Guide
Register with the Care Quality Commission (CQC)
Complete step-by-step guide to CQC registration for healthcare providers in England, including what activities require registration, application fees, fit and proper person requirements, and the full registration process timeline.
If you provide regulated healthcare or social care activities in England, you must register with the Care Quality Commission (CQC) before you start operating. Operating without registration is a criminal offence carrying serious penalties.
This guide takes you through the complete registration process, from checking if you need to register to receiving your registration certificate.
Step 1: Check if you need to register
Not all healthcare services require CQC registration. The first step is to establish whether your planned activities are 'regulated activities' under the Health and Social Care Act 2008.
Important: Each physical location where you provide regulated activities needs separate registration. The exception is domiciliary care, which registers once as an organisation regardless of how many locations you cover.
If your service doesn't fit these categories, you may not need CQC registration. However, many healthcare activities do require registration even if provided by a sole practitioner from a single room.
Step 2: Understand the costs
CQC registration involves both upfront application fees and ongoing annual fees. These costs are substantial and non-refundable, even if your application is refused.
Budget carefully for these costs. Application fees are non-refundable, so it's worth engaging with CQC's provider engagement team before applying if you're uncertain whether you need to register or which activities apply to your service.
Step 3: Establish your legal entity
Before you can apply, you must decide on your business structure. CQC accepts applications from:
- Limited companies - Most common for healthcare businesses
- Partnerships - All partners become 'nominated individuals'
- Sole traders - You become the nominated individual
Most healthcare providers operate as limited companies because this provides liability protection and clearer separation between personal and business responsibilities.
Step 4: Prepare the fit and proper person evidence
This is the most time-consuming part of the application. CQC must be satisfied that all directors, the nominated individual, and the registered manager (if appointed) are 'fit and proper persons' to provide regulated activities.
Start DBS checks early - Enhanced DBS checks can take several weeks to process. You cannot submit your application until these are complete or in progress. Consider signing up to the DBS Update Service so you can reuse the same DBS certificate for future checks.
Gather employment history - You must provide full employment history as specified in the requirements above, with explanations for any gaps. Contact former employers for written references.
Registered Manager qualification - If you're appointing a Registered Manager, they must have or be working towards the qualification shown above. Check whether your planned manager already holds this.
Step 5: Develop essential policies
CQC will expect to see evidence that you have robust policies and procedures in place before they approve your application. At minimum, you need:
- Safeguarding policy - How you protect vulnerable adults and children from abuse
- Complaints procedure - How service users can raise concerns
- Medication management policy - Safe handling, storage, administration, and disposal of medicines
- Infection prevention and control policy - Including hand hygiene, PPE, and outbreak management
- Health and safety policy - Risk assessments, accident reporting, fire safety
- Recruitment and selection policy - Safe recruitment including DBS checks and references
- Information governance policy - Data protection, confidentiality, records management
These policies must be specific to your service, not generic templates. CQC assesses whether your policies demonstrate you understand the risks specific to your regulated activities.
Step 6: Arrange insurance
You must have appropriate insurance in place before registration. CQC requires evidence of:
- Employers' Liability Insurance - Minimum cover as legally required if you employ anyone
- Public Liability Insurance - Appropriate cover for healthcare services
- Professional Indemnity Insurance - Essential for clinical services, amount varies by service type
Healthcare insurance can be expensive, particularly for higher-risk activities like surgical procedures. Obtain quotes early in your planning process. See the insurance requirements in Step 7 below for minimum amounts.
Step 7: Complete the CQC application
Once you have all evidence gathered, you're ready to submit your application through the CQC Provider Portal.
The application is completed online through the CQC Provider Portal. You'll need to:
- Create a CQC Provider Portal account
- Select which regulated activities you'll provide
- Provide details of your nominated individual and (if applicable) registered manager
- Upload all fit and proper person evidence
- Upload policies and procedures
- Provide details of your premises (including floor plans for care homes)
- Pay the application fee
Step 8: Respond to CQC queries
CQC will review your application and almost always comes back with requests for additional information or clarification. You have 28 days to respond to any information requests.
Common queries include:
- Requesting updated DBS certificates or clarification on employment gaps
- Asking for more detail on how specific policies will work in practice
- Requesting additional information about premises or equipment
- Asking how you'll meet fundamental standards in specific scenarios
Respond promptly - Failure to respond within 28 days can result in your application being rejected, and you'll lose your application fee.
Step 9: Registration decision
CQC aims to make a decision within 16 weeks of receiving a complete application, though complex applications can take longer.
Possible outcomes:
- Approved - You'll receive your registration certificate and can begin providing regulated activities
- Approved with conditions - Registration granted but with specific restrictions or requirements
- Refused - Application rejected, usually due to concerns about fit and proper person requirements or ability to meet fundamental standards
If refused, you can appeal the decision. The application fee is not refunded even if your application is refused.
After registration: What happens next
Once registered, your obligations are ongoing:
- Display your rating - You must display your CQC rating at your premises and on your website within 21 days of receiving it
- Pay annual fees - Due each April, based on your service size and type
- Submit notifications - Tell CQC about specific events (deaths, serious injuries, safeguarding incidents, staffing changes)
- Meet fundamental standards - Maintain compliance with all regulations
- Prepare for inspections - CQC will inspect your service and publish a rating
Enforcement and penalties
CQC has significant enforcement powers. It's crucial you understand the consequences of non-compliance:
The penalties were significantly strengthened in May 2022, with prison sentences now possible for operating without registration. CQC takes unregistered provision very seriously.
Geographic variations: Devolved nations
CQC only regulates health and social care in England. If you operate in Scotland, Wales, or Northern Ireland, different regulators apply:
Get help with your application
CQC offers support to help you through the registration process: