How to start a domiciliary care agency in the UK

1. Decide what you will provide

"Domiciliary care" covers everything from an hour of companionship to complex care with two carers, hoists and medication four times a day. Decide at the start which of these you will offer, because it decides your registration, your insurance, your staff training and your first customers:

• Personal care — washing, dressing, toileting, help with eating, prompting or administering medication. In England this is a regulated activity and needs CQC registration before you deliver a single call.
• Companionship and domestic help only — no personal care. Not regulated in England, but you cannot advertise or accept personal care work without registering.
• Live-in care, complex care, children's care — each adds requirements; children's services are regulated separately (Ofsted in England).

Most new agencies register for personal care from the start, because that is where the council and NHS contracts are, and because private clients' needs grow.

2. Company, insurance and the basics

• A limited company registered at Companies House, with a business bank account. Most councils will only contract with a company.
• Employer's liability insurance is a legal requirement the moment you employ anyone. You will also need public liability and, for personal care, professional indemnity and treatment cover. Use a broker who does care; general business policies exclude it.
• ICO registration — you will hold health data about vulnerable people, so register with the Information Commissioner's Office and appoint someone responsible for data protection.
• A registered office address and a phone that is answered. The regulator, commissioners and families will all ring it.
• PAYE and pension auto-enrolment set up before the first payroll.

3. Registering with the regulator

Each UK nation has its own regulator, its own application and its own inspection framework. You register the provider (the company) and the registered manager together, and you cannot deliver regulated care until both are approved.

The application asks for your Statement of Purpose, your policies, evidence of insurance, the manager's qualifications and DBS (or PVG / Access NI) checks, financial viability, and how you will meet each regulation. Expect a "fit person" interview for the nominated individual and the manager. Applications that arrive incomplete go to the back of the queue; a complete, well-evidenced application is the single biggest time-saver in the whole process.

4. The registered manager

Every agency needs a registered manager who is accountable to the regulator for the quality of care. In practice they need care management experience, a relevant qualification (in England, typically the Level 5 Diploma in Leadership and Management for Adult Care or a commitment to complete it), a clean enhanced DBS, and the time to actually manage. If the owner is not that person, recruit them before applying, because the application needs their details and they will be interviewed.

A manager who leaves takes your registration's stability with them; the regulator must be told and a replacement registered. Pay them properly and give them a system that does the admin, or you will be recruiting again in a year.

5. Policies and the Statement of Purpose

The Statement of Purpose is the document that describes who you are, what you provide, to whom, where and how. The regulator publishes what it must contain. It is also the first thing a commissioner reads.

You will need a policy set covering at least: safeguarding adults, medication, infection control, moving and handling, lone working, complaints, whistleblowing, data protection and record keeping, recruitment and DBS, training and induction, supervision and appraisal, accidents and incidents, missed and late calls, business continuity, and equality. Buy a professionally maintained set rather than writing them from scratch, then read them, because the inspector will ask a carer whether they know what the medication policy says.

6. Recruiting and checking carers

Safe recruitment is the area new agencies most often fail on at first inspection. For every carer you must be able to show: identity and right to work, an enhanced DBS with adult barred list check (PVG in Scotland, Access NI in Northern Ireland), a full employment history with gaps explained, two references including the last care employer, a health declaration, and an induction against the Care Certificate standards before they work unsupervised. Keep it in a file per carer that an inspector can open in a minute.

Then the ongoing evidence: mandatory training and its expiry dates, supervision at the frequency your policy states, an annual appraisal, spot checks on real visits. A compliance matrix — who is done, due and overdue — is the difference between "well-led" and a requirement notice. Which records answer which CQC question.

7. Winning the first clients

• Private clients come first for most agencies: they need no framework, they pay weekly or monthly, and a good local reputation spreads through GPs, district nurses, pharmacies and churches. Be listed on homecare.co.uk and your local directory, and have a website that states plainly what you do and what it costs.
• Local authority frameworks are where the volume is. Councils buy through Dynamic Purchasing Systems or framework tenders; most require you to be registered, insured, to have an electronic call monitoring system, and to accept their hourly rate. Register on the council's procurement portal and on the national portals so you see the tenders.
• NHS Continuing Healthcare and hospital discharge contracts come through the Integrated Care Board and usually need a track record first.

Whatever the source, quote in hours and be clear about double-handed calls, which are two carers' time and must be priced that way.

8. The systems to have before day one

New agencies run their first months on a spreadsheet rota, a WhatsApp group and a folder of paper MAR charts, and then spend a fortnight rebuilding everything into software once the first council contract demands call monitoring. Set up the software first. What it needs to do from the first call:

• The rota — the weekly plan for every client, every carer's day, and a clear view of what is unassigned. Rota planning guide.
• Electronic call monitoring — GPS check-in and check-out proving each call happened, which every council contract will require. ECM guide.
• eMAR — a medication record that is filled in at the door and cannot be back-filled at the weekend. eMAR guide.
• Care notes, incidents and body maps written on the phone, at the visit.
• The compliance matrix — training, supervision, spot checks, with due and overdue.
• Timesheets from actual times, including travel, so the minimum wage is provably met. Timesheets guide.
• A family view, because the first thing a private client's daughter asks is "how will I know you came?"

Choose on price at your size and at three times your size, and on whether the vendor migrates your data for free later. How to choose home care software has the checklist. Carelo's pricing is public from £59 a month for up to 15 carers with every module, both apps and unlimited clients included, which is why many first-year agencies start on it.

9. Costs and timescales, honestly

• Time to registration: plan for three to six months from submitting a complete application, longer if it is returned. Nothing regulated can be delivered until then, so the company will carry costs with no income.
• Start-up spend is dominated by the manager's salary before revenue, insurance, DBS checks, training, the policy set, the regulator's fees, and a small office. Software is the smallest line; a good one costs less than one carer's shift a week.
• Cash flow is the killer in year one. Councils pay in arrears, often monthly and on actual call-monitoring data, so an invoice built from the rota rather than from check-ins gets queried and delayed. Private clients paying weekly are what keep a young agency alive.
• The first inspection usually comes within the first year of delivering care. Everything in sections 5 and 6 is what it will look at.