptions
There are a number of exemptions from registration. For example, some doctors in independent practice do not have to register if they also provide NHS services as an individual.
This can be a complicated area and more detailed guidance can be found in the Scope of registration – see the section on 'Exemptions without a time limit'.
Looks like you will need to register? Here's some information to help you get ready
What you'll need to tell us in your registration for
1 State which type of legal entity you are and how many locations you have
Quick tip
We think most GP practices will register as a partnership and their surgery will be a location.
Providers of care such as limited companies, partnerships and individuals need to register with CQC. Providers then have to register any places where they provide care (locations).
In simple terms, a location is where you're based but the guidance around this is more complex so you need to read the full guidance on locations to make sure you understand.
It should usually be straightforward to work out who the legal entity is and which locations you should register. For example, most GP practices will register as a partnership and their surgery will be a location.
You need to make sure that you register as the correct provider type and for the correct locations.
Quick tip
Individual GPs working in a practice don’t need to register with CQC as providers.
Health care professionals that work for a provider also don’t need to register as a provider. For the purposes of registration, these colleagues are all classed as employees of the provider. This includes:
- permanent or temporary employees and other salaried staff
- agency staff or locums
- volunteers
- trainees
- people on secondment
There are three provider types. To help you register as the correct type, we’ve included some additional guidance below.
Partnerships
We expect most GP partnerships to register as a 'partnership'.
Only register as this if all partners have agreed to joint liability for the services you provide.
Don’t register as a partnership if:
- you don’t have an agreement in place to share liability (e.g. where you only have arrangements for expense sharing).
- each person provides services as an individual (without shared liability). Instead, each person will need to register separately as individual (see the section on 'Individuals' below).
- you're a limited liability partnership (LLP) or a complex partnership made up of partners who are not just individuals (e.g. if two companies have formed a partnership) - you should register as an organisation.
Who’s responsible for meeting the essential standards?
All of the partners and the partnership as a whole are responsible for ensuring that the regulated activities provided meet the essential standards.
You’ll also be asked to name a registered manager to share responsibility for meeting these standards. See more information on 'Registered managers' .
Who will be the main point of contact with CQC?
When you fill in the application form, we’ll ask you to nominate one of the partners to be the key point of contact. We’ll send notifications and correspondence to that partner.
Individuals
We expect single-handed GPs to register as an 'individual'.
Who’s responsible for meeting the essential standards?
You, as the individual, will be directly responsible for ensuring that the regulated activities you provide meet the essential standards.
Who will be the main point of contact with CQC?
You, as the individual, will be the main point of contact and will receive notifications and correspondence from CQC.
Organisations
Registered companies and other corporate bodies, charities, social enterprises, LLPs and complex partnerships made up of partners who are not just individuals (e.g. if two companies have formed a partnership) should register as this.
Who’s responsible for meeting the essential standards?
The organisation is responsible for ensuring that the regulated activities it provides meet the essential standards.
You’ll also be asked to name a registered manager to share responsibility for meeting these standards. See more information on 'Registered managers'.
Who will be the main point of contact with CQC?
When you fill in the application form, we’ll ask you to nominate someone (a ‘nominated individual’) to act as the main point of contact with CQC and receive our notifications and correspondence. See more information on 'Nominated individuals'.
Examples of organisations
- A limited company that provides a range of primary care services across a county, including a GP practice, a walk-in centre and a GP-led health centre.
- A social enterprise that provides a number of GP practices within a city.
Other types of organisations
There are many other models of service delivery that may affect how different providers should register. Here are some examples.
Federated practices
A federation is a group of practices that come together to share responsibility for a range of functions, which may include:
- developing, providing or commissioning services
- training and education
- back office functions
- safety
- clinical governance
The nature of federations ranges from a relatively loose alliance of practices to a more formal, managed model where the federation is a separate collective entity (for example a social enterprise).
If the federated practices form a separate legal entity that provides regulated activities, it will have to register with CQC as a provider in its own right.
If the practices within a ‘looser’ federation remain as separate legal entities – with each practices retaining legal responsibility for the regulated activities they provide – each practice will need to register as separate providers.
For example…
Example 1
Twelve practices have formed a loose federation. The purpose of the federation is to improve patient care by collaborating for staff training, peer review through clinical networks and for making the best use of existing premises and buildings.
