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For Groups, Federations and Complex Providers

GP Federations and Complex Providers

CQC is changing the way providers who are part of a Group are monitored and inspected. This covers anyone in a Groups or part of a service organisation such as an OOH and for GPs, any GP Federation, super practices, and multi-specialty community providers.

inspections provider level

A Quick summary

Any organisation working as a group/community will be treated as one single Accountable Care Organisation.
This affects NHS Trusts, Corporate Groups, Franchise Operations, Federations, and Out of Hours Services, in fact any organisation connected via common contract bids or as an integrated organisation, or under the umbrella of a branded service.

Control of Care

You have to register if any of the following apply to your Group or Federation:-

  • You exercise any form of control over care
  • Are involved in quality assurance of your members
  • Direct common policies and rules
  • Are involved in employment decisions in delivery of care or who is allowed to run the service

Groups, OOH & Federations

  • Independent providers to be inspected on same basis as NHS providers
  • Urgent care will be in focus, CQC looking for local variations in performance
  • Federations: New models to be introduced, not yet fully formulated

Adult Social Care

Every service will have a comprehensive inspection as standard
Organisations repeatedly rated as Requires Improvement MUST provide Action Plan of how and when they will get to Good rating
CQC will target management of 50% of your services rated as requires improvement or inadequate OR if there is significant concern with some members.


This will affect everyone

  1. Board members to be held accountable for performance.
  2. Failing locationa will trigger inspection of rest of group AND the head office.
  3. Your inspection report will now show that fellow members have failed.

The weakest link will drag down everyone in the Federation or Group, who will need to get a better handle on quality standards and ensure that EVERY member will pass CQC inspections.

If you are a member of such a group, you should be very concerned if any fellow member is not up to standard.

Effect on Board of Directors

The changes affect Groups, multi-discipline providers, and providers who are part of one Group/corporate entity.
If you are a board member, you need to be aware how individual members’ performance will now impact on your duties and responsibilities as a Board Member.

Quick snapshot for Head Offices:-

  1. Provider Level Assessment: Head office will go through a more formal audit and the Federation or Group given a “Provider-level assessment and rating based on member performance.
  2. Board members will be subject to KLOE assessment, primarily the Well-Led test, and held accountable for member failings.
  3. Targeting of the Federation if individual members are found to be inadequate or require improvement.
  4. Everyone’s inspection report will now mention failings of group members.

Your main hurdles

Performance variation and differing quality standards is the critical area to tackle. What makes this challenging is the absence of standardisation across the membership and lack of co-operation and shared standards between members.