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Developing a federated model of General Practice: Don’t create another layer of bureaucracy!

"Move out of your comfort zone. You can only grow if you are willing to feel awkward and uncomfortable when you try something new."  Brian Tracy, Author

I was challenged this week to explain why it wasn't possible for a GP federation to be formed with the sole intention of "protecting the income the practices have now"? 

Put simply this would only achieve one outcome, a new layer of bureaucracy for no real gain.

It would be impossible to maintain the current practice income without a wider remit to increase income through the delivery of new services. The company will have board and running costs that will have to be paid for, from any income it generates. Meaning if all the Federation does is manage current income e.g. LES, the Practices will have to take a pay cut, which is clearly not why you would form a Fedration.

To further explain, the current income is paid directly to the Practices who provide the services.  If the contract was awarded to the federation, even without any tendering and the associated costs of that, there would still be management costs to cover.  This includes the  running of the board and the organisation, not to mention legal costs for drawing up the relevant contracts for the practices within the federation. As indiacted above, a new level of bureaucracy for no real gain!

Federations have to come in to being with much bigger aspirations, and for me one of those has to be; to support a complete re-think of the current General Practice delivery model. If you are to achieve efficiency in both the service delivery and the management costs, whilst also increasing capacity to provide new services for the benefit of patients, you cannot do that by simply tinkering at the edges of what General Practice does currently; it will need radical redesign. Running harder to stand still is what we are trying to do now, and it simply doesn't work. As Einstein defined it; 'The defintion of insanity - to keep doing the same thing over and over again and expeting a different result."

Included within that redesign needs to be a focus on who delivers which services. By rethinking pathways to deliver more work in General Practice you will have to focus on how to really utilise all the skills at your disposal. For example, do you have to deploy the skills of GPs to deal with all the coughs and colds etc? Might it be better to redesign the system to focus the GPs on better management of Long Term Conditions, and arguably have the routine work delivered / managed in a different way? I certainly don't profess to have all the answers, I am however, able to facilitate and work through the key questions you need to address in order to change what it is right for you and your patients.

If you stop for a moment and consider the last full surgery you completed; how many of the patients who self selected and booked to see a GP really needed the skill level deployed for their care? This is where your capacity can be freed; it will not be easy but nothing worth achieveing ever is.  If it was, everyone would be doing it Without this kind of radical approach General Practice will not be able to cope with any shift in work, no matter how much income is on offer. This is another key point; in the Federations I work with and support; WORK = PAY  and NO PAY = NO WORK.  We never ask the practices to deliver anything that is not properly resourced, and in my experience the delivery of high quality outcomes is easier to get resource for than you might anticipate, particularly if you take the subcontracted route.

If federations are to succeed in making the roles in General Practice more attractive, and at the same time have the ability to deliver the work the NHS wants to shift from Secondary Care to Primary Care, this is likely to be the start point.

I already have examples of work being subcontracted from the local FTs to new Federations, well resourced and interesting clinical work; however, to get the delivery means rethinking the way current workload is managed/delivered.

As part of this approach I am seeing Federations partnering with the FTs, Community Providers and wider service providers, to improve training and education in pursuit of high quality services being delivered consistenly by all providers (removing variation).  This also leads to an improved collaboration and better communication with all stakeholders. The ultimate outcome though is an overall improvement in the patient journey, patient experience and patient outcome.

"Nothing splendid has ever been achieved except by those who dared believe that something inside them was superior to circumstance." Bruce Barton, Executive

Next time we will explore how you divide responsibilities within the board and across the company.

In the meantime, for more information on how BW Medical Accountants can support you in forming a federation, or to arrange to speak to one of our experts please contact or call 0191 653 1022.

Additionally, if you should have questions for us please email and we will do our best to answer these within the blog.

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