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Developing a federated model of General Practice: What a long way I thought we had come, and then this happened!

"There are risks and costs to a plan of action. But they are far less than the long-range risks and costs of comfortable inaction." John F. Kennedy, 35 President of the United States

Last Tuesday was an excellent day with one of our federation clients, we fianlised the Prime Ministers Challenge Bid and also worked on a subcontract with the local FT.  Everything went as planned and I left for a short drive to my next destination.

On arrival my inbox had exploded, with pretty much our entire Federation client base asking one question – “Is it possible that we could contract anything from the CCG, deliver the work, and then not get paid?”  This was the result of headlines in PULSE stating a CCG “will use £460,000 of funding earned by practices through prescribing incentive schemes to plug its deficit”. Full details on the following link: click here (If you subscribe to PULSE, you can read plenty of comments from medical professionals.)

While we will all have our opinions on the rights and wrongs of the approach, and the immediate consequences this will undoubtedly have on any future work the CCG asks of the Practices, the key here appears to be the contract mechanism.

If a federation is to contract to deliver any work, be that from the CCG, the Foundation Trust, Community Services or indeed any other organisation, the Directors have a legal duty to work in the best interest of their shareholders, and that is likely to lead them to only take on and deliver work on the basis of a legally binding contract. (The contract will clearly define what is required and what the payment is for completing the work.) This will therefore allow the company to take action to recover the money in the event of default, which is what appears to be missing here (at least from the information available at the moment).

This is the reason we focus our federations clients to work closely with their LMC when it comes to any dealing with the CCG over non-core work, ensuring a common view and providing a contract mechanism at scale, through the company, for any work to be taken on by the Practices.  Additionally, this is why we seek subcontracted work from the local FT (something we now have a track record of success with) as the way to best build the federation in the early days, with very little risk (assuming you can deliver to the standards

If the PULSE article turns out to be accurate (and I have no reason to doubt it isn’t totally accurate) and the CCG is using money “earned” by its Member Practices to “plug its deficit”, it will confirm all the worst fears I and many others have about the likely impact of co-commissioning, which could be a recipe for disaster. If CCGs are, as many appear, unable to impact Secondary Care to achieve savings/efficiencies, the likelihood is Primary Care and General Practice will become the focus for savings to balance the books and/or cut the deficits.  How long in that scenario before we have practices completely unviable?

For those who haven’t already explored the opportunities and benefits of federated working and forming a legal entity to represent General Practice at scale, is now the time for your practice to weigh up the benefits? Has the time come to explore this further and to make a conscious decision on the best way forward for you as a practice?  Don’t leave it to happen to you, take a positive step, and make a decision. Take control NOW!

"Ingenuity, plus courage, plus work - equals miracles.”
Bob Richards, Olympic Gold Medalist 

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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