The Care Quality Commission could ask the government to reduce its remit if it finds it cannot cope with registering all of the country’s GPs and dentists, the regulator’s chief executive has admitted.

During her second appearance at the Mid Staffordshire Foundation Trust public inquiry, CQC boss Cynthia Bower admitted the mammoth task would be a struggle and said if it became unrealistic the regulator would ask for further funding from the DH.

“If the DH responds ‘no’,” she said, “we would have to explain what the regulator could do within the resource envelope.”

Ms Bower was the last of four witnesses from the CQC to give evidence to the inquiry which is examining the role of regulation in the NHS and why failings at Mid Staffs were not spotted sooner.

Asked by chairman Robert Francis QC if she supported the government’s view that CQC should be a “regulator of ‘businesses’ not a commentator on the public sector” Ms Bower said it was the right approach.

She also revealed the commission had twice been turned down when it asked for changes to the legislation governing the CQC’s powers.

The CQC wants amendments to allow it to suspend registration in just one area of a trust, rather than the whole organisation, and to reuse evidence from previous incidents of non-compliance against trusts which repeatedly fail to meet core standards.

Inquiry counsel Tom Kark QC questioned how effective CQC inspectors, who include “ex-detective constables”, could be at assessing trusts, when few of them have clinical backgrounds.

Ms Bower said all staff were trained in regulation and revealed the board had decided against a model with teams built around specialist areas rather than regions because of the huge range of health and social services the CQC had to regulate.

She added: “Just to have someone who’s qualified as a nurse or a doctor 10 years ago and has worked with the regulator doesn’t necessarily mean that they’re entirely up to date with the latest practices in that particular field.”

Ms Bower defended the decision to abolish the investigations team that existed under its predecessor organisation the Healthcare Commission saying it was “partly a resource issue and partly a philosophy issue” in order to devote as much resource as possible to the front line.

Asked about the CQC’s own risk register in which the organisation identified its failure to intervene and stop poor care as a major risk, as reported by HSJ, Ms Bower said the purpose of the register was to “highlight difficulties”.

However, Mr Kark suggested that a television documentary exposing poor care at Pennine Acute Hospitals Trust, an organisation which the CQC had no concerns about, was a “crystallisation of that risk”. Ms Bower said the CQC’s systems were still “immature”.