To answer the question “Do I need TDDI for PEG feeding?”. You do not automatically need to add “Treatment of disease, disorder or injury” (TDDI) to your CQC registration just because you are PEG‑feeding and administering medicines via PEG in a domiciliary care service, but it depends on who is directing the treatment and how the task is delegated and governed.
Key CQC points
- CQC’s “treatment of disease, disorder or injury” regulated activity applies where treatment is being provided under the direction of a health professional, such as ongoing clinical interventions or nursing care that go beyond personal care.
- CQC’s guidance on enteral feeding confirms PEG feeding and medicines administration via PEG are clinical tasks, but they can be delegated by an appropriate health professional (for example, community nurse or specialist team) to trained, competent care staff, with clear care plans and governance.
When personal care registration is usually enough
If your domiciliary care service already holds registration for “personal care,” you generally do not need to change it, provided that:
- The NHS team (GP, community nurses, or specialist service) not your agency, makes the decision to treat, prescribes, and clinically manages the condition.
- A health professional has clearly prescribed the PEG feeding and medicines as specific tasks and delegated them in writing. This must include:
- A detailed care plan and risk assessment from that professional.
- Written delegation and a competency sign-off for each worker performing PEG tasks.
- Your staff implement the prescribed regimen (following set volumes, times, and procedures) without adjusting treatment or making clinical judgements outside the agreed plan.
In this model, the regulated activity remains personal care with delegated clinical tasks; TDDI is usually not required because you are not assuming responsibility for the clinical treatment itself.
When TDDI may be needed
Consider adding TDDI to your registration if your service:
- Provides nurse-led or complex clinical management at home (e.g., deciding PEG feed regimes, titrating treatment, or managing complications).
- Employs registered nurses who themselves assess, plan, and review treatment, rather than solely following NHS-provided care plans.
In these situations, the CQC will likely view your activities as “treatment of disease, disorder or injury,” requiring the TDDI registration.
Practical advice for your dom‑care service
- Ensure every worker who supports PEG feeding/medication has:
- Formal training specific to PEG and enteral medicines, delivered or signed off by the district nurse/clinical lead.
- Documented competency assessments, periodically refreshed.
- Keep robust documentation:
- Individual PEG care plan and risk assessment, clearly stating that the NHS team retains clinical responsibility.
- Written delegation from the relevant health professional (for each individual where possible).
- Check that your Statement of Purpose and policies explicitly describe:
- Support with PEG feeding and medicines as delegated health tasks within a personal care service.
- Escalation pathways for blocked tubes, site infection, intolerance, vomiting, etc., back to NHS professionals.
For a definitive answer on your specific operating model, we advise contacting the CQC registration team. Describe your scenario, specifying who prescribes, delegates, and reviews treatment and ask if it falls within your personal care registration or requires TDDI. Keeping their written clarification on file will support your governance position.
