Prescribed Information		Form of statement (words in italics indicate information which must be inserted by the provider)
1.	The number of different types of NHS services provided or sub-contracted by the provider during the reporting period, as determined in accordance with the categorisation of services— (a) specified under the contracts, agreements or arrangements under which those services are provided; or (b) in the case of an NHS body providing services other than under a contract, agreement or arrangements, adopted by the provider.	During [reporting period] the [name of provider] provided and/or sub-contracted [number] NHS services.
1.1	The number of NHS services identified under entry 1 in relation to which the provider has reviewed all data available to them on the quality of care provided during the reporting period.	The [name of provider] has reviewed all the data available to them on the quality of care in [number] of these NHS services.
1.2	The percentage the income generated by the NHS services reviewed by the provider, as identified under entry 1.1, represents of the total income for the provider for the reporting period under all contracts, agreements and arrangements held by the provider for the provision of, or sub-contracting of, NHS services.	The income generated by the NHS services reviewed in [reporting period] represents [number] per cent of the total income generated from the provision of NHS services by the [name of provider] for [reporting period].
2.	The number of national clinical audits M1 and national confidential enquiries M2 which collected data during the reporting period and which covered the NHS services that the provider provides or sub-contracts.	During [reporting period] [number] national clinical audits and [number] national confidential enquiries covered NHS services that [name of provider] provides.
2.1.	The number, as a percentage, of national clinical audits and national confidential enquiries, identified under entry 2, that the provider participated in during the reporting period.	During that period [name of provider] participated in [number as a percentage] national clinical audits and [number as a percentage] national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in.
2.2	A list of the national clinical audits and national confidential enquires identified under entry 2 that the provider was eligible to participate in.	The national clinical audits and national confidential enquiries that [name of provider] was eligible to participate in during [reporting period] are as follows: [insert list].
2.3	A list of the national clinical audits and national confidential enquiries, identified under entry 2.1, that the provider participated in.	The national clinical audits and national confidential enquiries that [name of provider] participated in during [reporting period] are as follows: [insert list].
2.4	A list of each national clinical audit and national confidential enquiry that the provider participated in, and which data collection was completed for during the reporting period, alongside the number of cases submitted to each audit, as a percentage of the number required by the terms of the audit or enquiry.	The national clinical audits and national confidential enquires that [name of provider] participated in, and for which data collection was completed during [reporting period], are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry. [insert list and percentages]
2.5	The number of national clinical audit reports published during the reporting period that were reviewed by the provider during the reporting period.	The reports of [number] national clinical audits were reviewed by the provider in [reporting period] and [name of provider] intends to take the following actions to improve the quality of healthcare provided [description of actions]. The reports of [number] local clinical audits were reviewed by the provider in [reporting period] and [name of provider] intends to take the following actions to improve the quality of healthcare provided [description of actions].
2.6.	A description of the action the provider intends to take to improve the quality of healthcare following the review of reports identified under entry 2.5.
2.7.	The number of local clinical audit M3 reports that were reviewed by the provider during the reporting period.
2.8.	A description of the action the provider intends to take to improve the quality of healthcare following the review of reports identified under entry 2.7.
3.	The number of patients receiving NHS services provided or sub-contracted by the provider during the reporting period that were recruited during that period to participate in research approved by a research ethics committee within the National Research Ethics Service M4.	The number of patients receiving NHS services provided or sub-contracted by [name of provider] in [reporting period] that were recruited during that period to participate in research approved by a research ethics committee was [insert number].
4.	Whether or not a proportion of the provider's income during the reporting period was conditional on achieving quality improvement and innovation goals under the Commissioning for Quality and Innovation payment framework M5 agreed between the provider and any person or body they have entered into a contract, agreement or arrangement with for the provision of NHS services.	Either: (a) A proportion of [name of provider] income in [reporting period] was conditional on achieving quality improvement and innovation goals agreed between [name of provider] and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation payment framework. Further details of the agreed goals for [reporting period] and for the following 12 month period are available [F1electronically at [provide a web link]]. Or: (b) [name of provider] income in [reporting period] was not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework because [insert reason].
4.1	If a proportion of the provider's income during the reporting period was not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework the reason for this.
4.2.	If a proportion of the provider's income during the reporting period was conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework, where further details of the agreed goals for the reporting period and the following 12 month period can be obtained.
