CQC Remains Inactive With Unregistered Providers

CQC Remains Inactive With Unregistered Providers

In their evasive response to an FOI request from GDPUK the CQC have as good as confirmed that they are all about optics and have little interest in outcomes. This relates to their abject failure to ensure that organisations that should register, actually do.

The background is uncontested:

The CQC describe themselves as “The independent regulator of all health and social care services in England.

If a person or organisation provides certain clearly defined ‘regulated activities’ they must register with the CQC.

This includes Direct to Consumer Orthodontics (DTC) where patients’ mouths are scanned as part of the process.

As reported on GDPUK at the time CQC made this clear in their statement in June 2021, confirming, “orthodontic treatments provided to patients following an intra-oral scan or when a patient has taken impressions themselves to be regulated activity”.

According to the regulator, these treatments need to be regulated in the same manner that clear aligner treatment planning and diagnosis is—meaning that any provider of these services must register with CQC first.

There is at least one DTC provider that has well promoted, city centre, shopfront locations, offering scanning for their orthodontic offering. These do not appear to be registered with the CQC.

The CQC claim to have an ‘unregistered provider process,’ which starts when information is provided to them of a possible case. There is no doubt that they are aware of the DTC providers.

The unregistered provider process is clear, a letter is sent to the suspected unregistered provider, setting out the options open to them. These are, to cease operating and apply to register, cease operating, or to explain why they they do not carry out regulated activities. Given the CQC statement in June 2021 the third option cannot apply to DTC orthodontics.

If the letter is not responded to in 28 days the process will be ‘escalated’.

By early February, the CQC had at an absolute minimum 6 months to ‘escalate’ their action, and the unregistered provider was still flourishing.

GDPUK sent the following FOI to the CQC and have now, a month later, received a response (CQC replies in bold):

1 When the CQC first received information relating to direct to consumer orthodontic  providers, carrying out regulated activities, who might not be registered. (One example would be Smile Direct Club who operate from 3 London locations as well as sites in Birmingham, Leeds Manchester and periodic pop-ups. The CQC has acknowledged that intra oral scanning, as carried out at these sites, is a regulated activity and so would require registration.)

Exempt under Section 12 (exceeds appropriate limit)

2 The date that the first letter or other communication from CQC, as part of its unregistered provider process, was sent.

Exempt under Section 12 (exceeds appropriate limit)

3 How many such letters have been sent to direct to consumer orthodontic providers.

From October 2020 nine letters have been sent.

4 Which DTC providers have applied to register or are known to have ceased unregistered operations in England since the CQC’s unregistered provider process commenced.

Information from October 2020 - specific details of the direct to consumer providers that have been issued with letters is exempt from disclosure engaging Section 43(2) and Section 31 of the Freedom of Information Act 2000. More detail regarding these exemptions can be found below.

5 What action has been taken in each case where a response has not been received by CQC within 28 days of sending its initial letter.

Our standard process is that if we do not receive a response to an URP letter we would have a management review meeting to consider next steps, which can include whether to undertake an URP inspection (enforcement visit to gather evidence) pursue other lines of enquiry to gather evidence e.g. witness statements or no further action if a review indicates the service has ceased to operate. Further detail is exempt from disclosure under Section 12 of the Freedom of Information Act.


There are many more pages in their response which refer to the FOI act and explain their grounds for withholding so much of the requested information. However from the answer given to question 5 it is clear that there are recognised pathways to follow. We have been given no evidence that any of these are being pursued by the CQC.

All we know for sure is that the CQC have over the course of at least 17 months sent 9 letters. Given their coyness when responding to our FOI, that may well be all that they have done.

The CQC can, when they want to, take action. On 10 June 2020, a domiciliary care provider was fined £34,833 and ordered to pay a £170 victim surcharge and £9,000 in costs as a result of a prosecution brought by CQC for failing to be registered.

Since the CQC are not willing to answer questions about unregistered DTC providers, here are some for the rest of us to ponder:

Are the CQC simply incompetent?

Are the CQC scared of engaging with the high powered legal teams representing very large businesses?

Did the CQC’s ‘Enforcement tree’ get blown over in the gale?

https://www.cqc.org.uk/sites/default/files/20170217_enforcement_decision_tree.pdf

Considering the long term threats CQC have made to careful compliant dentists regarding their potential punishments and sanctions, this regulator seems to have forgotten to regulate this branch of "dentistry".


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