Counting the cost to clinics of CQC inspection delays

Delays in the Care Quality Commission (CQC) registration process are impacting the establishment of new independent clinics that offer crucial local healthcare services. 

Experts from insurance broker Howden are reporting that operators of small clinics are particularly worried about the length of time the process takes, especially for an inspection to take place in order for registration to be approved. 

With waiting times of up to 12 months between application to register and the clinic being given the green light, would-be healthcare providers are paying out property and insurance costs without being able to trade. 

New clinics are having to pay for bank loans, lease agreements and insurance costs up front, unable to generate any income until the health regulator registers the service. The vast majority of these small healthcare providers are private, community clinics, offering much-needed local services.

“It is a real concern for them”, said Mark Copsey, Divisional Director at Howden Health and Care. “They are looking to provide valuable healthcare services in their local communities because they want to make people better and they are being prevented from doing that.” 

The cost of delays to inspection

The delays are due to a surge in applications from new healthcare providers looking to fill gaps in the market currently not offered by the NHS. There are also well-documented organisational problems within the healthcare regulator that are slowing down the inspection process. 

Autumn’s Review into the operational effectiveness of the Care Quality Commission, carried out by Dr Penelope Dash, found that the backlog in registrations was a particular problem for small providers trying to set up a new healthcare service and “could result in lost revenues and investment, which had a knock-on impact on capacity”. 

Mark Copsey explained that, while there is a clear registration process for new private clinics, significant delays remain. 

He said: “They are signing a lease agreement and to do that they need their property liability insurance in place, but the premises can sit empty for up to eight months before the inspection is even carried out. That does impact them from an insurance point of view because if that premise is unoccupied, that can jeopardise the cover.”

The CQC requires any new clinic to have both public and employee insurance in place before they can apply to register as a healthcare provider. However, with delays to the inspection times ahead of registration being granted, policies are being paid for without being used.

This is leading to applicants becoming increasingly frustrated with the process, with morale very low.

Peter Wickham, Divisional Director at Howden Health and Care, explained: “It is always a huge issue because people don’t want to accept their insurances until they are ready to trade, but that choice is taken away from them.”

Potential solutions

Howden does issue letters of intent for new clients stating to the CQC that these would-be healthcare providers are ready for the insurance and will be taking it out. This could offer a short-term solution to the problem, but accepting this guarantee is down to the discretion of individual inspectors. 

These letters of intent could confirm, as the application process continues, that an insurance provider is committed to working with the client to ensure all its insurance obligations are met. 

Mark Copsey said: “I think that would help new clinics immensely, saving them costs and time.”  

Longer-term, healthcare providers need clarity about when they can expect their registration to be confirmed, and the application process needs to be simplified. 

Mark Copsey added: “They are being asked to provide evidence of policies and insurance at the start of the conversation. Can the CQC not refine that process to say let’s get the application in before you even think about premises? That takes it into a six to eight months parallel conversation rather than having everything done in advance.”

He added that the insurance could easily be provided once the inspection has been carried out. Furthermore, healthcare providers are legally obliged to have this insurance in place once operational so would not be able to trade without it. 

Mitigating risk post-registration

Delays to inspection are not just occurring during registration. CQC aims to inspect new providers of independent healthcare services within 12 months after registration has been granted. However, according to the Dash Report, 21% of independent healthcare providers had been waiting five years or more for a rating in 2024. 

Lack of a rating or an outdated inspection report can influence patient choice or impact the decision of NHS Trusts looking to contract-out their services. It can also mean that healthcare providers are not always up to date on the latest CQC requirements.

Howden has launched a new risk management offering to support healthcare operators in this situation. Peter Wickham said: “It is added-value service for our clients. We have developed solutions, designed around the unique needs of the sector.”

This initiative is tailored to individual clinics, covering compliance and regulatory risk solutions, including mock inspections, conducted either remotely or in person, to ensure the provider meets and exceeds all necessary regulatory and legal requirements. 
 
“Good compliance and regulation are critical for providers as many people now use the CQC as a tool when selecting the best clinics for their needs”, Peter Wickham explained. 
 
With new leadership at the CQC promising a more efficient inspection process, it is hoped that the waiting times new entrants to the healthcare market currently face will be reduced, along with delays to re-inspection for established providers. 

This would remove layers of frustration and costs from new healthcare providers. Mark Copsey said: “The time to launch their clinics would be vastly improved, that would help improve the health of people in their local area.”

“Waiting lists for local NHS GPs don’t seem to be improving. These clinics are taking the load from the NHS. A lot of these clinics want to make a difference in their local community.”