Registering With the Regulator, Why Not?

Sophie Singh-Jagatia has a wealth of experience and knowledge within the area of regulation and governance. In 2019, Sophie joined with her business partner Tracey Jones to launch Inspire to Outstand Ltd. Tracey has been a nurse for over 20 years having roles in education and senior management. She is a published author and has contributed to medical journals through her role as an editorial board reviewer and author. 

When invited to write a piece about the application for registration with the Care Quality Commission (CQC), the objective was to offer a perspective on what we can offer in relation to support and what it feels like to be the applicant. We have therefore invited one of our clients to write this collaborative piece, Susie Byass, who owns Rejuvenating Solutions. Susie has contributed her thoughts and aspirations for registration with the government regulator in relation to both her own accountability and in growing her already successful dermatology and aesthetic clinic. This piece will enable the reader to gain some comprehension of the application process and some insight into additional expectations held by the regulator, alongside attaining impetus to apply.

The incentive for any aesthetic practitioner or clinic manager embarking upon the registration application process with the government regulator can be diverse. The reasons can range from motivation to demonstrate safe practice, to the ability to offer specific services, or just that they have a firm grounding in a National Health Service background, whereby regulation is mandatory and part of normal care delivery. Some Aesthetic clinics in England have been on the CQC register long before the changes in legislation came into force in early 2019.

This legislation requires healthcare professionals in England, who are carrying out specific cosmetic treatments or services, to register with the CQC otherwise face potential legal prosecution and action from their professional governing body.

Regulating these services means healthcare professionals are not only held accountable for the care they deliver professionally, but also legally. 

“I am a Registered General Nurse with a degree in nursing – and an MSc in Nursing Practice, which enables me to operate at an advanced level of clinical practice. I have been an Advanced Nurse Practitioner and Independent Nurse Prescriber since 2004 and have a wealth of experience spanning 33 years, both in and out of the National Health Service. My decision to specialise in Aesthetic Medicine was influenced by my primary care experience in the specialist areas of Women’s Health and Dermatology. My passion is the holistic promotion of health and well-being, which underpins the ethos at Rejuvenating Solutions for ensuring that only safe and appropriate, evidence-based treatments are performed and being an outstanding clinical hub of excellence. Our core services are aimed at offering a medical model directed approach to non-surgical aesthetic treatments to a demographically varied patient group, alongside being a clinic focusing on treating skin conditions such as acne and rosacea and soon to offer Bio Identical Hormone Replacement Therapy. We also perform ear syringing and once registration is complete we are aiming to launch a collaborative travel health clinic with a local NHS commissioner. Prior to entering the aesthetic world, I was amazed at how little regulation was in place to protect patients. I spent six months exploring what it would mean to enter into the speciality of Aesthetic Medicine. This led me to look at my professional legal framework. At the time, I approached the CQC, looking for guidance, and they stated that I did not warrant being CQC registered due to the services I offered. This made me question, why not? I am a healthcare professional, treating patients with a medical diagnosis. Other colleagues I have spoken to had no concept of my concerns or chose not to have the discussion, for reasons I am not clear. Why on earth would I want to put myself through an unnecessary and bureaucratic process was a response I received? The answer was clear…to differentiate myself from the shark-infested waters of what comes with unregulated activities in the Aesthetic arena and the questionable standards of care delivered by other healthcare professionals and non-healthcare people. My overall aim is to be recognised for delivering high quality, accountable and safe patient care which requires a robust and validated framework to work to. After reading another article by Tracey, I breathed a big sigh of relief, someone understood the questions I was asking. I approached the CQC again, who were informative, however, I felt overwhelmed at the volume of information I had to process in addition to the time I that would need to commit whilst continuing to run my busy clinic. It was at this point that I approached and appointed Inspire to Outstand Ltd to help me. I have found invaluable support in what is a very lonely place at times to help me through the process which has been demystified and the journey made easier by their extensive experience of the CQC process. The bespoke practical support they offer ensures that the correct process and systems are in place, this has greatly enhanced how we deliver patient care at Rejuvenating Solutions without it becoming just a paper exercise. The facility for an onsite clinic evaluation visit is an inestimable service, whereby Tracey and Sophie ensure that all features of the service have been considered. The fact that we are a clinic, nurse-led and have patients with a medical diagnosis/disease or disorder surely means I need to be CQC registered, not as a want, but a need. I would urge other colleagues to look at their practice and business, to question their regulatory framework alongside their own professional regulatory body.”

- Susie Byass owns and runs Rejuvenating Solutions in Berwick Upon Tweed | 14-11-2019

So why do some practitioners recognise the benefits of regulation by the government regulator, whilst others portray it as a mammoth task with both personal and financial recompense?

We have supported many practitioners through this process and aided them to demonstrate that the service they provide is safe, effective, caring, responsive and well-led. We were asked to offer some direction through this process in order to both encourage stimulus for embracing regulation and offer some guidance through what can be a venture into the unknown. 

The practitioners whom we have worked with to date range from small clinics run from converted home environments to large clinics in the centre of UK cities, however, all have to follow the same guidance as any large National Health Service Trust. 

