1. 1 (Part 1) Carl Marsh Head of Integrated Care (Part 2) Andy Brown Registration Advisor The Registration of GP ‘Federations’

2. 2 Registration Basics 1: Registered Providers 1.Providers S.10 Requirement to register as a service provider (1)Any person who carries on a regulated activity without being registered under this Chapter in respect of the carrying on of that activity is guilty of an offence. “Person” – means a legal person or ‘entity’ - i.e. individuals, partnerships or other bodies (e.g. companies) “Carries on” – means a person with ongoing direction and control of the regulated activity “Regulated activity” - means the health and social care activities set out in the Regulations

3. 3 Registration Basics 2: How does CQC decide? Section 12 - Grant or refusal of registration as a service provider If the Commission is satisfied that the requirements… are being and will continue to be complied with… it must grant the application; otherwise it must refuse it. “the requirements” – means the requirements of the Act, it’s associated regulations and any other relevant legislation. “are being and will continue to be” – because applicants cannot begin to provide regulated activity, the registration assessment focusses on inputs and likely compliance, whereas inspection is able to focus on outcomes and actual compliance. “grant” or “refuse” – means that CQC has only two options. It cannot delay while the applicant achieves compliance – the onus is on the applicant to be ready and able to satisfy CQC at the point of application.

4. 4 Registration Basics 3: Who must be fit? Applicants (Assessed by CQC) Where real persons are applying to be registered, their fitness is directly assessed by CQC as part of the registration assessment. “real persons” – means individuals, partners, managers. Non-applicants (Assessed by the Provider/Applicant) The directors of companies The nominated individual (bodies other than a partnership) The staff employed to deliver the regulated activity. “nominated individual” – means a senior person, with responsibility for supervising the management of the regulated activity, nominated to represent the provider in its dealings with CQC.

5. 5 Section 12(3) CQC has the power to make conditions on registration. CQC uses “Conditions” – To require a registered manager (where applicable) To restrict registered persons to providing regulated activity at or from certain places only - ‘locations’ To restrict the membership of registered partnership providers to specific partners (in order to allow continuity of registration) Registration Basics 4: Conditions

6. 6 “Location” – means the place at which the regulated activity is provided or from which regulated activity is managed (depending on the rules in ‘What is a Location?’) KEY POINT Locations are not registered. CQC does not register physical places or even services. We register the providers (and managers) of regulated activity. We then restrict them to providing or managing the regulated activity at/from the locations specified in their conditions of registrations. We use locations on our register and in our inspection model, to make information useful/meaningful to the public. Registration Basics 5: Locations

7. 7 Some changes can be made by notification (to CQC). Others can only be made by application. “Application” To begin or cease to provide/manage a regulated activity. To cancel your registration (i.e. altogether). If you need to vary your conditions of registration. “Vary conditions” To cease or start to provide/manage regulated activity at a location (“removing a location” or “adding a location”) A partner is leaving or joining the partnership (“remove partner” or “add partner”) If any other condition of registration needs to be varied. Registration Basics 6: Changes

8. 8 “Federations” A group of providers decide to provide services together (jointly). Federations must decide: What (regulated activities) will they provide? Who (which legal entity or entities) will provide them? Where (the locations) will they be provided? Have an agreement between themselves that makes these things clear. Federations How should they be registered?

9. 9 Remember: It is the regulated activity for which the provider must register. Not the type of service, the surgery or practice. If the federation provider is already registered, then they will only have to apply for any RA’s they don’t already have. Check the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the CQC publication ‘The Scope of Registration’. What will they provide? Regulated Activities

10. 10 Federations can choose to: Set up a new legal entity to provide the RA Agree that one of the participant providers will be responsible for the regulated activity Agree that all of the participant providers will share responsibility for the regulated activity. Remember: The provider is the person, partnership or body that controls and directs the regulated activity. Not all federations do this. They may sub-contract delivery of the regulated activity back to the participant providers. Who will provide them? Legal entities

11. 11 The new legal entity could be: A partnership A body (usually a company) It would: Apply to register for each of the regulated activities it proposed to provide. Appoint a manager/s to manage each of the regulated activities applied for. Satisfy CQC about its compliance with the requirements. Be subject to inspection by CQC. Pay annual fees to CQC. Who will provide them? New legal entity

12. 12 Where the provider is one of the existing participant providers they: Will normally already be registered. Are likely to have the regulated activities to be provided. May provide the regulated activity from their existing location/s. May use their existing registered manager/s. (If all of the above are true then no application of any kind would be required – they would simply need to amend their statement of purpose). Who will provide them? Existing legal entity

13. 13 CAUTION: Unless considered and planned for carefully this option has potential for considerable duplication, because: Participants may need to add multiple locations. Manager/s may need to add multiple locations. Alternatively: ‘Patient led’ – Participants enter into an agreement through which when a doctor sees a patient, they work for and under the direction of the provider of the surgery from whose list the patient comes. ‘Practice led’ - Participants enter into a written agreement through which it is always the provider of the practice in whose premises the patients are seen, which is responsible. (Please see our latest guidance for federations) Who will provide them? Participant providers

14. 14 “Location” – the place/s at which or from which the regulated activity is provided Determined by the rules in “What Is A Location” Most GP services covered by Rule 4 Surgeries only separate locations if they have a separate patient list This can lead to duplication if federation services are provided by the participant providers. Where will they provide it? The location/s

15. www.cqc.org.uk Andy Brown Registration Advisor 15 Thank you