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Developing a federated model of General Practice - Providers & commissioners working together in collaboration

A balanced and viable health economy is a statutory duty for a CCG, and my view remains the best way to achieve that outcome is for commissioners and providers to collaborate with the same goal in mind - a balanced and viable health economy.

As discussed in previous issues, the new contracting opportunities available, in prime, principle and alliance contracts lend themselves to this approach.

Why then is it that I regularly come across CCGs (not all by any means - there are some great examples in my work of fantastic engagement from CCGs) completely paralysed at the thought of speaking with or engaging with a GP Federation?  I need to explain here that engagement is not meetings - I can get as many meetings as I want; engagement is "an arrangement to do something  or go somewhere at a fixed time" for me the key point is the statement "to do something".

That something for me should be to collaborate (collaborate meaning "work jointly on an activity or project") on developing services, which make the appropriate shift from in hospital to out of hospital care, which of course is where the new contract options come in. Additionally, by including all possible providers in the collaboration we avoid/reduce conflict of interest problems, by ensuing everyone has a say.

Keep in mind at the end of the day whatever work and ideas are produced it is down to the CCG to develop the service specifications, not the work group, which of course means ultimately it is the CCG who remain the decision making body on what to commission and the procurement route to go.

Given the current financial position within the NHS, and the significant challenges we now face in the next 3 years, the newly emerging GP federations offer significant opportunity for CCGs. That opportunity though can only be realised where the CCG is willing to take a small risk and take the leap of faith that working in collaboration across providers is not going to see them facing challenges from those providers. The reason I say that is the other providers should of course be involved in the collaboration.

One health economy with one budget is surely now the way forwards, with a focus on placing the patient in the most appropriate setting for the level of care they require, with the healthcare professional best placed to deliver that care available in the location.

Interestingly those CCGs where there is no engagement are often the only group missing from the federation meetings, as it is now commonplace for the federations to work with the local FT, Community Services, Community and Voluntary Sector, Local Authority, Social Care etc. So common that many we support are now developing strategic partnership agreements and I have now been able to secure subcontracted work for federations from those other providers.

"Far better is it to dare mighty things, to win glorious triumphs, even though checkered by failure than to rank with those poor spirits who neither enjoy much nor suffer much, because they live in a gray twilight that knows not victory nor defeat." - Theodore Roosevelt, 26th U.S. President.

This quote has never been more applicable than now; the CCGs not engaging can carry on as they are and many will end up over the abyss (instead of just staring in to it) or they can drive through clinical change.

To answer another prominent bloggers question, "what does the NHS need to change in to"? The NHS doesn't need to change in to anything, what it requires to remain the NHS as we know it, free at the point of access, is clinical change, with investment, real investment, in General Practice, via federations which work at scale and pace, to deliver high quality services, consistently well over all practices by having people work to agreed thresholds and standards.  Those thresholds and standards simply require the right balance between standardisation and consistency, while also allowing for local empowerment and flexibility. Above all they require accountability from federation to practice for the services and outcomes, something those we support are comfortably  achieving without the need for threats and/or confrontation.

It's not rocket science, but I am not sure CCGs unwilling to engage in "doing" will see it that way.  I still see many instances daily of people creating bureaucracy for the sake of it, hiding behind "the system" rather than working to challenge the ways of the past and the system they work within. Time for some foresight and CCGs owning, driving and recreating their local system, not having one imposed that they maintain and then blame.

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  our blogs.

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  • BW Medical Accountants have a good working knowledge of General Practice and are keenly aware of the challenges Practices face within the changing environment of the NHS.  We have been very impressed by the way BW Medical continue to deliver the range of services they provide from Accounts to Tax and NHS Pension advice. 

    We have found Practice consultation and engagement from BW Medical specifically helpful to shape the future of the Practice.

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    GP Practice, Newcastle
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    The service we receive and the interest they show in our practice assures us that they have a genuine interest in us and commitment to us.  More importantly they are always helpful and polite to answer even the dumbest of questions!  They give us confidence and reassurance knowing that they are always very up-to-date with all the numerous changes within general practice and we would have no hesitation in recommending them to other practices seeking a professional and personal accountancy service.

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    The James Street Family Practice, Lincolnshire
  • We changed to BW Medical Accountants and I would say we have just had the most transparent and understandable end of year meeting and the best planning advice I have ever had in 16 years of practice.

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