CCGs surf a new wave of GP federations

17 August 2015

The NHS is preparing for a second wave of GP federations, with increasing interest and support from clinical commissioning groups (CCGs), according to speakers at a recent PCC event.

Andrew Lockhart-Mirams, a senior partner with London solicitors Lockharts, has been advising GP practices on how best to prepare and organise their federational form for several years and is noticing a revised push for scale in primary care services.

Lockhart-Mirams said: “Three to five years ago there was a huge push towards federating, led by entrepreneurial, charismatic GPs who could see the benefits and managed to get people with them to progress their ideas. That by no means covered the whole of the country and there were still large areas where people were very uncertain what to do. Now I think we are seeing a second wave of support and there is greater interest from CCGs who see federating as not only good for practices but also their organisations. When I first started doing these talks the rooms were full of GPs and practice managers from the provider side with very few from CCGs but commissioners now outnumber their GP representatives, the emphasis is changing.

“In Kent a few years ago the local councils decided to reduce the number of social care contracts from about 180 to 20 – and if you apply that scenario to the health service you can see the benefits in terms of slashing procurement costs and reduced administration.

“By the end of this financial year I would imagine NHS England will be asking CCGs ‘how many of these individual contracts do you have and why is your filing cabinet full of them, why are you not contracting with a federation?’ Replacing all of these individual contacts must have a huge advantage in terms of time spent monitoring and checking key performance indicators.”

While Lockhart-Mirams outlined some of the key legal considerations in federating, Mark Wilson, PCC associate, spoke to delegates about the potential benefits, costs and financial arrangements of the federation model.

Wilson said: “If you ask the question ‘why federate?’ there is the view that everyone else is doing it, creating the risk that this becomes a self-fulfilling prophecy. There is the risk that federating could add bureaucracy and become a middle-man with no value.

“In the rush to federate people need to get the balance right between governance and accountability on one side and delivery on the other. Federations need to be lean and nimble. The risk is that some with burdensome committee structures begin to resemble NHS organisations that do not aid swift decision-making. There is a balance to be made between accountability to members and giving people a remit and authority to deliver. A good federation should deliver immediate value and continue to deliver value every day.

“A federation must not be a drain on general practice, needing a drip feed of resources, and remember we are not just talking about cash. Setting up a federation takes time and energy and that is often given for free by GPs and practice managers. Time in this instance is an opportunity cost that could easily be spent elsewhere.”

Among attendees at the Leeds event were Dr Marion Smethurst, GP, and Natalie Young-Calvert, practice manager, from Marine Lake Medical Practice in the Wirral. They explained their reasons for considering a new service model: “Federating will give us a voice at the table. There’s a financial imperative to this, re-investment is not happening and federating will help us with cost-cutting in areas such as the sharing of policies and procedures. By having a bigger clinical footprint we will have a bigger voice for primary care as well as the potential to bid for tenders and take on sub-contract work.

“Today has given us the thinking time to work through our plans. It’s been useful to spend time together, to think strategically and to receive guidance around the most appropriate type of legal entity.”

Download the August 2015 issue of Commissioning Excellence as a PDF

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