Within this loose federation, all 12 practices remain separate legal entities – each responsible for providing their own services and care.
All practices within this federation must register with CQC as individual providers of regulated activities.
Example 2
XYZ federation is an association of four GP practices that have come together to provide a bigger and better range of services for their local community. XYZ federation is a social enterprise and, therefore, a separate collective legal entity made up of the four GP practices.
Each individual practice does not need to register with CQC as a separate provider, as they are not separate legal entities responsible for the delivery of its services. It is XYZ federation that will need to register as the provider because it's a separate collective legal entity responsible for all regulated activities provided at each of the four practices.
Joint ventures
Where a regulated activity is provided as a joint venture or complex partnership between two providers, the venture will often be a legal entity in its own right and, therefore, must register as a provider. Where the joint nature of the venture is reflected in contracts or agreements – rather than in organisational form – each party may need to register as a provider depending on the individual case.
For example…
If a group of GP practices works in partnership to deliver certain clinical services but each maintains separate accountability for the service they deliver, they would each include this service as part of their GP practice registration.
If they formed a separate legal entity to provide this service, that legal entity would need to register in its own right.
Hosting arrangements
Where an activity is carried on by provider A, but hosted by provider B, provider A will need to register regardless of its host.
For example…
If a provider runs two walk-in centres and one of them is attached to a hospital emergency department, the walk-in centre provider must include this in its registration but the host hospital does not need to.
Renting arrangements
Where provider A rents out its facilities to provider B, provider B will need to register in its own right if it provides a regulated activity in those facilities.
For example…
Where a hospital already registered with CQC rents out a room or a clinic to a GP partnership, the GP partnership will still need to register in its own right if it is providing services independently of the hospital.
Equally, where a GP practice rents out a room to a midwife who provides a weekly maternity clinic, the GP practice is not the provider of the service and, therefore, doesn’t have to include this in its application.
Still not sure?
Email our National Customer Service Centre or call us on 03000 616161 - select option 3 (registration) and then option 2 (primary medical services).
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When you apply to be registered with CQC, we'll ask you to declare whether you comply with all of the essential standards of quality and safety for each regulated activity you provide at each location. To do this, you need to understand how we define a 'location'.
Quick tip
Read our location examples, which show how some common GP practices and other primary medical services might register their locations.
Definition of a location
A location is a place in which, or from which, regulated activities are provided or managed. In our definition of a location, we count each place where people may be treated as a location if the regulated activities provided in these places are managed independently.
What does this mean in practice?
As a general rule, each separate walk-in centre or GP-led health centre will be classed as a location. If you have a single GP practice, this will also be classed as one location.
If you have more than one GP practice, or main GP practice and branch surgeries, you'll need to consider the following:
- If you have more than one GP practice, each GP practice will be classed as a location.
Or
- If you have GP practices that you consider to be main surgery and branch surgeries associated with the main surgery, you can include the branch surgery under the main surgery’s location as long as only patients from the same registered patient list are seen or treated at those places. If the branch surgery treats patients from a different registered patient list to that of the main surgery, the branch surgery will need to be included in your registration as a location in its own right.
If you have more than one location, you can register them all on one registration application form.
For example…
Example 1: A GP partnership with one surgery
This partnership provides services from their main premises. They also make home visits to their patients when necessary and run a fortnightly clinic in a local village hall for patients who cannot make it to the surgery.
The practice has a single list of registered patients – the patients they see in the fortnightly clinic and in their own homes are on their registered patient list.
The partnership only needs to register their main premises as a location.
- The main practice building needs to be registered as a location because they treat patients there.
- Even though they treat patients in their own homes, they don't need to register them as locations because those services are delivered from the main practice.
- The local village hall – where the fortnightly clinic is run – doesn't need to be registered as a separate location. Even though they treat patients there, the clinic isn't managed independently and the patients they see are registered with the main practice.
Example 2: A GP practice with two surgeries – a main practice and an independently managed branch surgery
This partnership provides services from a large practice. They also have a branch surgery, which is managed independently from the main practice and is based in the next town.
The main practice and branch surgery have separate patient lists.
The partnership needs to register the two surgeries as separate locations because they are managed independently and each have their own patient lists.
Example 3: A GP Practice with one main surgery and a branch surgery
This practice provides services from their main surgery and also run a branch surgery close by in the same town.
The practice only has one list of registered patients, which is held and managed at the main surgery. When patients book an appointment, they can be seen at the main site or the branch surgery.
Although the branch surgery is physically located separately from the main surgery there is no need to register the branch surgery with CQC as a location in its own right. Because the branch surgery is managed from the main surgery and both surgeries treat patients from the same registered patient list, the practice should register the two surgeries as a one location. This is because the branch surgery is managed from the main surgery rather than being managed independently.
Example 4: A single-handed GP who visits local care homes
This single-handed GP runs his own small practice. He has a special interest in the care of older people and spends part of his time visiting patients in several care homes.
This single-handed GP only needs to register his practice as a location because this is where all of the services he provides are managed from.
Even though he treats patients at the care homes, he doesn't need to register them as locations because the patients are registered with the main practice and the visits are managed from the main practice.
Example 5: A limited company providing a mix of primary medical services
This limited company runs two walk-in centres and three GP surgeries.
One of the walk-in centres and one of the GP surgeries are based in the same building and share the clinic, waiting room and reception area. The headquarters are also based in this building.
The other surgeries and the walk-in centre are in nearby towns.
This limited company needs to register four locations:
- The walk-in centre, GP practice and headquarters are one location.
- The other two GP practices and walk-in centre are all separate locations because they all provide services that are managed independently and they all have separate patient lists.
Example 6: A single-handed GP who works solely as a mobile doctor
This single-handed GP operates solely as a mobile doctor visiting patients in their own homes and in care homes.
He manages his service and his appointments from an office he rents in a building owned by another GP Practice. Patients are never seen or treated in this office.
He only needs to register his office as a location because this is where the services he provides are managed from.
Even though he treats patients in their own homes and at care homes for example, he doesn't need to register these places as locations. Only the office where the GP manages the visits and the services provided needs to be registered as a location.
Example 7: A social enterprise running a GP practice and a walk-in centre
This social enterprise runs a GP practice with a list of registered patients and a walk-in centre where anyone can turn up to receive unscheduled primary medical services.
Both the GP practice and the walk-in centre are located in the same building. For this reason, the social enterprise will need to register the GP Practice and the walk-in centre as one location.
Although the GP practice and the walk-in centre are two different ‘services’ they can be included in the same registration within the same location.
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2 Tell us what legally regulated activities you'll register for
Quick tip
We've provided help on the most common activities we'd expect primary medical services to register but you should read the full guidance to make sure you register for the correct ones.
We regulate 15 different activities under the Health and Social Care Act. If you carry out any of these activities, you have to register with us.
It may help you to think of these as the services you provide.
We’re expecting up to 9,000 GP practices and 1,000 other primary medical services to register with us. Of those, we expect…
All to register for:
- Treatment of disease, disorder and injury
Most to register for:
- Diagnostic and screening procedures
- Surgical procedures (don’t register this if you only perform curettage, cautery or cryocautery of warts, verrucae or other skin lesions)
- Maternity and midwifery services
Many to register for:
- Family planning services (but only if you fit or remove IUCDs)
You need to make sure you register for the right regulated activities. Full details of all the activities can be found in our Scope of Registration document.
An overview of the regulated activities most relevant to primary medical services
Treatment of disease, disorder and injury
This includes any assessment and treatment undertaken by, or under the supervision of, any specified health care professional in relation to disease, disorder or injury. This list of health care professionals includes doctors, nurses and midwives.
We would expect...
...all GPs and other primary medical services to register for treatment of disease, disorder and injury.
Surgical procedures
This covers surgical procedures carried out by a health care professional that are for the purpose of treating disease, disorder or injury; or cosmetic surgery; or for religious observance (e.g. circumcision).
You don't need to register this activity for the following minor surgical procedures:
- Curettage, cautery or cryocautery of warts, verrucae or other skin lesions undertaken by a medical practitioner using local anaesthesia or no anaesthesia.
- Nail surgery and nail bed procedures on the foot carried out by a health care professional using local anaesthesia or no anaesthesia.
We would expect...
