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Care Quality Commission and Monitor

NHS reforms explained The final instalment of our reforms guide reveals how the new NHS will be regulated

Catch up with the rest of this six-part guide on C+D's NHS reforms homepage.

  What are they?

The Care Quality Commission (CQC) and Monitor have expanded roles under the provisions laid out in the Health and Social Care Act 2012.

The two will work together to oversee and regulate the quality of care in England. As has been the case for some time, the CQC registers providers of health and social care and checks that they are adhering to the terms of that registration.

It is now also responsible for adult social care providers. Monitor was already the independent regulator of NHS Foundation Trusts and has now taken on a host of new roles, mainly ensuring that NHS services are efficient, effective and value for money. It is also responsible for ensuring choice and competition.

What will they do?

The CQC and Monitor are expected to work in partnership with complementary roles. The CQC will continue to register and monitor providers of health and social care; in short, it will regulate standards alongside professional regulators.

Monitor will be the ‘sector regulator' whose duty is to "protect and promote the interests of people who use healthcare services". This is a key change from its previous focus solely on institutions. Monitor will make sure the governance of organisations is sound, in order to avoid the likelihood the CQC will identify problems.

If a problem is identified, Monitor will check those problems are fixed. Its main role is in "promoting the provision of services [that are] economic, efficient and effective". It will also be responsible for:

● setting prices

● enabling integration of care

● preventing anti-competitive behaviour

● maintaining service continuity

● overseeing licences for NHS foundation trusts and NHS-funded providers.

How do they fit into the new NHS?

The CQC and Monitor take an overview approach, and are therefore outside the direct network. They work closely together – the first as the independent regulator of providers of health and social care, and the second as the sector regulator overseeing pretty much everything else.

Healthwatch England, a new, independent ‘consumer champion' that will also sit within the CQC, has also been created. This is an independent body with its own statutory powers, with the aim of making sure "consumers' voices are heard and best practice is delivered in health and social care nationally". It is comprised of 152 local branches that act as a national network to collect evidence of service shortfalls.

Healthwatch England has the power to recommend the CQC takes action, although it cannot enforce it. Each Healthwatch branch is commissioned by its local authority, and is accountable to it rather to than to Public Health England.

Monitor will have a very close relationship with NHS England (formerly the NHS Commissioning Board), with which it will jointly set NHS tariffs and oversee continuity of services; it will also have several partnership agreements around choice and competition and on integrated care to guide commissioners. This will be a particularly tricky role, as Monitor will also regulate NHS England itself.

What do pharmacists need to do?

Very little; the Royal Pharmaceutical Society's policy and practice lead Heidi Wright points out that there will still be no requirement for community pharmacies to register with the CQC because the General Pharmaceutical Council (GPhC) has its own inspectors. This means pharmacies are automatically exempt from holding a licence with Monitor.

However, there are grey areas that haven't been clarified around ‘any qualified provider' status, and some uncertainty about how the bodies affect pharmacists who have been commissioned to provide a service by clinical commissioning groups (CCGs).

"At the moment CQC and Monitor don't have a huge impact on community pharmacy, but there is a lot up in the air and it will be a case of waiting and seeing what happens," she says.

The work of Monitor may have some impact on the work of pharmacy around competition and setting NHS prices but, again, how exactly this will work is currently unclear. However, it is unlikely to remain this way for long.

"The importance of Monitor to pharmacy may well grow over time," Ms Wright adds.

There is significant debate among health experts as to the effect of pharmacy's exclusion from Monitor's competition remit; while some argue that pharmacy is clearly competitive and requires regulation, others suggest that pharmaceutical regulations are already too complex and additional legislation is not needed.



Importance to pharmacy (out of five)

Care Quality Commission ⦁ ⦁

Monitor ⦁ ⦁ ⦁ ⦁

Number in England Care Quality Commission 1

Monitor 1 local area teams reporting to a central board

Healthwatch England 152 local branches

This week, you should: Reflect on how the NHS reforms have affected your business so far, and look back at this six-part guide to make sure you're ready for future changes.

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