SPH was commissioned by an STP group of CCGs to carry out a clinical audit of secondary care providers undertaking a range of procedures. We deployed an experienced consultant clinician, utilising our audit tool to review hip and knee replacements, cataracts, grommets and spinal injections across a mix of NHS Trusts and non-NHS providers. Patient records were selected randomly from a data extract and the audit tool was adapted to take full account of the complex eligibility criteria for each procedure. Our consultant clinician engaged with provider consultants/surgeons, to discuss and agree whether or not there was evidence in the patient notes that demonstrated each patient met the eligibility criteria in the commissioning policies. The aim of the audit was to establish the non-compliance rate for each procedure and provider, and also to uncover the key reasons underpinning any systematic non-compliancy. The aggregated annualised value of non-compliant procedures undertaken across the five providers was substantial at £1.9m and ranged from 15% to 80% of the annual activity value of each provider.