...some NHS general practice and other primary medical care providers to register for surgical procedures.
For example, you may be required to register for surgical procedures if you provide the ‘minor surgery enhanced’ service. We would not expect the ‘minor surgery additional service’ to trigger this activity as it is limited to curettage, cautery and cryocautery.
Diagnostic and screening procedures
This includes a range of procedures related to diagnostics, screening and physiological measurement, including imaging procedures such as ultrasound. It also includes some instances of the removal of tissue, cells or fluids from the body, to diagnose disease, disorder or injury or to monitor its cause or extent. In primary medical care, this activity will be triggered by cervical screening, taking vaginal swabs, ambulatory blood pressure monitoring or the use of ultrasound.
You don't need to register for this activity if you only perform minor diagnostic tests such as 12 lead ECG, single or repeated blood pressure checks, urine analysis or peak flow measurement.
We would expect...
...all GP practices to register for diagnostic and screening procedures.
If you provide other primary medical care services, you must consider if they require you to register for this activity.
Maternity and midwifery services
This activity covers maternity and midwifery services, including ante- and post-natal care, where they are carried out by, or under the supervision of, a health care professional.
We would expect...
...some GP practices and other primary medical care providers to register for this activity.
For example, we expect GP practices that undertake the ‘maternity services additional service’ to register for this activity.
Family planning services
This activity only relates to services for the insertion or removal of an intrauterine contraception device by, or under the supervision of, a health care professional.
It doesn't include contraceptive injections or insertion or removal of contraceptive
implants.
We would expect...
...some GP practices and other primary medical care providers to be registered for this activity.
We don't expect a GP practice to register for this activity solely on the basis that they undertake the ‘contraceptive services additional service'. This is because the contraceptive services additional service specifically excludes intrauterine contraception devices.
Transport services, triage and medical advice provided remotely
This activity covers transport services where they involve a vehicle that was designed for the primary purpose of transporting people who require treatment. This excludes vehicles with a different primary purpose, such as taxis, volunteers using their private cars, or mortuary vehicles and Dial-a-Ride vehicles.
We would not expect GP practices to be registered for this part of this regulated activity.
Medical advice provided remotely
Remote advice is captured by this activity when clinical advice is given over the phone or by email and that advice is for immediate attention or constitutes triage, and it is provided by
a body established for that purpose.
We would expect...
...some other primary medical care providers to register for transport service, triage and medical advice provided remotely.
As the definition highlights that the body registering must be established for the purposes of triage, we would not expect most GP practices to be registered for this activity.
If you provide out-of-hours services to your own patient list we would not expect you to be registered for this activity.
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Less common regulated activities for GPs and other primary medical services (added 29 March 2012)
Personal care
The definition of personal care means physical assistance, prompting or supervision given to a person in connection with:
- eating or drinking
- toileting (including in relation to the process of menstruation)
- washing or bathing
- dressing
- oral care
- care of skin, hair and nails (with the exception of nail care provided by a chiropodist or podiatrist).
We would not expect...
...most GP practices and other primary medical care providers to register for this activity.
Nursing care
Even though the majority of GP practices will employ nursing staff, the definition of this activity only covers nursing care where it is not part of another regulated activity.
Therefore, in most cases, activities carried out by nurses working in general practice and primary care will be covered by other regulated activities.
For example, you may employ nurses to provide care and advice to patients with long-term conditions such as diabetes. But this activity will be covered under the ‘Treatment of Disease, Disorder and Injury’ and does not require you to also register for ‘Nursing care’.
We would not expect...
...most GP practices and other primary medical care providers to register for this activity.
Accommodation for people who require nursing or personal care
Accommodation for people who require treatment for substance misuse
Accommodation and nursing or personal care in the further education sector
These activities all include the provision of residential accommodation.
We would not expect...
...most GP practices and other primary medical care providers to register for these activities.
Assessment or medical treatment for people detained under the Mental Health Act 1983
This activity covers where people are detained or recalled for treatment or assessment under the Mental Health Act 1983. It only relates to the detaining authority itself (e.g. hospitals) even where other people – such as GPs – are involved in the assessment.
We would not expect...
...most GP practices and other primary medical care providers to register for this activity because they are not detaining services.
