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Developing a federated model of General Practice: The solution to an ever worsening problem

"If you just set out to be liked, you would be prepared to compromise on anything at anytime, and you would achieve nothing." Margaret Thatcher,British Prime Minister

At the close of 2014 I found myself doing something I don’t normally do, looking back!  The reason I don’t look back is that I can’t affect what has already gone, I can only affect what’s about to happen. However, I did reflect on where we were a year ago how and far we have come in supporting General Practices to form federations.

In 12 months we have established on average just over 1 new federation each month, and already have a further four in development as I write, and three more starting the process in the first quarter of 2015. 

The ongoing engagement is in part due to the model we use to establish ‘your’ federation – we do not offer an off the shelf solution but rather take the time to develop what you need based on local circumstances. In each case we redesign the delivery model to meet the challenges that are here and now, while also future proofing them for the medium and longer term. 

Beyond that we have then gone on to support directly the vast majority of these new federations, working at risk in place of charging fees. This has proved popular and has resulted in a very different and improved way of working for everyone involved.

We have secured new business for the federations which has seen their relationship with the local Foundation Trust clarified resulting in properly resourced clinical work. This work might have traditionally been dumped on the General Practice un-resourced but because it has been addressed through the federation negotiating in a more coherent professional manner as a collective has resulted in a manageable new contract.

This work valued at more than £2,000,000 to the federations involved, has seen us build a track record of strong outcomes for these newly formed companies, which of course outweighs their early risk of failure through lack of income and engagement from their members.

This will definitely be a continued focus in 2015 as it has proven to be an excellent way of bringing the providers together to work in collaboration rather than competition. It also gives stability in the early days to a new federation, particularly where CCG engagement is poor, which in my experience is not uncommon.

Given that co-commissioning comes in this year, and the demise of QoF moves ever closer, we could soon see a recipe for disaster in general practice being cooked up right in front of us.  This is why I believe our approach remains the right one.  The federation is there to grow and develop general practice, and maintain viability in the most turbulent of times the NHS has ever faced.

For those who may still be wondering if federating is the right way forwards I have three questions:

1. If not now, then when will be the right time, what has to happen beyond the current situation to make you stop and consider what the future looks like?

2. If not you (as in general practice) then who should decide how you work?

3. If not a federation, what is your solution going to be to the current challenges being faced by general practice and the wider NHS; how do you play a part in delivering the five year vision with a model that isn’t working confronted with ever decreasing income? 

While a federation may not be the right answer for everyone, stop for just a few minutes and think about what the future holds and how to respond.  Make a conscious decision to fact find and then make the right decision for you individually and as a practice on the best way forwards.

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

Scott Mckenzie

Scott Mckenzie

NHS Management Consultant

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