Merseyside Family Doctor Association

WELCOME GP Federations & AGM

27 November 2014

GP Federations : What really works?

Dr Stephen Cox, GPClinical Chief Executive NHS St

Helens CCG

Briefly about me• GP St Helens• Started as educator – GP Tutor and Trainer• PCT 2002 Board• Medical Director of RCGP Innovation Unit• Elected RCGP Council 2005,6 and Faculty Board• MD Halton and St Helens PCT• MD Merseyside• Clinical Accountable Officer NHS St.Helens CCG• Managing concerns, clinical commissioning, quality matters.

Federations

• What are they?• Why bother?• Have they worked so far?• Risks of not federating?• Conclusions

Star Trek The United Federation of Planets, usually referred to as "the Federation", is an interplanetary federal republic composed of planetary sovereignties depicted in the Star Trek science fiction franchise. The planetary governments agree to exist semi-autonomously under a single central government based on the Utopian principles of universal liberty, rights, and equality, and to share their knowledge and resources in peaceful cooperation and space exploration

RCGP definition

A Federation is a group of practices and primary care teams working together, sharing responsibility for developing and delivering high quality, patient focussed services for their local communities.

RCGP• RCGP Roadmap 2007• Lord Darzi Review• APMS• ‘Aspiring to Excellence’• Ideological• Common purpose

As the coalition government moves forward with their plans for clinical commissioning, the Royal College of

General Practitioners (RCGP) commissioned an online resource to

support GP practices forming federations.

Developed by The King's Fund in partnership with the RCGP, the Nuffield

Trust and Hempsons Solicitors, this toolkit provides advice and support to practitioners and managers in primary care who are thinking about, or have already embarked upon, developing a

federation to provide and develop services collaboratively.

Federations• key building blocks in developing a federation• deciding on a federation’s legal structure• federation governance• involving patients and the public• engaging the wider primary care workforce• improving quality and safety• education and training• developing and redesigning services• tackling public health issues• sharing back office functions• working with an external partner

Legal Form • Private company limited by shares (CLS)

• Private company limited by guarantee (CLG)

• Community Interest Company (CIC) limited by shares or guarantee

• Industrial and Provident Society (IPS)

• Charity

• Limited Liability Partnership (LLP)

WHY BOTHER?Federations

Why bother? – RCGP survey• Strengthening the capacity of practices to develop new services out of

hospital • To form an entity that can tender for services offered by a future GP

commissioning consortium • To make efficiency savings/economies of scale, for example in back

office functions or the procurement of practice services • To improve local service integration across practices and other providers • To enhance the capacity of practices to compete with external private

sector companies • To strengthen clinical governance and improve the quality and safety of

services • To develop training and education capacity

Why bother?• Recruitment issues• Retirement issues• Income dropping• High % GP income will not come from GMS/PMS• Need to bid for contracts e.g. LES’s• New GP Contract• Need leads for ‘everything’• CQC requirements• Fragmented community services need focus• Safety in numbers?

HAVE THEY WORKED SO FAR?Federations

Examples

• Ideological• Geographical• Business focussed

Ideological - example• Federation of St Helens Training Practices• Formed 2007• Share training resources• Induction of staff incl. registrars• Education events• CQC registration

Geographical - example

Out of Hours Providers : StHelens RotaOpt in boroughHigh % local GP’s working

Business focussed

• Share staff : PM PN Salaried Gp’s• Share HR resource• Other front or back office functions• Share clinical resource – QOF areas etc• Vehicle for bids for practices • Bids for other services : Sunset West Social

Enterprise , Washington, Tyne and Wear

Research Evidence – Kings Fund and Nuffield – 10 lessons

1. The motivations for practices to federate vary.2. Function affects form 3. Independence from the statutory sector accords longevity. 4. Involving doctors is relatively easy – it is harder to be more

inclusive.5. Primary care organisations are good at planning and

developing services within primary care and community settings

10 lessons continued

6. Primary care organisations are more likely to make substantive change where they have direct control of budgets and where there are direct financial incentives for professionals. 7. Clinical leadership and engagement are essential 8. High quality management and infrastructure support is critical

10 lessons continued

9. Primary care organisations increase transaction costs within local health economies

10. Major service transformation will require highly organised primary care as a bedrock.

RISKS OF NOT FEDERATING?Federations

Risks

• Actual sustainability : wage costs, reduced funding…• 25% retirement rate in next 5 years urban areas• Succession planning• Continue to attract LES monies• To protect independent contractor status• NHSE Five Year View : Specialist Community Providers

CONCLUSIONSFederations

Conclusions• One size doesn’t fit all• One model doesn’t fit all• Federations are part of a journey• What is your journey?• Safety in numbers• Sustainability