Management of supply of blood and blood derived products
This activity only relates to management and supply of:
- blood and tissue products
- donor organs
- stem cells
- bone marrow
It doesn't cover storage of or access to those products.
Having appropriate equipment and supplies, and storing them, will be covered by activities such as ‘treatment of disease, disorder or injury’ or ‘surgical procedures’. Therefore, you won't have to register for this activity separately.
We would not expect...
...most GP practices and other primary medical care providers to register for this activity.
Termination of pregnancies
The termination of pregnancy, by any method (either surgical or medical), is included in this activity. It does not include advice on termination of pregnancy or prescribing of the 'morning after pill'.
We would not expect...
...most GP practices and other primary medical care providers to register for this activity.
Services in slimming clinics
This activity only applies where the physical location is a slimming clinic. It doesn't apply to clinical sessions.
We would not expect...
...most GP practices and other primary medical care providers to register for this activity.
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3 Tell us who in your organisation will be responsible for complying with the essential standards
Quick tip
Some practices we spoke to thought their practice manager should be the registered manager.
Because registered managers need to be able to influence compliance with the essential standards, a partner is usually more appropriate.
All providers of care need to tell us who will share responsibility for ensuring that the essential standards are met.
Most providers will need registered manager(s). These people will share legal responsibility with the provider for ensuring that the regulated activities meet the essential standards.
You'll only need a nominated individual if you register as an 'organisation'. This person will act as the main point of contact with CQC for each regulated activity. This should be a director, manager or company secretary.
You need to make sure you choose the appropriate people to be your registered manager(s) and nominated individual(s).
What is a registered manager
A registered manager is someone who is registered with CQC to be in day-to-day management of one or more regulated activities. The registered manager has legal responsibilities and they share the legal responsibility for compliance with the regulations with the provider.
Who needs one?
Partnerships and organisations
You'll need a registered manager if you 're registering with CQC as a partnership or an organisation.
Individuals
You'll also need a registered manager if you're registering as an individual who is not in day-to-day charge of the regulated activities you deliver.
How many registered managers should there be?
A manager can be registered for one or more regulated activities, and at one or more locations.
You can appoint more than one person to be the registered manager at the same location if they manage different regulated activities, or if job share arrangements are in place.
Who should be the registered manager?
We know that many practice managers are being considered for the role of registered manager. In some cases this may be correct but the roles and responsibilities of practice managers vary significantly and it may not always be appropriate.
The person registered as the registered manager needs to be in a position where they are in day-to-day charge of the regulated activities and can influence how those activities are delivered. This is because they have a responsibility to ensure that the provider is compliant with the essential standards. For this reason, in most cases it should be a partner that takes on this role.
For example…
Example 1
Sally is the practice manager for a practice that has three GP partners.
Sally has been appointed the person at their practice who will complete the application form and gather all the information from the partners required for the form.
In her practice, Sally manages the day-to-day running of the practice – including things like human resources, information technology and financial management. However, it is the partners who manage how the regulated activities are carried out. They're responsible for making sure that the services provided in the practice are safe and that there is good-quality care provided in line with the essential standards.
For example, when delivering the regulated activity relating to diagnostics and screening, it's the partners who are responsible for ensuring that patients receive this care in a clean environment that meets infection control guidelines (essential standard: outcome 8) and that the equipment used is safe (essential standard: outcome 11).
Therefore in this scenario, it is one of the partners who should be the registered manager, not Sally.
Example 2
Bob is a practice manager at a practice where he is a partner with two other GPs.
As a partner, Bob is jointly responsible with the other partners for the day-to-day management of the care that's delivered at the practice. As such, he's in a position to take legal accountability for the overall quality and safety of the service and he's able to influence and ensure compliance with the essential standards.
This means Bob is a suitable candidate to take on the role of registered manager.
For example, as the registered manager for the regulated activity of maternity and midwifery services (and in his role as partner in the practice) Bob can ensure the activity is delivered in a way that meets the essential standards, including making sure that people are safeguarded from abuse (essential standard: outcome 7) and that the medicines involved in the care are managed appropriately (essential standard: outcome 9).
Example 3
Janine is the clinical director for a limited company that runs two walk-in centres.
Janine is part of the senior management team of the limited company. She's already responsible for monitoring the quality of the services in both walk-in centres and for ensuring their compliance with existing legislation and best-practice guidance. As such, she's in a position to take legal accountability for the overall quality and safety of the service and is able to influence and ensure compliance with the essential standards across both walk-in centres.
Therefore Janine wold be an appropriate person to take on the role of registered manager.
For example, as the registered manager for the regulated activity of Treatment of Disease, Disorder and Injury (and in her role as clinical director) Janine can make sure the activity is delivered in a way that meets the essential standards, including ensuring the care and welfare of people who use services (essential standard: outcome 4) and assessing and monitoring the quality of service provision (essential standard: outcome 16).
Example 4
Andrew is the medical director for a large practice with four locations, and job shares that role with Katie. Andrew is in that role on Monday, Wednesday and Friday, and Katie takes on the role on Tuesday and Thursday.
Within their practice, Andrew’s and Katie’s position has been identified as the most appropriate role to be given the responsibility of registered manager for the regulated activity of ‘Treatment, Disease, Disorder and Injury’. Together they share, with their provider, the legal responsibility of ensuring they are compliant with the essential standards for that activity.
In the registered manager section of the registration application form they will tick the ‘job share’ option, and both will be able to be identified as the registered manager for that activity.
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If you're applying for registration as an organisation, you'll need to nominate someone to act as the main point of contact with us.
This should be someone who has responsibility for supervising the management of the regulated activity, for example a director, manager or company secretary.
You'll need to nominate an individual for each regulated activity. However, the nominated individual can cover all or several regulated activities and can be the same person as your registered manager.
4 Tell us if you already comply with the essential standards or if you need to think about any changes
How to prepare
Think about whether the regulated activities you provide at each of your locations comply with the 16 essential standards of quality and safety.
Read the guidance
If you aren’t already familiar with the essential standards, you should start by reading our Guidance about compliance: Essential standards of quality and safety.
This guidance is relevant to all health and social care services. It focuses on the outcomes for patients – that is, what patients should be able to expect from the care they receive. It includes a ‘prompts’ section for each essential standard that will help you ask the right questions of yourself.
For each essential standard, our guidance also contains the actual text from the regulations. The essential standards are there to help you understand how the regulations can be translated into outcomes for patients but you should also read and understand the regulations – you’ll be inspected and regulated against these.
Guidance from other professional bodies
Other bodies – such as the BMA – also provide guidance about compliance specific to GPs and other primary medical services. You can review the BMA's recently published Guidance on CQC registration.
You need to comply with the essential standards of quality and safety.
Read our guidance to find out what each of the essential standards mean for you and your patients.
CQC will monitor compliance against the 16 essential standards, which are split into five general themes
Treating people with respect and involving them in their care
- Respecting and involving people who use services
- Consent to care and treatment
Provision of care, treatment and support that meets people’s needs
- Care and welfare of people who use services
- Meeting nutritional needs
- Cooperating with other providers
Caring for people safely and protecting them from harm
- Safeguarding people who use services from abuse
- Cleanliness and infection control
- Management of medicines
- Safety and suitability of premises
- Safety, availability and suitability of equipment
Staffing
- Requirements relating to workers
- Staffing
- Supporting workers
Management
- Assessing and monitoring the quality of service provision
- Complaints
- Records
We know there have been questions and concerns about certain essential standards so we have included extra guidance on these here to help you in your preparations for registration.
If you’re still not sure whether you’re compliant with this essential standard, read the full guidance on Meeting nutritional needs (outcome 5).
We don’t expect this essential standard to be relevant to GPs and other primary medical services because they don't provide food and drink to patients as part of their service. This doesn’t mean you should declare non-compliance as this would indicate that patients are at risk.
If this standard isn’t relevant to you, when you fill in your registration application you should declare that you're compliant with this standard.
If you’re still not sure whether you’re compliant with this essential standard, read the full guidance on Safety and suitability of premises (outcome 10).
We know there are concerns about the standard related to the safety and suitability of premises.
We won’t refuse you registration just because you don’t have modern or state-of-the-art premises. We'll only take action if patients are being put at risk by unsafe premises.