To make an application to the healthcare regulator encompasses the provision of details about the regulated activities the clinic plans to offer and the place from which these services will be provided. This is a part of the process that requires the practitioner to not only review their current service but also anticipate what provisions will be added to the portfolio during the time of the application.

As the process from start to finish can take several months it is worth taking some time to analyse what foresight the clinic has for the future. This requires the practitioner to articulate what is known as a ‘Statement of Purpose’. 

The Care Quality Commission website has been described as a maze of unanswered questions, and for practitioners new to the area of regulation this can be both frustrating and exhausting. Our team help the practitioner to navigate their way through both this information and the logistics of the application preparation. By setting points within the process, we request specific information from the registered manager or we signpost links to additional guidance. This has been evaluated as a less daunting structure for any manager, not only on their registration journey but also running a busy successful clinic.

We view the preparation for the application as a voyage, whereby we lead the applicant along a path of new information. It is well-documented that to fully understand new information then this should be administered in bite-size volumes to avoid overwhelming the learner with too much information often making the process both confusing and discouraging (Knowles 1984, Leppink et al 2015, Wittrock 1989,  Young et al 2014, Merril 2002 ).

The aim of the registration process permits the regulator to scrutinise the governance structure of the company to gain an understanding of how the services will be provided once registration has been agreed and granted. A detailed account of the robust systems and processes in place will enable the applicant to evidence how they assure the regulator that the clinic will provide high-quality care.

As with all areas of health and social care should these systems not be in place, the regulators have no assurance that the applicant will provide person-centred care in an environment that is fit for purpose and responsive to the needs of the patients. The process similarly dissects the professional status and personal qualities of the leadership team to ensure they have the competencies, skills and experiences to meet with the requirements of relevant regulations. Therefore the registered manager must be of good character and the start of this analysis will commence with the required Disclosure and Barring Service application (DBS).

An area often overlooked by clinicians and managers working in the field of Aesthetic practice is the company vision or pledge. It is essential for the company to have a vision as this conveys the direction of where the business model will travel. Where the vision is underpinned with strong aims and objectives, the applicant offers an insight to the promise they endeavour to make to their patients and reassures the regulator.

As a company Inspire to Outstand Ltd have articulated and adhere to our directors pledge whereby we promise to offer an ethical and honest service. Our aim is to reassure our clients that we will support them through the registration journey in such a way that they can be assured of a service underpinned by integrity. For anyone applying for registration, it is important to be clear about the business structure of the company, as different entities have different legal implications. Failing to fully disclose all details including directorship and partners, could lead to rejection of the application.

When formulating the governance structure to the business, the applicant must be mindful of how innovation and learning is demonstrated. This is in many formats, both in relation to exhibiting continued professional development, mandatory training and updated instruction related to deteriorating patients.

This learning is not only related to education but also to risk. As a forever evolving industry, it is essential to learn when things go wrong and what changes were put in place to maintain patient care and treatment and improve the service offered. 

Essentially any applicant must prepare a synopsis of how they will offer care underpinned by the core foundations of the CQC and be safe, effective, caring, responsive and well-led. This provides the evaluator with information about how you as a healthcare professional comply with the requirements of the relevant regulations. When submitting an application, one must demonstrate how processes and systems are in place to support both the manager and team to deliver high-quality effective care.

In instances, whereby the evaluator is not satisfied with the assurances provided, the likelihood of registration being denied is increased. Any registration application will include a clinic inspection and visit from the regulator. This can be seen as one of the most significant parts in the process and one which we aim to ensure our clients are fully prepared for. By offering a clinic evaluation visit as part of our service provision we can assure the applicant that all aspects of the service have been surveyed.

Once registration is awarded the registered manager becomes legally bound to the declaration signed which confirms that the clinic will meet the regulations set out by the Health and Social Care Act. It is now that the most important part of being regulated begins. As a provider of regulated services, the benefits of assurance, marketing and promotion can be embraced as the clinics holds the endorsement of the only Government regulator in England. Therefore it is crucial that the clinic continues to maintain safe, effective, caring, and responsive, well-led care.

References

^{Health and Social Care Act 2012: fact sheets - Publications - GOV.UK. [online] Available at: www.gov.uk/government/publications/health-and-social-care-act-2012-fact-sheets [Accessed 28/8/2019].
Knowles MS (editor). Andragogy in Action: Applying Modern Principles of Adult Education. San Francisco, CA: Jossey Bass, 1984.
Leppink J, van den Heuvel A. The evolution of cognitive load theory and its application to medical education. Perspect Med Educ 2015: 1–9, 2015.
Merrill MD. First principles of instruction. Educ Technol Res Dev 50: 43–59, 2002.
Wittrock MC. Generative processes of comprehension. Educ Psychologist 24: 345–376, 1989.
Young JQ, Van Merrienboer J, Durning S, Ten Cate O. Cognitive load theory: Implications for medical education: AMEE guide no. 86. Med Teach 36: 371–384, 2014.}

Inspire to Outstand Ltd support businesses to prepare for the Healthcare Regulator application process.