Register with the Care Quality Commission (CQC)

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.

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.

You register once as a provider; each location where you provide regulated activities is added to your registration. Annual fees are calculated per location.

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.

Understand the costs

CQC does not charge a fee to apply for registration, or to vary it. Once registered, you pay an annual fee, invoiced on the anniversary of your registration.

Budget for the ongoing annual fee. It's worth engaging with CQC before applying if you're uncertain whether you need to register or which activities apply to your service.

Establish your legal entity

Before you can apply, you must decide on your business structure. CQC accepts applications from:

• limited companies and other organisations, the most common choice for healthcare businesses, which must appoint a 'nominated individual'
• partnerships, where the partners register together and do not appoint a nominated individual
• sole traders, who register as individuals with no nominated individual

Most healthcare providers operate as limited companies because this provides liability protection and clearer separation between personal and business responsibilities.

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.

You must provide full employment history as specified in the requirements above, with explanations for any gaps. Contact former employers for written references.

There is no statutory qualification for registered managers: CQC assesses their qualifications, competence, skills and experience (Regulation 7). For adult social care, the Level 5 Diploma in Leadership and Management for Adult Care is the Skills for Care expectation.

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:

• a safeguarding policy on how you protect vulnerable adults and children from abuse
• a complaints procedure for service users to raise concerns
• a medication policy covering safe handling, storage, administration and disposal of medicines
• an infection prevention and control policy, including hand hygiene, PPE and outbreak management
• a health and safety policy covering risk assessments, accident reporting and fire safety
• a recruitment policy for safe recruitment, including DBS checks and references
• an information governance policy covering data protection, confidentiality and 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.

Arrange insurance

You must have appropriate insurance in place before registration. CQC requires evidence of:

• employers' liability insurance at the legal minimum if you employ anyone
• public liability insurance appropriate for healthcare services
• professional indemnity insurance for clinical services, at a level that depends on the service

Healthcare insurance can be expensive, particularly for higher-risk activities like surgical procedures. Obtain quotes early in your planning process. See the insurance requirements below for minimum amounts.

Complete the CQC application

Once you have all evidence gathered, you're ready to apply. The CQC provider portal closed for new registration applications on 18 November 2024 - you apply using downloadable forms submitted by email (the portal is still used for notifications).

The application is made on CQC's downloadable forms, submitted by email. You'll need to:

• Download the application forms from the CQC website
• Select which regulated activities you'll provide
• Provide details of your nominated individual (if you're an organisation) and (if applicable) registered manager
• Include all fit and proper person evidence
• Include policies and procedures
• Provide details of your premises (including floor plans for care homes)

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.

Registration decision

There is no fixed decision period - the process is rigorous and registration can take a few months.

Possible outcomes:

• approval, when you receive your registration certificate and can begin providing regulated activities
• approval with conditions that restrict or add requirements to your registration
• refusal, usually over concerns about the fit and proper person requirements or your ability to meet the fundamental standards

If refused, you can appeal the decision.

After registration

Once registered, your obligations are ongoing:

• Display your CQC rating at your premises and on your website within 21 calendar days of its publication.
• Pay the annual fee, invoiced on the anniversary of your registration and based on your service size and type.
• Notify CQC of specific events, such as deaths, serious injuries, safeguarding incidents and staffing changes.
• Keep meeting the fundamental standards.
• 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:

Operating without registration is an either-way offence carrying an unlimited fine and/or up to 12 months' imprisonment. CQC takes unregistered provision very seriously.

Get help with your application

CQC offers support to help you through the registration process: