Published: 20 February 2019
CQC have recently confirmed on 8 February 2019, in a letter to the Association of Tongue-tie Practitioners (ATP), that ‘frenulotomy’, where carried on, by or under the supervision of a healthcare professional, is the Regulated Activity (RA) ‘surgical procedures’.
Independent midwives who are exempt from the need to register with CQC for the RA ‘maternity and midwifery’ services, will need to register for the RA ‘surgical procedures’ in order to carry out this procedure.
Frenulotomy is not the RA ‘maternity and midwifery services’, even when it is carried out by a midwife. This RA is defined by paragraph 10 of Schedule 1 to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Tongue-tie is a condition which most often manifests as a difficulty by the infant to breast feed and attach to the mother’s breast. This is not the RA ‘maternity and midwifery services’ because treating it is not part of midwifery care. It is carried out on the child, either soon after birth or at any time subsequently (including in adults where it causes other difficulties, by other health care professionals such as dentists).
Frenulotomy is the RA ‘surgical procedures’ because it involves the surgical cutting, using an instrument (normally blunt-ended scissors), to divide the lingual frenulum. This RA typically involves the use of instruments inserted into the body, including incision with instruments.
There have been requests that individuals may continue to perform frenulotomy while any necessary applications for registration are made and determined. In this situation CQC does not have the power to grant this. Registration with CQC is a statutory obligation for all those wanting to carry on a regulated activity.
Section 10 of the Health and Social Care Act 2008 makes clear that non-compliance with this obligation is an offence. CQC has no power to disapply Section 10, nor to grant providers permission to carry on a regulated activity without registration. Neither can we issue a catch-all statement to providers to the effect that no action will be taken against any such provider in any circumstances. However, we can and do treat each case on its merits, considering the individual circumstances and the risks to patients in seeking to apply Section 10 in the public interest.
Providers who are registering for the regulated activity ‘surgical procedures’ solely because they undertake frenulotomy will not be charged a fee for being registered with CQC at the point of registration up to and including 31 March 2020. This is regardless of how those providers are structured legally or commercially. CQC will assess the cost of regulating these providers and consult on the implementation of fees from the financial year starting 1 April 2020, as part of the next fees consultation which will open in the autumn of 2019.
Individuals who need to apply to be registered if they carry on the RA of ‘surgical procedures’ can find more information, including the link to the application form.
For additional reference, NICE guidance, Division of ankyloglossia (tongue-tie) for breastfeeding: “Interventional Guidance Procedures [IPG149]” NICE 2005, is available.