As a result of the current outbreak of coronavirus, like many of us, CQC has changed the way it is working. Each week, CQC circulates a bulletin to help GP practices understand what CQC has changed as well as providing links to helpful information.

An article which CQC recently published, advising professionals about the update to the online notification of deaths form, appears to have caused some confusion amongst the primary care sector.

It is important to be clear that the rules regarding notification of deaths have not changed. CQC does not require practices to notify CQC of all suspected or confirmed COVID-19 deaths.

As usual, practices are only required to notify CQC of deaths that occurred:

• while a patient was in consultation with a healthcare professional;
• while at your health centre, practice or surgery;
• during a home visit.

Alternatively, a death must be notified where it occurred within two weeks of a clinical interaction with practice staff, if the death:

• was, or may have been, as a result of the care or how it was provided, and
• could not be attributed to the course which the illness or medical condition would naturally have taken if the deceased had been receiving appropriate care and treatment.

The change CQC made to the online form makes it clear where a death was also as a result of suspected or confirmed COVID-19, in addition to the criteria above.

CQC has advised that where a decision has been made for frail patients to be managed in their home or a nursing/care home environment, GPs do not need to notify CQC if they die. As ever, it is vital to keep a clear record of made, including any capacity or best interest decisions.

CQC has published some working examples highlighting where notifications do or do not need to be made to CQC. These are set out below.

Case studies

Example 1

A frail elderly patient with multiple health conditions becomes infected with COVID-19. An appropriate best interest decision is made not to admit the patient to hospital, and this is clearly recorded in the patient record. The patient subsequently dies from the COVID-19 infection.

Is statutory notification to CQC required?
No. Given the higher mortality rates in this patient group this would be considered an expected death and no notification is required.

Example 2

A frail patient with multiple conditions becomes infected with COVID-19. A home visit by the GP is deemed necessary but this is not possible. (This could be due to a lack of PPE equipment as described in PHE guidance current at the time or a shortage of available staff.) The patient subsequently dies.

Is statutory notification to CQC required?

Yes. The practice was unable to provide care due to limitations caused by the coronavirus outbreak. Notification should be made to CQC to allow us to understand the pressures providers are facing locally. This will help us to develop a better understanding and national picture of system pressures.

Example 3

Practice A cannot continue to deliver services to patients due to staff illness and staff self-isolating in line with guidance. Practice A is part of a Primary Care Network (PCN) with four other practices in the local area. Services are being provided by the other practices in the PCN on behalf of practice A.

Is statutory notification to CQC required?

No. Temporary arrangements have been put in place for patients to ensure they have access to essential GP services.

Hot tubs/red sites

If GP practices are or intend to care for patients with COVID-19, through a hot tub or red site, the following advice from CQC should be taken into consideration:

1. If the provider is already registered to carry on the regulated activities of treatment of disease, disorder or injury (TDDI) and diagnostic and screening procedures from the location where the hot hub/red site is being set up – the provider should briefly update their statement of purpose and notify CQC of this change. CQC acknowledges this will not be an immediate priority for providers at present.
2. If a provider is hosting a hot hub/red site on behalf of a Primary Care Network or a group of practices – the host provider should briefly update their statement of purpose and submit the notification to CQC. Again, CQC recognises that this process may take a little longer than usual, given the current circumstances.
3. An existing provider is setting up a hot hub/red site from a new location (eg a marquee, football stadium etc.) – the provider should submit an application to vary their registration.  The application should be marked with COVID-19, to speed up the registration process.

If you would like more information, please get in touch with our healthcare solicitors by calling 01202 786171 or emailing online.enquiries@la-law.com.