Revealed: How CQC registration is running over budget and has failed dozens of dental practices

From The Pulse

Revealed: How CQC registration is running over budget and has failed dozens of dental practices
By Andrew McNicoll | 20 Jan 2012

Exclusive: More than 30 dental practices and an unknown number of private GP practices have failed to secure registration with the Care Quality Commission, in the first sign that regulation by the new body is prompting some providers to shut down.

The figures for those failing to register, revealed to Pulse under the Freedom of Information Act, come as the regulator also admitted that shifting registration to a new online system will push the total cost £5.5m beyond its initial budget.

The CQC has previously played down fears that its registration process would lead to the closure of providers, publically stating last June that ‘we have not closed down any dental practices’ and reassuring GPs earlier this month that surgeries would not be closed over not having disabled access.

But the regulator disclosed this week that 36 of the country’s 8,232 dental providers have not completed registration, with some subsequently closing. A further 68 dentists have been identified as ‘potentially unregistered providers’ by the CQC and could face prosecution if they are found to continue operating.

The CQC said: ’27 providers have not secured registration with the Commission and have either ceased providing a service or are subject to our unregistered services policy. The remaining nine require specific information to allow their registration to be concluded.’

However the CQC was unable to say how many private GP practices had failed registration because of a ‘temporary technical problem’.
Dr Jack Edmonds, chair of the Independent Doctors Federation and a GP in Harley Street, London, said the IDF had held ‘amicable talks’ with the CQC but warned that the regulator’s inability to provide data on the number of private practices failing registration was symptomatic of a wider issue.

He said: ‘The law requires us doctors to be open, transparent and have evidence that backs up what we tell the CQC. We have to jump through a number of hoops.’ ‘You want us to be transparent? Well, you should be transparent. It is a matter of fairness. The IDF would like to help the CQC if they are having problems – we don’t know if they are as they have not shared any information with us.’

The CQC also revealed for the first time the likely cost of the registration process, which was budgeted at £29.1m. It has spent £25m on registration of all providers so far, and expects to spend a further £3m on NHS GP registration – but also now expects to plough a further £6.5m into IT to support its registration programme that it did not originally budget for.

Dr Peter Swinyard, chair of the Family Doctor Association and a GP in Swindon, expressed concern at the overspend and insisted any additional costs run up by the CQC should not be passed on to GPs.‘The cost of CQC is a very sensitive issue for GPs. To be asked for a lot of money for something with no merit in it for general practice is a big ask.’

A CQC spokesperson said: ‘We are projected to be within budget for initial registration of all providers, with a projected spend of £28 million against a budget of £29.1 million. The additional £6 million is for the development of an online service that will simplify ‘business as usual’ processes for all providers – for example applying to change the status of their registration. GPs will also benefit from this as they will be able to carry out their initial registration online.’

The cost of the CQC
£29.1m – Original CQC budget for registration
£25m – Cost of registering dentists, social care providers, private GPs and others so far
£3m – Estimated cost of registering NHS GPs
£6.5m – Additional unbudgeted cost of shifting ‘registration and regulation’ to an online system.

Bringing premises up to scratch
Hundreds of GP practices sign-up for software to prepare for CQC registration

The Monday Morning Quote #149

“Your ability to adapt, be flexible and deal with the unexpected is one of the most powerful assets you possess.”

David Bowie

The Monday Morning Quote #150

“The value of a thing sometimes lies not in what one attains with it, but in what pays for it – what it costs us.”

Friedrich Nietzsche

Northern Ireland’s take on the IOTN

From the BDA newsdesk:

4.0 IOTN score for orthodontic care in NI proposed
Proposals to introduce a threshold of 4.0 on the Index of Treatment Need (IOTN) for entitlement to orthodontic care for children in Northern Ireland are reported by BBC Online. Parents whose children are not assessed at such a level, but nonetheless wish their offspring to undergo treatment, will have to pay for it privately, incurring a bill of at least £2,000, the report notes. Commentary from the BDA and individual practitioners criticises the proposal to set a different IOTN threshold from that in place in England and warns that children of parents who cannot afford to pay for Health Service care will be at a disadvantage.

When the IOTN was introduced to the NHS in England & Wales I likened it to a valve that would only ever be tightened. Starting, as it did, at the same time as the new contract in 2006 the implications seemed to have been overlooked by many. Setting the “bar” at 3.6 gave a smooth transition without frightening the wire benders too much, but when I recently re-read the the rules in light of the news from Ulster I realised that the guidelines said that,

“Orthodontic treatment would only be provided for:

  • Grade 4 or 5 of the Dental Health Component (DHC) of the IOTN” or
  • Grade 3 of the DHC of that Index with an Aesthetic component of 6 or above”

So it’s easy for those in control of the purse strings to strike out the second statement thus tightening the valves. Of course it could be that in Northern Ireland they have just forgotten to include the second statement and we’re all getting our knickers in a twist over an administrative omission – but somehow I doubt it.


The Monday Morning Quote #148

“A leader is not good because they’re right.

They’re good because they’re willing to learn and to trust.”

General Stanley McChrystal

“HMRC business record checks condemned” more interference?

If you’re Vodafone or Goldman Sachs it’s fine to do half a billion pound deals with Her Majesty’s Revenue & Customs but if you’re small enough to be picked upon and harried, look out.

HMRC has faced criticism over its planned business record checks.

From April this year, HMRC plans to spot-check 20,000 firms’ business records – inadequacies could result in fines of up to £3,000.

But the measures have been slammed by business leaders and Tory MPs, who claim that the move will cause more trouble for already struggling businesses.

Speaking to The Independent, national chairman of the Federation of Small Businesses (FSB), John Walker said: “Despite the worsening economy, HMRC is launching this scheme regardless of the consequences.

“We have spoken to HMRC and expressed our concerns about this a number of times. But as far as they and ministers are concerned it is a policy aim to make this happen.

“There is a huge difference between the rhetoric of the Government about helping small businesses and what it is doing in reality.”

The move is particularly poignant following the recent revelations of favourable tax treatment of larger firms. Priti Patel, the Conservative MP for Witham said: “The attitude of HMRC to small businesses is frankly disgraceful when they are blatantly doing deals with large firms which have allowed them to escape millions of pounds in tax liabilities. It seems as though HMRC sees small businesses as low-lying fruit to meet their targets. That kind of persecution is outrageous.”

Reacting to the criticism, an HMRC spokesman said: “HMRC recognises that the launch of the Business Records Checks pilots has caused considerable concern to the tax profession, and that the project would have benefited from more detailed consultation with tax professionals at an earlier stage. In the light of these concerns, HMRC will undertake a strategic review of the project, in consultation with the professional and representative bodies.”

The spokesman added: “The findings of the review will be shared with representative bodies in January 2012, and final decisions will be made by HMRC before the end of the current financial year.”

Thanks to PG&T

A f*ree textbook of skin cancer and its mimics.

Aimed at medical students, doctors trying to get (re) acquainted with dermatology and other paramedical staff this new on-line text book is worth investigating by dentists and their teams. Dentists are in the enviable but responsible position of seeing our patients regularly and are therefore better placed to observe changes of the head and neck than other members of the health team.

Follow this link

and yes, there is a family link between the writer of this blog and the author of the book.


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