Hands around the health service

This article was featured in Practice Business October 2015 edition.

In our ever-changing NHS, where the pressures on GPs and primary care are greater than ever before, the introduction of Federations has been hailed as a way forward.

While we are still unclear about their long-term role, Federations are enjoying growing popularity, with recent findings showing that in 15 CCG areas across England, most or all of the GP practices are already part of a collaborative group.

Understandably, the idea of joining a Federation will prove popular to GPs wanting to go for the ‘strength in numbers’ approach in an attempt to most effectively run their service offering and provide for patients.

The likely introduction of a seven day GP service is proving to be a catalyst for many practices to join or form a Federation – through sharing increased resources, the burden of having to operate all week long can be made as bearable as possible.

Additionally, through operating as a collective, Federations have the ability to facilitate:

• improved service delivery (primary care at scale) – extended opening hours, wider range of services, support for urgent care and patients with long-term needs across the local health economy and even investment in new premises;
• better staff development;
• the opportunity to work more effectively with community and secondary service providers; &
• opportunities for federations to employ specialists, which bears striking resemblance to the Multi-Speciality Community Provider (MCP) mode.

But for all the many positives, it remains crucially important that becoming part of a Federation is a decision that is not taken lightly, for all there may be a sentiment that GPs are being ‘pushed’ into this as their only option in a hugely pressured primary care sector.

Federations can vary significantly in their structure and approach, and can operate as a commercially-focused business or are equally viable as a more loose alliance. A company with share options, a Limited Liability Partnership (LLP) or a social enterprise are among the options on how to structure the Federative. However, the common factor between all is being governed by a corporate structure, which carries the accompanying legal and financial obligations.

Furthermore, working as a collective necessitates a shared vision and approach – there must be a synergy and common purpose between the federating practices, rather than feeling it is their only option. As with entering into any business decision, it has to be one that is right, commercially and practically, for the individual GP practice.

From a legal perspective, the range of options available to GP practices looking to join or form a Federation makes is a less rigid process, and one that can be devised by the GPs involved, rather than being dictated from above.

However, governance remains the issue where most guidance needs to be sought, and as a minimum, members of a Federation should seek advice on the financial and legal aspects of their collaboration, covering aspects including pensions and VAT, governance and compliance.

While Federations are certainly a ‘hot topic’ at present, the concept is still a relatively new one, and we have yet to find definitively whether this is the way forward or not. For GP practices uncertain about joining, there are options available. It is possible to work with a network on an informal basis, before deciding on the direction for a practice.  And further, as an alternative to a Federation, there are Super Partnerships (large scale practices created by merger) and also the multi practice set-up, involving small scale partnerships managing several sites and a range of services.

While the role of general practice and primary care is set to change even further in the months and years ahead, it is important the right decision is made for your practice and its unique circumstances and challenges.

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If you need any information about this or any other healthcare related matter, please contact Victoria Armstrong or a member of the healthcare team.