If your premises don’t meet this essential standard because, for example, you don’t have the correct disabled access, you need to be managing those risks to patients. If you are already managing the risks to patients effectively by adapting your service provision to meet the needs of patients, you should declare that you are compliant with this essential standard.
Otherwise you should declare that you are not compliant. You will still be able to register, but we'll ask you to create an action plan that tells us how you're going to manage the risks to patients when you fill in your application.
Look at the outcomes for patients
Lots of primary medical services have asked us what procedures and processes they should have in place in order to comply.
It's likely that you can use your existing procedures to check your compliance. What’s important is how you identify and manage risks to patients.
The focus of compliance with the essential standards is on outcomes for patients rather than processes and procedures. We also recognise that the way different providers monitor and demonstrate their compliance varies and depends on your size, the range and complexity of the services you provide, how many staff you have and how they work together.
Use existing information
It might be helpful to start by thinking about how you already monitor the quality and standard of your services. For example, you might be gathering information and evidence for the Quality and Outcomes Framework (QOF), Primary Care Trust (PCT) contract monitoring or through involvement in quality schemes such as the Royal College of GPs’ Quality Programmes.
You may also be collecting feedback from patients about their experiences of care in your practice, for example through your Patient Participation Group. You can use all this existing information to monitor your own compliance.
You can still submit your registration application even if you don’t comply, but we’ll ask you to create an action plan.
We’ll only refuse registration or add conditions to it if we think there are risks to patients.
If there are any essential standards you don’t comply with, we’ll ask you to complete an action plan on your registration application to tell us:
- Why you don’t comply (up to 2000 characters)
- What you will do to become compliant (up to 2000 characters)
- How you’ll make sure you continue to be compliant (up to 2000 characters)
- The date you expect to become compliant (day/month/year)
How do you create an action plan?
You can start creating your action plan(s) as soon as you’ve decided if you comply with the essential standards.
- They should be concise and succinct and should follow the section titles and character limits above.
- Some plans might cover more than one essential standard. For this reason, we’ve made sure that the online form will allow you to create them to cover one or several essential standards.
- We’ll only ask you for a text version of your plan(s) in your application – you won’t be able to upload any additional documents or files and you shouldn’t send any evidence to us unless we specifically ask you to.
- You might want to start creating action plans using Word or other text file formats before you start your application. If you do, you’ll be able to copy and paste them into the online form.
5 Tell us which service types you will need to register
Quick tip
The majority of GP practices only provide 'Doctors' treatment services' and 'Doctors' consultation services'.
In some cases you may need to register other services types so check the guidance carefully.
There are 28 service types. When you fill in your application form you will be asked to tell us which service types you provide.
We expect:
- All GPs and some other primary care providers to register for ‘Doctors’ treatment services’ and ‘Doctors’ consultation services’.
- Some GP practices to register for ‘Mobile doctors’ services’.
- Some minor injury units to register for ‘Acute services’.
- All urgent care centres, minor injury units, GP-led health centres and walk-in centres to register for ‘Urgent care services’.
You need to make sure you register for the right services types. Read about each of the service types in more detail below.
Doctors' treatment services
We would expect all GP practices and most primary medical services to register this service type.
What does this service type involve?
This service type involves doctors working in premises or a room designated for minor medical treatments as well as medical consultation.
Often the doctor will complete medical consultations, including physical examination and simple physiological measurements (such as blood pressure tests, weight checks, peak flow readings). They will discuss diagnosis and treatment options and may prescribe medicines for the patient to take at home. They will also undertake minor invasive investigations or procedures, such as conscious endoscopy, in a treatment room designed for this purpose.
There may be other health care professionals, for example nurses, supporting the work of the doctor.
Doctors' consultation services
We would expect all GP practices and most primary medical services to register this service type.
What does this service type involve?
This involves doctors working in premises or a room designated for medical consultation.
Often the doctor will complete medical consultations, including physical examination and simple physiological measurements (such as blood pressure tests, weight checks and peak flow readings). They will discuss diagnosis and treatment options and may prescribe medicines for the patient to take at home.
There may be other health care professionals (e.g. nurses) supporting the work of the doctor.
Mobile doctors' services
We would expect some GP practices to register this service type.
We would not expect other primary medical services to register this service.
What does this service type involve?
This service type involves a person living in their own home and receiving care and/or support in order to promote their independence.
