Merging your Practice is a major decision and there are many factors that you need to consider before taking the plunge. (For more details, see: When is a GP practice merger not a merger?)
One important step is the CQC registration. This is often overlooked as an ‘administrative matter’, when in reality it can inform both the structure and the timing of the merger.
The situation is further complicated because NHS England’s processes don’t align well with the CQC’s.
Below, we’ve run through some of the most common merger scenarios and what you need to do:
- If a partner, or partners, join an existing partnership (Practice A) and close their previous practice (Practice B), then Practice A’s CQC registration will continue. The CQC will need to be notified of the names of the new partners in Practice A and an application made to terminate Practice B’s registration.
- If a partner, or partners, join an existing partnership (Practice A) and their previous practice (Practice B) becomes a branch surgery of Practice A, then Practice A must apply to have their CQC registration varied BEFORE the merger, to include the new branch surgery and any new services which were previously provided by Practice B but not by Practice A. The merger should not take place until a decision notice has been received. Notification will also be required to terminate Practice B’s registration.
- GPs from two separate practices may sometimes become partners in each other’s practices, but continue to trade as two separate entities. This is more common among smaller practices, where it can help in managing 24-hour retirement and reduce risk. Whilst each practice will keep its own CQC registration, if a practice moves from a single hander to a partnership in this process, they must re-register first. If they are already a partnership, then they just need to notify the CQC of the change in partners.
- If two practices merge to form a new practice, then a new CQC registration will be required BEFORE the merger can take effect. After the merger, notification should then be sent to cancel the two old registrations.
One of our clients kindly agreed to share their experience of this process. They were a partnership merging with a single hander, with the single-hander’s building to be used as a branch surgery following the merger:
“We did not submit the application for the practice to become a branch until we had signed and completed the legal documentation – we thought it was tempting fate and too presumptive to do this in advance. When you start filling out the online forms, however, it warns you that it takes 5 weeks for them to deal with any registration amendments.
“The next hurdle was that the online form needed the registration number on the practice’s original registration certificate – nobody knew what this was and consequently there was a delay tracking it down. I contacted CQC for help and was told that my query would be dealt with within 3 days but all they did was signpost me to the website, which is where I had started.
“I assumed our own registered manager could automatically be the registration manager, but you have to send the individual a separate invite that they then need to respond to, like on initial registration. Further delay is caused as that individual needs a CQC DBS check, unless the last one was within 6 months.
“We have also had to amend our Statement of Purpose and once again that is sitting pending the registered manager completion.
“Once the new DBS check has been confirmed, I can complete the registration form we started and at this point cancel the current, individual registration.
“It seems a totally clunky and onerous process and it would have been nice to have had ‘line of sight’ from the outset, instead of believing that each step is the final stage only to find that there is another to follow.”
As this example shows, the CQC processes are not straightforward and they do not work well alongside the many other steps in a practice merger. However, it’s important to take care, as it is a criminal offence to provide registrable services without the appropriate provider registration.
Our advice would be to work with experienced professional advisers to build a realistic and comprehensive ‘roadmap’ at the outset. This would cover all the key steps and set realistic dates to achieve them.
For more advice on the merger process, you may be interested in:
10 Steps to a Successful GP Practice Merger
For more information about mergers, or for any other enquiries, please contact Daphne Robertson on 01483 511555 or email [email protected]