5.	Whether or not the provider is required to register with the Care Quality Commission (“CQC”) under section 10 of the Health and Social Care Act 2008 M6.	Either: [name of provider] is required to register with the Care Quality Commission and its current registration status is [insert description]. [name of provider] has the following conditions on registration [insert conditions where applicable]. The Care Quality Commission (has/has not) taken enforcement action against [name of provider] during [reporting period]. Or: [name of provider] is not required to register with the Care Quality Commission.
5.1.	If the provider is required to register with the CQC— (a) whether at end of the reporting period the provider is— (i) registered with the CQC with no conditions attached to registration, (ii) registered with the CQC with conditions attached to registration, or (iii) not registered with the CQC; (b) if the provider's registration with the CQC is subject to conditions what those conditions are; and (c) whether the Care Quality Commission has taken enforcement action against the provider during the reporting period.
6.	F2. . .	F2. . .
6.1.	F2. . .	F2. . .
7.	Whether or not the provider has taken part in any special reviews or investigations by the CQC under section 48 of the Health and Social Care Act 2008 during the reporting period.	Either: [name of provider] has participated in special reviews or investigations by the Care Quality Commission relating to the following areas during [reporting period] [insert details of special reviews and/or investigations]. [name of provider] intends to take the following action to address the conclusions or requirements reported by the CQC [insert details of action]. [name of provider] has made the following progress by 31st March [insert year] in taking such action [insert description of progress]. Or: [name of provider] has not participated in any special reviews or investigations by the CQC during the reporting period.
7.1.	If the provider has participated in a special review or investigation by the CQC— (a) the subject matter of any review or investigation, (b) the conclusions or requirements reported by the CQC following any review or investigation, (c) the action the provider intends to take to address the conclusions or requirements reported by the CQC, and (d) any progress the provider has made in taking the action identified under paragraph (c) prior to the end of the reporting period.
8.	Whether or not during the reporting period the provider submitted records to the Secondary Uses service M7 for inclusion in the Hospital Episode Statistics M8 which are included in the latest version of those Statistics published prior to publication of the relevant document by the provider.	Either: [name of provider] submitted records during [reporting period] to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data: — which included the patient's valid NHS number was: [percentage] for admitted patient care; [percentage] for out patient care; and [percentage] for accident and emergency care. — which included the patient's valid General Medical Practice Code was: [percentage] for admitted patient care; [percentage] for out patient care; and [percentage] for accident and emergency care. Or: [name of provider] did not submit records during [reporting period] to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data.
8.1.	If the provider submitted records to the Secondary Uses service for inclusion in the Hospital Episodes Statistics which are included in the latest published data: (a) the percentage of records relating to admitted patient care which include the patient's— (i) valid NHS number; and (ii) General Medical Practice Code; (b) the percentage of records relating to out patient care which included the patient's— (i) valid NHS number; and (ii) General Medical Practice Code; (c) the percentage of records relating to accident and emergency care which included the patient's— (i) valid NHS number; and (ii) General Medical Practice Code.
[F39.	The provider’s Information Governance Assessment Report overall score for the reporting period as a percentage and as a colour according to the IGT Grading scheme.	[name of provider] Information Governance Assessment Report overall score for [reporting period] was [percentage] and was graded [insert colour from IGT Grading Scheme].]
10.	Whether or not the provider was subject to the Payment by Results clinical coding audit at any time during the reporting period by the Audit Commission M9.	Either: [name of provider] was subject to the Payment by Results clinical coding audit during the reporting period by the Audit Commission and the error rates reported in the latest published audit for that period for diagnoses and treatment coding (clinical coding) were [percentages]. Or: [name ofprovider] was not subject to the Payment by Results clinical coding audit during [reporting period] by the Audit Commission.
10.1	If the provider was subject to the Payment by Results clinical coding audit by the Audit Commission at any time during the reporting period, the error rates, as percentages, for clinical diagnosis coding and clinical treatment coding reported by the Audit Commission in any audit published in relation to the provider for the reporting period prior to publication of the relevant document by the provider.
[F411.	The action taken by the provider to improve data quality.	[name of provider] will be taking the following actions to improve data quality [insert actions].]

SCHEDULEE+WInformation to be contained in Part 2 of the relevant document