The CQC is the Care Quality Commission, the independent regulator of health and social care services in England. It registers, inspects, and rates services like hospitals, care homes and GP practices to ensure they provide safe, effective, and high-quality care. The CQC's work helps protect people who use these services and informs the public about the quality of care they can expect. 

The CQC has the power to take action against providers who are not delivering adequate services, or are failing to meet safeguarding regulations, resulting in avoidable harm.

Other regulatory bodies

Each of the other UK countries has its own independent organisations responsible for the regulation of health care services and workforce, as outlined below:

You need to consider whether the activities that you (or your business) carry out come under the regulation of any regulatory body.

The health care services regulated by the regulatory bodies in all UK countries typically include:

• Care homes (nursing and residential)
• Nurse agencies
• Domiciliary care agencies
• Independent clinics and hospitals
• Hospices
• Mental health and learning disability services
• Nurse agencies
• Respite care
• Cosmetic surgery providers
• IV therapy clinics (if clinical)
• Private GP services

For details of clinical activities that require CQC regulation, see The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, or the CQC’s Quick guide to regulated activities. See the website for the relevant regulatory body in your country in the section above for a full list of the services they regulate.

In Northern Ireland, Scotland and Wales, the regulatory bodies regulate whole services, rather than individual clinical activities. This means that if your service provides regulated care, you must register the entire operation.

Failure to register is a criminal offence that could result in a fine or imprisonment.

Health care support workers

In Northern Ireland, Scotland and Wales there is a broad requirement for health care support workers to be registered, especially if you work in social care. Check with your employer and the with relevant regulatory body in your country for advice on whether you are required to register.

There is no such registration requirement in England.

Earwax removal

In England, earwax removal treatment is a regulated activity that must be registered with the CQC, if the treatment is carried out by a listed health care professional (this includes registered nurses).

This has presented a strange scenario, as non-listed healthcare professionals (such as beauticians or audiologists) are not recognised by the CQC as requiring registration, despite carrying out this activity.

The RCN is concerned about this approach, as it creates a two-tier sector of providers of the same service. We have questioned whether this activity is sufficiently specialist in nature to warrant regulatory oversight by the CQC, as no formal qualifications or training are required, and the equipment is readily available. In addition, registered professionals are already subject to regulatory oversight by the NMC.

The CQC has indicated that it is considering whether changes can be made to the regulations to remove earwax removal services delivered by listed health care professionals from the scope of registration, and will update us if there is a change of position. However, the position currently remains the same – if you provide this service and have an active NMC registration, you need to be registered with the CQC, and you should start the registration process as soon as possible to avoid any delay, as registration can take months.

If you receive a letter from the CQC about working unregulated, see the section below for what to do next.

Intravenous therapy

All providers in England administering intravenous therapy and products must be registered with the CQC. This was introduced in 2022. This link to the CQC website explains the intravenous services that must be registered and what providers must do to register.

If you provide this service, you should start the registration process as soon as possible to avoid any delay, as registration can take months.

If you receive a letter from the CQC about working unregulated, see the section below for what to do next.

If you have received a letter from a regulatory body about not being registered for an activity you are undertaking, please apply for registration (you can apply for CQC registration here) and respond with the following considerations that apply to you:

• explain you were not aware it was a regulated activity (if this is the case)
• apologise
• include details of your business/clinic and any treatments you carry out relating to the regulated activity
• provide details of your service users, and whether you get referrals from another service
• include confirmation of your insurance arrangements to practise these activities
• make it clear that you want to continue carrying out the activity and want to register.

Note that the letter from the CQC includes the following wording: “you do not have to say anything, but it may harm your defence if you do not mention, when questioned, something you later rely on in court. Anything you do say can be used in evidence.” This wording is “a caution” and a legal requirement that people suspected of a criminal offence are given when asked to comment on allegations. It is not the same as being issued with “a caution” that is an outcome in criminal proceedings. You do not need to notify the NMC if you are asked to comment under caution like this, as it is not an outcome of a criminal offence.

What will happen next?

Enforcement officers will decide whether to:

• close the case
• refer the case to a decision-maker to consider issuing a fixed penalty notice or bring criminal prosecution
• make further enquiries.

If the regulatory body invites you to attend an interview under caution, please contact us for us to arrange an agent solicitor to accompany you.

For all other regulatory body enquiries, you can use our free legal assistance helpline.

If a complaint is made to the CQC (or country equivalent) about you, you should:

• clarify the nature of the complaint with your employer
• engage with any internal investigations
• gather any relevant evidence and write your own record of events
• prepare for possible NMC involvement, even if none exists yet.

Note that as the CQC is not a regulator of individuals, you will not need to respond directly to the CQC, nor “defend yourself” before the CQC.

The Maternity and Newborn Safety Investigations Programme (MNSIP) is part of a national strategy to improve maternity safety across the NHS in England, and is run by the CQC. NHS trusts in England are required to report certain patient safety incidents that happen in maternity care to the MNSIP. This is so that an independent investigation can be carried out and, where relevant, safety recommendations can be made. Investigations involve families, NHS trusts and the staff involved, however blame is not placed on individuals, and individual members of NHS staff are not investigated by the MNSIP.

Any NHS staff involved in an MNS investigation are typically treated as witnesses, as they are considered to be helping with the investigation. Therefore, if you are involved in such an investigation, please see our Witnesses guide for information.

If, as a result of a Maternity and Newborn Safety Investigation, your employer does want to investigate your specific involvement, see our Investigations guide for next steps and when you might need to contact us. 

If you are a registered provider, manager or responsible individual of a regulated health or social service or activity, you may be required to notify your regulatory body about relevant changes, events and incidents that affect your service or the people who use it. For example, you may need to notify your regulatory body if you are charged with or convicted of a criminal offence, there is a safeguarding incident, serious injury, or abuse, or there is a change in your fitness to carry on the regulated activity.

The CQC provides guidance on what a registrant must notify them about (in England). For other countries, please see the website for the relevant regulatory body in the section above for information about the changes, events and incidents that require notification, or contact them directly if you are not sure.

If you have also been referred to the NMC and/or DBS, please see our NMC and/or DBS guidance, and contact us for support.

You must self-refer to the NMC if you've been disciplined by another regulatory or licensing organisation. This includes organisations that don't work in health and care. This duty is outlined in the NMC code, section 23.4. Not telling the NMC may be a breach of the Code and could result in them taking additional regulatory action. If you are considering self-referring to the NMC, please see our NMC self-referral guidance.

If you have been invited by the police or a regulatory body to attend an interview under caution, please see our Cautions, convictions and interviews guidance.

If you have been referred to the NMC and/or DBS, please see our NMC and/or DBS guidance, and contact us for legal support.

If you have been involved in a work-related safeguarding incident, please contact us for local support. Note that we are unable to support with non-work-related safeguarding issues, however, you can use our free legal assistance helpline.

The RCN legal team cannot support with other regulatory issues, however, you can use our free legal assistance helpline

Care Quality Commission (England)

Regulation and Quality Improvement Authority (RQIA) (Northern Ireland)

Care Inspectorate (Scotland)

Healthcare Improvement Scotland

Healthcare Inspectorate Wales (HIW)

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014