15.07.15
GP federations – making them work
Mary Chant, partner in the health and social care team at law firm Blake Morgan, discusses the drive to consolidation in primary care structures.
Primary care is at the heart of the NHS and is recognised in the NHS England Five Year Forward View as “one of the great strengths of the NHS”. It focuses around the concept that everyone in the population has access to a family doctor through the system of registered patient lists.
This model has many benefits but times have changed since the formation of the NHS. The 2015 requirements mean dissolving barriers between health and social care and creating a more integrated approach to the provision of primary and secondary care.
The public, if asked, would probably say they regard their GP as at the core of their access to healthcare and clearly there is a strong argument for GPs to remain at the centre of the provision of care. The Multi-Specialty Community Provider, one of the new models of care identified in the Five Year Forward View, does just that. It anticipates extended groups of GP practices coming together and mentions GP federations, though thankfully doesn't prescribe how they should be formed.
GP federations are not new; they have been promoted by the Royal College of General Practitioners since 2010 and many have been formed up and down the country. However, the word ‘federation’ is not a term of art; it means different things to different people.
There is no ‘one size fits all’ for a federation: its structure depends on a number of factors. However, it is important that a clear purpose or purposes are identified at the outset. Not all its future uses need be identified but some vision as to how it might develop is important.
There can be a concern that a federation will lead to the loss of independence of member practices and is nothing more than a disguised merger; fear of the unknown and a suspicion of ‘ulterior motives’ can be an obstacle to a federation’s formation and successful operation. There is no need for practices to feel threatened: the ‘joined up’ approach can extend as far as they feel comfortable and to the extent needed for the best provision of care in an area. A step-by-step approach is often best – start small, and as practices become more comfortable with the way the federation is working, look at other potential benefits.
Federations can be used in various ways. The main driver may sometimes be to create back office savings or economies of scale, although it is prudent to be clear about how those may be generated. Just forming a federation does not cause them to appear magically. For many GPs, a federation has the potential to improve local service integration, strengthen clinical governance, or develop training and education capacity in their area.
The real potential is to use a federation more directly for service delivery. It can tender for contracts, deliver the services through its member practices or through directly employed staff, develop new methods of care delivery, and develop out-of-hospital services. Many also feel that they are better able to compete for contracts because an efficient federation is much more than the sum of its parts.
Federations can take a range of forms. Some are informal networks of practices, others are based around contractual arrangements between the member practices. However, if it is to take on contracts, deliver services and employ staff in its own right it needs to be a legal entity, often a company, where the practices are members and in turn appoint directors. Although the federation is a legal ‘person’, it is owned, managed and controlled by the GPs.
Clearly, for such an arrangement to work, members need to have a commonality of objective and vision. Without that, they are unlikely to stay together, let alone be able to develop and deliver new services or new models of care.
Any collaboration or network only works properly if the members are willing participants looking to drive it forward. Federations are no exception. There is some administration to be done, regardless of the structure used, but there is also a need to stimulate discussion, provoke thought leadership and capture ideas.
The potential benefits of a well thought out federation are significant – and can be a great opportunity for some ‘bottom up’ innovative thinking!