The care they receive is regulated by the Care Quality Commission, but the accommodation is not.
The support that people receive is continuous, but is tailored to their individual needs. It aims to enable the person to be as autonomous and independent as possible, and usually involves social support rather than medical care.
Urgent care services
We would not expect most GP practices to register this service type.
We would expect most other primary medical services – such walk-in centres and urgent care centres - to register this service type.
What does this service type involve?
This service type is provided in parallel with an emergency department and can vary greatly from one provider to another.
The service type generally comprises a triage service, run by doctors and nurses.
Providers will not usually screen people whose symptoms require immediate, very urgent or emergency care. Instead, they screen standard cases where time is not of the essence and, where possible, refer these for immediate consultation with an on-site primary care provider.
They may provide services such as:
- consultations with a doctor
- physical examinations and simple physiological testing and measurement
- diagnosis and treatment
- prescribing medicines
- referrals to other primary care services.
Acute services
We would not expect most primary medical services to register this service type.
We would expect some minor injury units to register this service type.
What does this service type involve?
Acute services are complex and vary greatly. Generally, they include medical and/or surgical investigations, diagnosis and treatment for physical illness or condition, injury or disease.
They can include services to adults, children or both. They may include services to a broad range of patients or to a particular group of people.
They can:
- admit people on a day case basis or as inpatients.
- admit people at short notice or in an emergency (whether or not they have a dedicated emergency department).
- see people on an outpatient basis.
They may also provide services such as:
- surgical operations
- specialist medical treatments
- emergency
- consultations
- diagnostics
- maternity and neonatal
- pathology
- termination of pregnancy
- complex dental procedures
- liaison psychiatry.
People are usually admitted to the service under the care of a medical or clinical practitioner. The service may employ a broad range of health care professionals to meet the needs of the people using the service. Some providers may be smaller than others and may not offer the same range of acute services than, say, a local district hospital may offer (such as an emergency department).
For more information about each service type, read pp.13 to 31 of Guidance about compliance: Essential standards of quality and safety
We would not expect any primary medical services to register for these service types
- Ambulance services
- Blood and transplant services
- Care home services with nursing
- Care home services without nursing
- Community health care services
- Community-based services for people with mental health needs
- Community-based services for people with a learning disability
- Community- based services for people who misuse substances
- Dental services
- Diagnostic and/or screening services
- Domiciliary care services
- Extra care housing service
- Hospital services for people with mental health needs, a learning disability or problems with substance misuse
- Hospice services
- Hyperbaric chamber services
- Long-term conditions services
- Prison health care services
- Rehabilitation services
- Remote clinical advice services
- Residential substance misuse treatment and/or rehabilitation services
- Shared lives
- Specialist college services
- Supported living services
6 Start thinking about Disclosure and Barring Service (DBS, formerly CRB) checks
When you register with CQC, some members of your organisation may need a DBS check. For registration, we only accept CQC-countersigned DBS checks at enhanced level.
What you should be doing now
Read the information we've added below and consider who in your practice or organisation will need to apply for a CQC-countersigned, enhanced level DBS check and when they need to apply.
Apply for a DBS check
CQC-countersigned, enhanced level DBS checks
You'll need a CQC-countersigned, enhanced level DBS check if you’re registering as:
- a partner in a GP partnership
- an individual
- a registered manager.
- Don’t apply too early for these checks – they’re only valid for six months and need to be valid at the time we assess your application.
- Most providers and registered managers need to apply for these checks now – but bear in mind that they’re valid for a limited time.
Apply online
The DBS application process is now online at https://cqc.disclosures.co.uk/.
Once you've completed your online DBS application, you'll be asked to print out a referral letter. You'll need to take this and the proof of identification requested in the form to one of 300 Post Offices to verify your identity. The Post Office charges a fee of £17.50 for this.
You'll then receive your CQC-countersigned, enhanced level DBS certificate in the post. The process should take about one week though it may be longer.
Red pins indicate Crown Post Offices while yellow ones represent agency branches.
All opening hours are correct as 10 May 2012. You can find out more on the Post Office branch finder by selecting the 'CQC & CRB ID Verification Service'.
You can also download a list of either the Crown Post Offices or the agency branches that offer this service below.
