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Federations - Unfunded work revisited

"In the confrontation between the stream and the rock, the stream always wins, not through strength but by perseverance." H. Jackson Brown, Author

You may recall a post back in July where I looked at the ‘custom and practice’ of General Practice picking up work that is not funded; or perhaps more accurately work dumped on them by the local hospital, or work not commissioned by the CCG, yet practices are still expected to do the work for free. 

Sometimes a CCG commissions and pays some of its practices to undertake work, but not others, and those practices not commissioned are expected to do the work for free. I also highlighted the excellent advice from the BMA which many of the federations we work with are now following. 

As I highlighted back in July it is ‘custom and practice’ for General Practice to provide work free of charge, which consumes just as much time and practice resource as funded work. This comes at the same time as practices are being challenged nationally by the whole health economy for not offering better access. 

The arguments and discussion about the subject are ongoing, including an article in PULSE from Dr Zoe Norris about the topic:

For me the article is spot on, and demonstrates a very clear solution: a hospital subcontracts the work it cannot or does not want to provide, properly resourced, back to General Practice, through a federation or another provider organisation that can deliver the work at scale. This ensures that the hospital has only one contract to manage, and at a stroke will resolve the issue.

What I’m arguing is that if the work that clearly should attract a fee was properly funded, via a subcontract based on a percentage of the PbR (Payment by Results) Tariff price paid to the hospital, the Practices would absorb many of the items that cannot have a price put on them without question.

Both parties win:

The workload is properly funded, meaning practices can pay staff to deliver the work, which helps stabilise practice income and keep’s it viable.

The hospital wins as the workload is no longer with them, but is more cost effectively delivered by the practices, while they retain a percentage of the tariff.

Of course the CCG could simply commission directly with the practices; however, in 209 CCGs I have yet to see this happen, meaning the quicker and easier solution is for the providers to sort it out between themselves.

Or we can of course continue as we are – at loggerheads!

“The definition of insanity is doing the same thing over and over again and expecting a different result."

Albert Einstein

If you are thinking about federating, and would like 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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