Intro

All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

All Tongue Tie Providers Now Need to Register with the CQC - Outcome & Implications for Parents

Many people still don't truly understand the whole hoo-ha with the CQC.  The confusion I think is the result of a number of factors; the embellishment of whispers, passed along morphing into a "ban" and resulting in a rather bizarrely worded petition to "reinstate providers" - so I've tried to form an analogy that might help give a better understanding.

In your local area is a private road that connects a housing estate to a busy working area. Nobody really knows who the road belongs to, only that some have permission to use the road and some don't need permission. There's a list of prohibited activities that can't be undertaken on the road - for example dancing and shouting, but walking isn't mentioned.

The police don't do anything about people walking on the road, since it isn't causing anybody any problems. The risks to the public of people walking down the road are minimal, because only people who work at the end of the road are carefully walking down it, and in 20 years, there's been no problem; all "walkers" are trained in road safety and their regulatory body ensures they follow standards, to use roads in a safe and responsible manner. A local group check on two occasions if they can use the road and the police reply that they can.

One day, a member of aforementioned local group contacts the police call centre independently to ask if he needs permission to use the road. The call handler (who has no idea about the road in question as they haven't heard of it before), gives the standard response which is to have a look at the local maps, ownership deeds and decide for themselves.

The person takes this back to the local group - concerned they now don't have permission to use the road. The local group contacts the police again, asking for confirmation they legally have express permission to use the road. The call handlers again say it's up to them to decide - there isn't a blanket rule as when it comes to roads, some need permission and some don't..

The group hires a barrister to ask the police for a definite yes or no answer - can we walk down this road without permission?  Who owns this road? Is it technically illegal to trespass? If so can you give us permission to trespass until we've planned an alternate route?  If we are acting illegally, will you, the police take action to stop any of us?

The police state that the road is privately owned, which can be in no doubt if we look at the deeds. The law states most need permission to walk down it - and no they can't give permission without application, because they don't own the road and can't break the law themselves.

They state if someone is acting illegally, of course they may take action to stop them, however if those who have always walked that way, choose to continue walking that way until they find an alternate route, they can consider each person passing on their own merits. For example, if they're from the area and are in the process of applying for permission to pass, are governed by the road safety regulatory body, following the rules and are insured to be in the area - the police can choose not to take any further action.

Frenulotomy has been undertaken by midwives and nurses in the UK for 20 years. Ironically the only fatality reported is at a CQC regulated hospital.  There seems to be confusion that registering with the CQC makes practices safer - and there are some areas of healthcare where this is true.  However tongue tie has historically always been performed by sole registered, insured, healthcare professionals, with an absence of significant adverse effects. If you have a complaint, you contact the healthcare provider's regulatory body (NMC, GMC etc) - this is still the case when CQC registered.

The CQC is designed to regulate hospitals, GPs, Care homes and suchlike - "to monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety".  The OFSTED of healthcare, they are body bound to act in the interest of the public.

Hospitals, clinics etc employ a lot of staff, not all are HCP, they need to know places are following safety protocols and have ways of monitoring satisfaction in the setting.  If we look at their fundamental standards - how many even apply to a self-employed midwife treating 3 tongue ties per week in someone's home? 

When it's one or two people working alone as registered healthcare professionals, their own training and insurance ensures fundamental standards of quality and safety are met -they're not bloody Bupa!

As soon as the ATP started pinning down the CQC, some members (including the chair herself) started completing their CQC applications. - knowing they would have little choice but to deem tongue tie a surgical procedure. By virtue of the law and their own guidance, when backed into a corner, they had little choice but to require registration.

The question is, what happens next?

The costs of preparing and maintaining CQC registration are huge (the application form alone takes weeks to complete, in part again because it's really designed for larger organisations with "staff policies", not a "one-man band").  No doubt some who just did a few here and there will decide not to continue in practice - and for those who do register, these costs will likely be passed on to parents.  Many who ceased practicing before Christmas as advised by the ATP, may have already had such an impact to their business and earnings from which it could be difficult for them to recover.

This is likely to make tongue treatment less attainable to those least able to afford it, leading the way for larger clinics and hospital treatments over the personal one to one service many have valued for so long.
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I spoke with the CQC 18.2.19 and clarified the following (posted initially on the Infant UK tongue tie group)

1) Since pressed legally, the CQC now really have little choice but to regulate frenulotomy. They recognise that it's low risk, has been practiced for years and so on, and as such wasn't an area of interest to them; however, legally it's impossible for them to argue that scissors, a frenulum and blood isn't surgical. Therefore, when asked to define the legal position - they've had to concede pin holding HCPs need to register. The CQC don't write the laws (parliament do), they interpret and enforce them.
.2) The only exemptions in terms of "practicing privileges" apply to doctors with GMC registration (as outlined in numerous pieces of legislation). Petitioning parliament would be the only way to potentially extend this exemption to other HCPs. Similarly if people wanted to propose frenulotomy should be on the list of exempt procedures (like toenails for example), they'd need to do the same.
3) They didn't/don't automatically expect midwives/nurses who are certified/insured and co-operating with the CQC, to stop practicing privately whilst applications are completed/processed. Under the law they cannot give permission for a "grace period", however they do decide who they do/don't prosecute and any action has to be in the public interest. Note - THERE IS NOT A BAN as some have claimed.
4) The CQC ONLY regulate registered healthcare professionals. In this RA osteopaths will require registration, however they do not regulate lay healthcare professionals eg IBCLCs, thus they will not be required to register.
5) If contacting the CQC, please remember those that answer are call handlers. Please ask to speak to the registration team for detailed information.
6) ETA: For the avoidance of doubt, frenulotomy does not fall under the regulated activity ‘maternity and midwifery services’, even where it is carried out by a midwife. Tongue-tie is a condition that is usually picked up in infancy, as a difficulty to breast feed and attach to the breast. Older children or adults may require the treatment related to speech difficulties and, where this is the case, the condition is treated by other healthcare professionals. Treating it is not part of midwifery care. It is post-natal care (see NICE interventional procedures https://www.nice.org.uk/guidance/IPG149).
Click here for Letter ATP received from the CQC and sent to ATP members


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