Is there anything I need to do if I see patients from my home?

Registration

Seeing patients at home is still carrying on a regulated activity, so in England the address must be a location on your CQC registration. If you are an individual provider in full-time day-to-day charge of the service, you may not need a separate registered manager. See running a private practice by yourself and registering with the CQC.

The CQC applies the same test to a home as to any clinic. Regulation 15 requires premises to be clean, secure, suitable for their purpose, properly used, properly maintained and appropriately located. It must refuse registration if you cannot show you will meet it.

Making the room suitable

Treat the consulting room as a clinical space, not a spare room that doubles as a clinic.

• Dedicated and private. A room used only for clinical work, where conversations cannot be overheard, with a lockable door and somewhere private for patients to undress.
• Infection control. Handwashing facilities, wipeable surfaces and hard flooring. The CQC's guidance says clinical rooms should not have carpets.
• Waiting and access. Somewhere for patients to wait that does not pass through family areas, and access to a toilet.
• Equipment and emergencies. Your diagnostic kit, an AED, oxygen and emergency medicines. See equipment and emergency drugs.
• Medicines and records. Locked storage for medicines and any paper records, away from family members.
• Clinical waste. A secure store for bins awaiting collection and a contract with a licensed carrier. See dealing with medical waste.

Planning

You do not necessarily need planning permission to work from home. If there is no material change of use, permission is not required. The Planning Portal says permission will probably be needed if:

• your home will no longer be used mainly as a private residence
• your business will cause a marked rise in traffic or people calling
• it involves activities unusual in a residential area
• it will disturb neighbours at unreasonable hours or create other nuisance.

If you are unsure, you can apply to your council for a certificate of lawful use. Remember that the Class E(e) use class for medical services does not include premises attached to the practitioner's home. Guidance differs in Wales, Scotland and Northern Ireland, so check with your local planning authority.

Mortgage, lease and deeds

GOV.UK says you may need permission from your mortgage provider or landlord to run a business from home. Check your title deeds or lease for covenants that restrict business use, and ask a solicitor if the wording is unclear. Leases of flats in particular may restrict business use or visitors.

Insurance

Home insurance may not cover business use, equipment or patients visiting. Tell your home insurer, and arrange public liability cover for patients and employers' liability cover if you employ anyone. Your medical indemnity covers clinical work, not accidents on the premises. See essential insurance.

Tax and business rates

• Business rates. You do not usually pay business rates if you use a small part of your home for business. You may have to pay them, as well as Council Tax, if you provide services to people who visit the property, employ people to work there, or have changed your home for the business. Contact the Valuation Office Agency, or your local assessor in Scotland, to check.
• Expenses. A proportion of costs such as heating, lighting and broadband can be claimed as business expenses.
• Capital Gains Tax. You may have to pay Capital Gains Tax on the part of your home used for business when you sell it.

How you structure this depends on whether you trade as a sole trader or a company. See tax implications.

Safety, privacy and family life

• Health and safety. You need to manage health and safety as you would in any other business. Carry out a risk assessment of the room, the route in and any shared areas. See health and safety standards.
• Fire. Include the clinical room and the patient route in a fire risk assessment, and store oxygen safely.
• Lone working. Decide how you will call for help in an emergency or if a patient becomes aggressive, especially for evening appointments. Consider seeing new patients only when someone else is in the house.
• Chaperones. The CQC expects a chaperone to be offered for intimate examinations. Formal chaperones should be impartial and trained, so plan how you will provide one when you work alone at home.
• Accessibility. Homes often have steps and narrow doors. You must make reasonable adjustments, and if you can't, have an alternative such as a rented room. See accessibility requirements.
• Confidentiality. Keep records, screens and phone calls out of reach and earshot of family members, and make sure your home network is secure.

Scotland, Wales and Northern Ireland

Registration is with Healthcare Improvement Scotland, Healthcare Inspectorate Wales or RQIA, each with its own premises standards. Planning, business rates and fire safety are devolved, so check the rules where you live.