This article relates to the CQC key question: Is your practice well-led?
We are increasingly seeing groups of registered GP practices and primary care teams who are collaborating. These groups, sometimes known as ‘federations’, can be either a formal or informal association of practices that work together to provide a greater range of services or to share knowledge.
The CQC often receives queries from GP practices about this issue, particularly focused on how these providers or services should be registered. As a result, we have produced guidance to help groups of registered providers who wish to form a federation understand their duties and responsibilities about the registration requirements.
If you are considering forming a federation, please read the full guidance on the CQC website:
We also advise you to contact us at the earliest opportunity to discuss:
- any potential changes to existing CQC registration, or
- any new registration that you may need to apply for as a result of forming a federation.
Federations can be formed in a number of ways, so whether or not they need to register with CQC will depend on how they are arranged. In our guidance we summarise the issues that federations should consider and provide case studies to illustrate different registration scenarios.
Federations that have formed a legal entity
Under the Health and Social Care Act 2008, all ‘service providers’ who carry on regulated activities must register with CQC. The two key things that need to be considered when forming a federation are:
- It is always the provider of the regulated activity that must be registered. For example, the provider of care or treatment. When services are provided jointly, or at a shared location, not all of the parties involved may provide regulated activity. Whatever the arrangement, the provider of any regulated activity should always be identified and they must register with CQC.
- Only legal entities can register. People who come together informally, without any kind of legal constitution, are unlikely to have formed a legal entity.
Most providers will already be registered. However, where the federation establishes a legal entity to provide the regulated activity, only that legal entity will need to be registered in respect to that activity. Where the federation is an informal arrangement, which has not established a legal entity to carry on the regulated activity, then each of the parties providing regulated activity will need to be registered separately with CQC through the normal registration process.
Federations that have not formed a legal entity
The following information relates to federations that have not formed a new legal entity and therefore do not need to register in their own right.
In these instances, regulated activity is usually provided by each of the providers that are part of the federation and they will usually already be registered in their own right for the regulated activities they will be providing for the federation.
However, we have had queries from practices relating to situations where providers provide care and treatment (regulated activities) to patients from other practices at surgeries other than their own. This usually improves access for patients but can trigger the need for providers to add those surgeries to their conditions of registration.
Our updated guidance suggests some options that federations can use to avoid the need to add each other’s locations.
Federations that have chosen not to form a legal entity could arrange themselves in one of two ways:
- Option A – ‘patient led option’
- Option B - ‘premises led option’
Option A – ‘patient led option’
The participant providers enter into a written agreement between themselves, so whenever a doctor sees a patient they work under the direction and control of the provider of the practice from whose list the patient comes. Under this arrangement, the patient’s regular practice provider is always responsible for the regulated activity provided – no matter which doctor sees them or in which premises they are seen.
In this case, none of the federation participants would need to add any locations, because each provider would only ever be responsible for the regulated activity delivered to their own patients. The participants would use each other’s locations as satellites or branches of their own location – they’d simply list them in their statements of purpose.
Option B - ‘premises led option’
The participating providers enter into a written agreement detailing that it is always the provider of the practice in whose premises the patients are seen who is responsible for the regulated activity delivered there. When a healthcare professional works in the premises of another participating practice, they are always working for the host provider, following their policies and procedures, regardless of whose list the patient comes from.
Providing that the federation only delivered regulated activities in the premises of its participants, then none of the federation participants would need to add any locations.
In Options A and B the federation would need to document the agreement carefully to ensure that the identity of the provider (of the regulated activity) was always clear. We would need to be satisfied that the provider could be held to account.
There are two case studies in our guidance, 7a and 7b to help illustrate this in practice.
If you have questions about new models of care, including federations, please contact us at: firstname.lastname@example.org
Please contact us at email@example.com for all questions about registration, including those about any potential changes to existing CQC registration, or new registration that you may need to apply for as a result of forming a federation.
- Professor Nigel Sparrow is senior national GP advisor and responsible officer at the CQC