Reviews, the NHS Provider Capability Assessment and AFTs

There has been a flurry of recent NHS commissions for developmental well-led reviews. Our CEO Professor Andrew Corbett-Nolan examines what is behind this and argues why, during 2026, this is not just sensible but essential.

Recognise it or not, in every sense we suddenly find ourselves in a new world. As our National Health Service embarks on its transformative 10-Year Health Plan and Medium-Term Planning Framework for 2026/27 to 2028/29, trusts face a defining moment.

At a time of financial constraints and service pressures the introduction of Advanced NHS Foundation Trusts (AFTs) and the prospective establishment of Integrated Health Organisations (IHOs) signal what the government believes will be a shift towards collaborative, efficient and high-quality care delivery. Whether you agree it will unlock the hoped for benefits (and for the record, I do) AFTs are the name of the game in 2026 and the push towards these will be unrelenting.

Central to navigating this complex landscape will be robust governance and leadership, underpinned by developmental well-led reviews and NHS provider capability assessments (PCAs), particularly their board capability elements. These tools are critical for trusts preparing for AFT status and aligning with the NHS’s strategic priorities.

This article explores the issues surrounding developmental well-led reviews in the context of the NHS’s strategic priorities, the evolving regulatory landscape and the specific governance challenges trusts face as they prepare for AFT status and potential IHO designation.

At GGi we have front row seats for this through our work with multiple NHS organisations and other system partners. To us it is barn-door obvious that independently commissioned developmental well-led reviews should now be aligned with both these new national ambitions and as well as local needs.

The origins and evolution of developmental well-led reviews

The concept of developmental well-led reviews was formalised in 2017 by NHS Improvement (now part of NHS England) in its guidance, Developmental Reviews of Leadership and Governance Using the Well-Led Framework: Guidance for NHS Trusts and NHS Foundation Trusts. This landmark document established a structured, non-regulatory approach for trusts to assess and enhance leadership and governance, tailored to local contexts.

The 2017 framework introduced eight key lines of enquiry (KLOEs), providing a comprehensive lens to evaluate governance, culture, and leadership. It recommended externally facilitated reviews every three to five years, complemented by self-assessments and peer reviews, to drive continuous improvement.

Since 2017, the NHS has evolved significantly with the establishment of integrated care systems (ICSs), a focus on system working and the introduction of the CQC’s Single Assessment Framework in 2024. These changes have elevated the importance of well-led reviews, and their utility is not just ‘a dry run for our CQC well-led’. A new context demands appropriate board leadership and as trusts prepare for AFT status and potential IHO designation developmental well-led reviews should help boards with the much needed reset they will find essential.

Additionally, the NHS provider capability assessment, introduced to evaluate organisational and board-level readiness for advanced responsibilities, has become a critical component of this preparation with a specific focus on board capability. This needs incorporating too.

The NHS’s strategic context: 10-Year Plan, Medium-Term Framework, and Advanced NHS FTs

The NHS’s 10-Year Health Plan, launched in 2025, outlines a bold vision to reform healthcare delivery, reduce waiting times and empower frontline leaders through a reinvigorated foundation trust model. The Medium-Term Planning Framework for 2026/27 to 2028/29 provides a roadmap for sustainable improvement, focusing on urgent and emergency care, elective care reform and workforce sustainability.

These plans introduce new governance challenges, particularly for trusts transitioning to AFT status (and all must) or preparing for IHO contracts.

Advanced FTs incentivise high-performing trusts with greater autonomy, provided they demonstrate excellent governance, financial sustainability and quality of care. The authorisation process, detailed in NHS England’s Advanced Foundation Trust Programme – Guide for Applicants (2025) assesses trusts across three priority areas: leadership, quality, and financial sustainability with a strong emphasis on collaboration within ICSs. Trusts must achieve a good or outstanding CQC well-led rating and a provider capability score of at least amber-green highlighting the centrality of governance and board capability.

IHOs, described as a ‘contract-based delivery method’, require trusts to redesign care pathways, collaborate across providers, and demonstrate robust assurance systems. As I noted in GGi’s recent article, The new era of strengthened NHS foundation trust governance, the governance expectations for Advanced FTs and IHOs demand organisational self-awareness and transparency, achievable through rigorous developmental well-led reviews integrated with provider capability assessments.

The role of NHS provider capability assessments

The NHS provider capability assessment (PCA) is a structured framework designed to evaluate a trust’s readiness to take on advanced responsibilities, such as Advanced NHS FT status or IHO contracts.

The PCA assesses organisational performance across multiple domains with a particular focus on board capability. This evaluates the effectiveness of board leadership, decision-making and governance structures. Key elements of the board capability assessment include:

• strategic leadership: the board’s ability to set a clear vision, align with ICS priorities, and drive system-wide collaboration
• governance effectiveness: robust assurance processes, risk management, and integration of quality, finance, and operational governance
• board dynamics: cohesive, inclusive, and transparent decision-making, with strong engagement with frontline staff and service users
• system-minded behaviours: demonstrating collaborative leadership within the ICS and a commitment to population health outcomes.

The PCA’s board capability elements align closely with the CQC’s well-led framework, making their integration with developmental well-led reviews a powerful tool for trusts.

By combining these assessments, trusts can identify gaps in governance, strengthen board-level leadership, and demonstrate readiness for the rigorous Advanced FT authorisation process. For example, a trust with a PCA score below amber-green may struggle to meet Advanced FT criteria, underscoring the need for targeted board development.

