Should PAs register with the Care Quality Commission?

As more people are encouraged to have their care and support provided by Personal Assistants (PAs) the role and tasks they are asked to undertake can leave some wondering if they should be registered with the Care Quality Commission (CQC). This bulletin is based on guidance from skills For Care.

What is CQC?

The Care Quality Commission is the independent regulator of health and adult social care services in England. Its job is to ensure people get good quality care by monitoring, inspecting and regulating services and publishing what they find. It also protects the interests of people whose rights are restricted under the Mental Health Act.

CQC sets out standards for good quality care, and has the ability to enforce those standards through its inspections and assessors. It also aims to promote improvements by providing independent, reliable information and advice.

Who does not have to register?

Most PAs we support are employed directly by the individual who needs care and support and paid directly by them, funded either by health, social care or self funding. In these circumstances, neither the PA nor the employer needs to register with CQC.

This is because the current Regulated Activity of ‘personal care’ has an exemption relating to PAs. It applies where the individual is employed without the involvement of an agency or employment business and their work is controlled and directed by the individual, or a related third-party (a close relation of the person who needs care who manages the employment of the PA on their behalf).

This exemption applies even if the PA is sometimes required to carry out clinical health care tasks, which a healthcare professional has delegated to a PA they have assessed as being competent at that task.

The CQC has a much broader definition of employment than HMRC or employment law. They include PAs who consider themselves self-employed but have an agreement to work directly for an individual and be paid directly by them. You must check your employment status with HMRC and with consideration to employment law and pensions regulations. Under most circumstances a PA is considered an employee.

Small user led organisations (like Active Independence) who support people to find PAs are also exempt. This is because they don’t have any formal ongoing role in monitoring or directing an individuals’ care and support package.

Who may have to register?

  • If a PA is a registered nurse or other healthcare professional and they are employed by an individual in a professional capacity to carry out regulated activity of “treatment of disease, disorder or injury” they may need to register as an individual provider.
  • If a PA is organising holiday or sickness cover for a number of individuals on a regular basis this might mean they should be registered.
  • If a number of PAs are working as a small team providing care and support for a small number of individuals and often swap shifts among themselves, they need to get legal advice on their model of working and check if they should be registered with CQC.
  • If a PA introduces new PAs to an employer and then has an ongoing role in monitoring, reviewing and directing those PAs, then it is likely they will need to register.

For example, if a mother and daughter set themselves up as a private limited company offering their services to a number of individuals, then they need to register with CQC. Here the exemption doesn’t apply because they are employed by the company and not the person needing care.

If you are still unsure whether or not you need to register with CQC, our advice would be to contact them directly. If you are considered to be carrying out a regulated activity or service then it’s a legal requirement to be brought into the registration system.

Further information and advice

Click here to visit the Care Quality Commission website