Contents
- Introduction
- Who has to register?
- General exceptions and exemptions from registration
- The regulated activities
- Glossary of terms
General exceptions and exemptions from registration
This section contains:
- Medical practitioners in independent practice
- Individual budgets, self-funded nursing care or personal care and individual user trusts
- Third party exceptions
- Other exceptions
A number of general exceptions may apply to registration with CQC (read Schedule 2 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014). These include exceptions that:
- clarify which aspects of a service do not need to be registered separately
- apply to certain types of provider
- apply only in certain circumstances (see the guidance for each regulated activity).
Where a provider is exempt from the need to register for a specific regulated activity or if an exception under Schedule 2 applies, they should still check if they need to register for any other regulated activities.
Medical practitioners in independent practice
In Schedule 2, paragraph 3, an exception applies to the provision of treatment in a surgery or consulting room by a medical practitioner who is (or a group of medical practitioners who are):
- a service provider already registered for the regulated activity of Treatment of disease, disorder or injury
or
- employed by such a service provider
and either
- on the medical performers list for a designated body
or
- employed by a service provider that is a designated body.
By medical practitioner, we mean a doctor registered with the General Medical Council.
This exception does not apply to medical practitioners who are carrying out the following procedures detailed in Schedule 2, paragraph 4:
- treatment carried out under anaesthesia or intravenously administered sedation, apart from the following procedures detailed in Schedule 1, paragraph 6(2):
- nail surgery and nail bed procedures on any area of the foot that are carried out using local anaesthesia or without anaesthesia
- curettage (scraping), cautery (burning) or cryocautery (freezing) of warts, verrucae or other skin lesions carried out using local anaesthesia or without anaesthesia
- medical services provided in connection with childbirth
- the termination of pregnancies
- cosmetic surgery, with the exception of:
- the piercing of any part of the human body
- tattooing
- subcutaneous injections of a substance(s) to enhance appearance
- removal of hair roots or small blemishes on the skin by applying heat using an electric current
- haemodialysis or peritoneal dialysis
- endoscopy, other than using a device that does not have a lumen or another channel designed to pass fluid or instruments through, or remove body tissue or fluid or any other item from, a person’s body
- providing hyperbaric therapy, by administering oxygen (whether or not combined with one or more other gases) to a person who is in a sealed chamber that is gradually pressurised with compressed air, where the therapy is carried out by or under the supervision or direction of a medical practitioner
- intravenous, intrathecal or epidural administration of medicines or diagnostic agents
- the therapeutic or diagnostic use of x-rays, radiation, protons or magnetic resonance imaging
- invasive cardiac physiology tests.
For the purpose of this guidance, granting of practising privileges by a designated body is considered the same as being employed by the designated body.
This exception does not apply to an organisation or a partnership that employs a range of staff as well as medical practitioners. It does not apply to treatment provided outside of a surgery or consulting room, or to treatment provided remotely over the telephone, by video consultation or by email.
This diagram illustrates this exception for medical practitioners working in private practice.
Individual budgets, self-funded nursing care or personal care and individual user trusts
Nursing care
A person can use their own finance or individual budget (provided by the local authority or health authority) and make their own arrangement for nursing care where a registered nurse works directly for them and under their control, without involving an agency or employer in managing or directing the care provided. In this case, the registered nurse may not need to register with CQC. However, this exception only applies to the regulated activity of Nursing care. If nursing activities involve treatment, then the regulated activity of Treatment of disease, disorder or injury is likely to apply instead. There is no exception from registration for the regulated activity of Treatment of disease, disorder or injury for nurses who are directly employed by an individual.
Personal care
A person, or a related third party on their behalf, can make their own arrangement for personal care where a care worker works directly for that person and under their control, without involving an agency or employer in managing or directing the care provided. In this case, the care worker does not need to register for the regulated activity of Personal care.
These exceptions for Personal care and Nursing care only apply where a person directly employs a care worker to provide their personal care or a nurse to provide them with nursing care. If the care worker or nurse stops working for the person in a directly employed capacity and instead sets up a limited company for business arrangements, they then work for their own company. The company then becomes responsible for providing personal or nursing care and has an ongoing role in how the service is provided. In this case, the company may be in scope for registration and need to register for the regulated activity of Personal care and/or Nursing care.
If directly employed individuals provide nursing or personal care in their own home overnight, they are providing the regulated activity of Accommodation for persons who require nursing or personal care, and they may be in scope for registration and need to register (unless the care is provided through a Shared Lives Scheme).
An individual user trust can be set up to make arrangements for services to meet the health or social care needs of a named person. The user trust is exempt from registration as it is the provider of the services and not the body of trustees that is carrying on the regulated activity. This is detailed in Regulation 4(4) of the Care Quality Commission (Registration) Regulations 2009.
Introductory or employment agencies
Employment agencies (sometimes known as introductory agencies) are exempt if:
- they only help people find registered nurses, nursing associates or care workers, and
- they do not have any role in managing or directing the nursing or personal care that a registered nurse, nursing associate or care worker provides.
See further details of what we mean by having no ongoing role in providing a personal care service.
Third party exceptions
The following are some examples of exceptions from registration for other services. They are grouped together because they represent services that may be organised through a third party, which may be the provider's 'customer'. This arrangement is different from most other health and care services, which are organised directly between the provider and the person who uses the service. It is not a complete list; see Schedule 2 for full details of exceptions.
- Medical or dental service occupational health schemes (that do not involve treatment requiring admission to hospital) organised through an employer, where these are for the benefit of the employee only.
- Medical or dental services organised by a government department that do not involve treatment requiring admission to hospital (for example, medical assessments to determine eligibility for social security benefits, or services arranged on behalf of people by the Maritime and Coastguard Agency).
- Assessment and treatment that is related to insurance and organised through insurers (for example, if an assessment is needed as part of assessing claims for injury through accident insurance, travel insurance or motor insurance). However, this exception does not include services organised through private medical insurance schemes.
- Defence medical and dental services organised through the armed services, including education and training for delivering health and dental care that is provided by, and delivered to, armed services personnel.
- Forensic medicine or dental services (for example, for people detained in police custody) that is organised solely through a local policing body as defined in section 101 of the Police Act 1996.
Other exceptions
The following are also activities excepted from registration:
- Any health or social care activity carried out by a carer for a member of their family or someone they are in a personal relationship with, where the care is provided during that family or personal relationship for no commercial consideration. This means a person does not pay another person when they provide or promise to provide a service. A family relationship can include people treating each other as if members of the same family, so long as they are living in the same household. A personal relationship means a relationship between or among friends, including family friends.
- Primary ophthalmic services (for example, high street optometrists) or ophthalmic services that are of the same kind as those provided by high street optometrists.
- Primary pharmacy services (for example, high street pharmacists) or pharmacy services that are of the same kind as those provided by high street pharmacy services.
- Treatment provided by a registered nurse to pupils in a school, where the nurse is engaged and directed by the school. In general, this will exempt school registered nurses in independent schools, but not in public sector or state schools, where the school nursing service will be included in the registration of the relevant provider.
- First aid provided in the following circumstances by:
- organisations established to provide first aid
- healthcare professionals in unexpected or potentially dangerous situations requiring immediate action
- non-healthcare professionals who are trained to deliver such treatment.
- Nurses' agencies acting as an employment agency that supplies staff to organisations carrying on regulated activities, but that do not provide any regulated activities themselves.
- Activity carried on for the purpose of testing for coronavirus (COVID-19) presence or antibodies, or for processing, analysing or reporting the results of those tests (see the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Schedule 2 paragraph 12).