The actual ‘secret sauce’ of a high performing board will not come just from a pro-forma governance template such as well-led or the PCA. There is an ocean of literature evaluating high performing boards and a simple audit-type review applied to a board against a framework completely misses out what actually works to support board effectiveness. Developmental well-led reviews need undertaking by teams that understand the organisational development motors for board performance as well as the applicable frameworks (in this case well-led and the PCA) otherwise by keeping an eye on the ball the actual goal itself is missed.

Current issues in developmental well-led reviews and provider capability assessments

Integrating developmental well-led reviews with provider capability assessments addresses several pressing issues, enhancing their relevance for NHS trusts:

1. Alignment with the CQC’s Single Assessment Framework: The CQC’s shift to the new Single Assessment Framework in April 2024 replaced the eight KLOEs with quality ‘we’ statements, now emphasises system working, workforce equality, diversity, inclusion and environmental sustainability. The CQC’s flexible, data-driven inspection approach requires trusts to maintain continuous readiness. Recent inspections, such as those at Cambridgeshire and Peterborough NHS Foundation Trust (2025) and St George’s University Hospitals NHS Foundation Trust (2025), highlight challenges like inconsistent co-production with service users, delays in complaint handling and weak risk management. Developmental well-led reviews, enhanced by PCA board capability assessments, ensure governance arrangements align with CQC expectations and support trusts in achieving a good or outstanding well-led rating.
2. Preparing for AFT and IHO governance requirements: The AFT authorisation process places governance and board capability at its core, requiring integrated oversight of quality, finance and operations. IHOs demand additional scrutiny of a trust’s ability to manage complex contracts and deliver system-wide efficiencies. A combined well-led review and PCA can identify gaps, such as inadequate risk escalation processes or limited board engagement with frontline staff, as seen in recent review of a trust in the Midlands in 2024. By addressing these, trusts can build the capability needed to succeed in the authorisation process and secure IHO contracts.
3. Tailoring reviews to local contexts: The 2017 guidance emphasised scoping reviews to reflect local priorities, a principle that remains critical. Trusts operate within diverse ICSs, each with unique population health needs and partnership dynamics. Integrating PCA board capability elements ensures reviews address specific challenges, such as enhancing medical engagement or embedding compassionate leadership, while aligning with ICS goals. A piece of learning from GGi is the importance of co-designing review specifications (we do an initial scope refinement stage to our reviews) to adequately reflect local contexts, maximising their developmental impact and supporting system-minded behaviours.
4. Responding to evolving risk and safety environments: The CQC’s updated inspection processes reflect a shift towards system-based safety and quality improvement. Trusts must demonstrate robust risk management, as highlighted in St George’s inspection, where delays in emergency department protocols posed safety concerns. A combined well-led review and PCA evaluates how effectively risks are identified, escalated, and mitigated, aligning with the NHS Patient Safety Strategy and Martha’s Rule and ensuring boards are equipped to oversee safety at a strategic level.
5. Embedding continuous improvement and innovation: The NHS’s Medium-Term Framework and 10-Year Plan prioritise continuous improvement and innovation. However, CQC inspections note inconsistent uptake of quality improvement initiatives, as seen in Cambridgeshire and Peterborough NHS Foundation Trust’s report. A well-led review integrated with PCA board capability assessments evaluates whether trusts have the governance structures and leadership culture to support innovation, drawing on the six principles of enabling innovation in the CQC and NHS England’s Enabling Innovation and Adoption in Health and Social Care (2024).

GGi’s learning on developmental well-led reviews

For nearly 17 years, GGi has been a trusted partner to many NHS boards (both successful and troubled) through delivering developmental well-led reviews, rapid CQC preparation assessments and board development programmes that drive meaningful change.

Our team of senior consultants, many with extensive NHS and other public sector leadership experience, combines deep sector knowledge with an agile, collaborative approach to deliver reviews that are both rigorous and supportive. Our recent work, including my own research on high performing boards, and the new AFT authorisation process underscores our role as thoughtful analysts who anticipate and interpret the NHS’s evolving governance needs. In short, we are informed witnesses. Because of what we see GGi’s reviews have developed to be grounded in a commitment to capturing what trusts do well while identifying actionable areas for improvement.

This has led us to the view that developmental well-led reviews should be undertaken with explicit consideration of the PCA and AFT authorisation in a way that helps the NHS trust concerned put in the building blocks that will be needed. To do this competently the review provider must have a knowledge hinterland that extends beyond the pro-forma codes or frameworks and into the effectiveness literature for high performing boards.

GGi has written extensively on this as part of our knowledge sharing approach and the good news is that none of this is actually new. We particularly encourage all to reach out beyond NHS templates and develop an affinity with the wider high performing board literature. Much that was first developed by Harvard Business School in the early 2000s, as well as the compassionate leadership work of thought leaders such as Professor Mike Thomas in the north west, is particularly relevant to the NHS, higher education and indeed CICs.

The path forward

There has been a recent flurry of commissions for developmental well-led reviews. It is clear that as NHS trusts prepare for the AFT authorisation process and the potential transition to IHOs, a developmental well-led review is not just a good practice, it is being increasingly and rightly understood as a strategic necessity.

By aligning governance arrangements with the CQC’s Single Assessment Framework, addressing themes from recent inspections and tailoring reviews to local contexts trusts are looking to build the organisational capability needed to thrive in a reformed NHS. This is very sensible.

At GGi, we understand that governance is the backbone of high-quality care. As part of good governance NHS boards would be well advised to think of their developmental well-led reviews as a unique opportunity to reflect, improve and demonstrate their readiness for the challenges ahead rather than an audit to get ready for CQC.

Thankfully from the various commissions we see going out board secretaries increasingly understand this. As the NHS embarks on its most ambitious plan in a generation it is easy to understand why so many NHS boards are understanding that now is the time to invest in meaningful, well-constructed developmental well-led reviews.