Response to a consultation on the framework for the registration of adult health and social care providers

Introduction

MPS welcomes the opportunity to comment on the registration requirements set out in this document.  We recognise that the pilot scheme will give more information about how the requirements will work in practice and the transitional arrangements in moving from the current system to the proposed system.

Specific comments

Chapter 2: Registration requirements for essential safety and quality

We propose to introduce a generic set of registration requirements (set out in regulations) for all providers offering services that are within scope. These requirements will be supplemented by compliance criteria, to be developed by the Care Quality Commission, that are specific to the type of activity. These will be consulted on at a later date. Do you agree with this approach? Do you have any comments?

Yes, we do agree with this approach, and are pleased to see that each specific activity will be taken separately and consulted on. 

Are the areas covered by the registration requirements (set out in Annex A) the right ones to provide the assurance of the essential levels of safety and quality that we are aiming for? If not, are there any we need to add or take out?

Yes, we believe that these are the right areas to provide the assurance of the essential levels of safety and quality. 

Does the wording of the registration requirements in Annex A provide appropriate coverage of these areas? If not, what do we need to add?

We have specific concerns about one of the examples given in Annex A, which refers to an expectation that every consultation would be accompanied by a diagnosis. This, in practice, is unattainable.

In reference to the second registration requirement 2 – Safeguarding people when they are vulnerable – it is possible to argue that anyone consulting a health professional is vulnerable.  They are usually unwell, worried and, in some cases, not well-informed about their situation.  We would expect the different organisations preparing the guidance to give further details on how vulnerable people within their specialty will be recognised. 

Registration requirement 17 refers to supporting workers to give people the care and treatment they need.  Doctors are obliged by their registration body to offer what assistance they reasonably can in an emergency, even if this takes them outside their area of expertise.  This should be reflected in this requirement.

Are there any overlaps, or gaps or unintended consequences that will not be picked up by other parts of the system? If so, what are they?

As the system is set out in the consultation document, we cannot see any areas in which there are gaps, overlaps or unintended consequences.  The pilot scheme with the Royal College of General Practitioners may do so.

What are your views on the transition arrangements for existing providers to enter the new registration system?

The transitional arrangements lack practical details but the ”bare bones” of the plan seem sensible.  However, without further information about how the transfer to the new scheme will work, it is very difficult to comment more fully. 

Chapter 3: Scope – which health and adult social care services should be registered?

Do you agree with our proposed list of regulated activities in Annex B to be included within the scope of registration?

Yes, we do agree with the proposed list of regulated activities to be included within the scope of registration.

Are there any high-risk services not covered? If so, what are they?

There are areas that we are concerned to see are not considered to need regulation. Under surgical services, non-surgical cosmetic procedures are not considered to need regulation. Patients in such groups are frequently vulnerable, and the scope for exploitation is certainly there.  We suggest that this needs to be considered.

Under the dental services section, tooth-whitening procedures have not been referred to.  We suggest that this is an area that needs regulation.

We suggest that there may be situations in which complementary medicines and therapies should be regulated. Therefore, the proposed regulated activities will need to include more details of when this may be appropriate.

Have we proposed any inappropriate registration of lower-risk services? If so, which are they?

We do not believe that there have been any proposals for inappropriate registration of lower-risk services; however, with more detailed implementation plans, there may be some identified.

What are your views on the exclusion of non-urgent patient transport services under the Emergency and Urgent Care activity topic?

This is not an area that MPS is able to comment on.

What are your views on the proposals for the registration of agencies who supply workers to other registered providers, under the 'Personal Care' and 'Nursing Care' activity topics?

This is not an area that MPS is able to comment on.

Are the activities for registration described at the right level of detail, given that they will be underpinned by more specific and legally enforceable regulations? If not, what do we need to change?

There are specific areas where further clarification would be valuable. However, it is difficult to do this without guidance from professional bodies and other organisations.

Is there a risk of inappropriately deregulating high-risk activities in this approach? If so, what do we need to do to avoid that?

We do not believe that this approach will lead to the deregulation of high-risk activities.

Have we determined the right situations in which to register a manager? If not, what do we need to change?

Without further details, it is difficult to comment on whether or not the right situations in which to register a manager have been determined.  It is also very unclear about where and how GP surgeries would fit in.

Chapter 4: Registration of primary care

Does the list of activities in Annex B appropriately capture the services, where people might be at risk of harm provided in primary care settings?

Yes – we believe that the services provided in a primary care setting are covered by the list of activities set out in Annex B.  

In particular, do you agree with our proposal that ultimately all GP and primary dental services should be within the scope of registration? If not, what are your views?

We do agree that all GP and primary dental services should be within the scope of registration.

Does the list of activities in Annex B inappropriately capture some services that are less likely to cause harm when provided in primary care settings? If so, what are they?

In our opinion, the list of activities in Annex B does not inappropriately capture some services that are less likely to cause harm when provided in primary care settings.

What information would you expect the new Commission to draw on when making decisions? How could it best do this?

We would suggest that the new Commission makes full use of the information captured within current regulation and contracts. 

What is the scope for rationalising the existing requirements on primary care providers if a registration system is introduced?

Primary care providers are subject to many regulatory requirements – a rationalisation of these would be welcome.  We would, however, suggest that this is not undertaken without the input of the relevant professional bodies.

When should services provided in primary care settings be required to register? Should we phase in registration?

This is not an area that MPS is able to comment on.

If we do phase in registration, how should we determine the services to be captured?

This is not an area that MPS is able to comment on.

Is our assessment of the costs and benefits in our accompanying Impact Assessment (available on the DH website, alongside the consultation document) reasonable? Do you have any additional information on impact that we could use?

This is not an area that MPS is able to comment on.

Annex A: Proposed topics for registration requirements – for essential levels of safety and quality

Please refer to our comments under Chapter 2.

Annex B: Scope

Please refer to our comments under Chapter 3.
 
Should you require further information about any aspects of this consultation, please do not hesitate to contact me.