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NHS working at Scale / GP Federations

We act for GP Provider companies across England. To date we have secured over £2M worth of income for the GP Practices we support. Our consultancy services in this area are first class and we have a proven track record in achieving results.

NHS working at Scale

The new NHS market, and the contractual changes in the way Local Enhanced Services are being tendered, are a very real challenge to General Practice. 

At BW Medical Accountants, we firmly believe that it is essential that General Practice, as providers, meet these challenges head on. To do that though you need to be prepared to re-think the current delivery models, particularly if you are to be in a position to secure services for patients at a local level whilst maximising control of delivery and quality.

One solutions to meet these challenges is to develop a GP Provider company or 'Federation'.  A GP Federation can simply be an informal association of GP Practice; equally it might be the full amalgamation of GP Practices into a "Super Practice"; however, many Practices prefer to remain independent and instead choose to form a company to protect income and allow them to bid for services.

In order to understand the possibilities around developing a GP Provider Company or Federation we recommend you fully explore the various options and take the opportunity to invite all local GPs whether Partners or salaried, Business Managers and Practice Managers to attend a meeting where you can discuss the options and decide what may suit you best locally.

We have vast experience of facilitating these meetings to ensure they are productive and that everyone in attendance has a voice. (References are available) At the meeting our experts will take you through the key benefits of collaborating and will outline the options available to you.  We will share with you our experiences of what other groups of practices around the country have done and why. We will also detail the options for you and explore what setting up a Provide company would actually involve.

The purpose of the meeting is to ascertain whether there is an appetite to work together at scale and if there is, to agree a way forward. It may be best to collaborate on a smaller scale initially to ensure engagement. We know the reason that many provider companies have failed to date is that they have not achieved company wide buy-in and member practices have not fully understand their responsibilities in making it work. Our engagement programme is a practical way to ensure success from the start.

Every group we deal with is different and has its own requirements meaning we can ensure you get the best advice and correct structures for you.  Additionally, you can be assured that with the right level of commitment it is possible to set up a new Provider company / GP Federation from initial discussions through to launching a fully-fledged federation in 8 weeks as we have a streamlined process to ensure you get the best advice and avoid the pitfalls.

What is already clear is that doing nothing really isn't an option unless General Practice is willing to accept lower earnings year on year for the foreseeable future.

For further details, talk to our specialist consultant Scott McKenzie.

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Key benefits of forming a GP Federation:

  • A legal entity Federation provides protection to all member practices and provides an effective means of bidding for services.
  • Protection of GP income streams - the Federation can bid for LES activity. (LES contracts are being removed by stealth in some parts of the country).
  • The Federation can partner with local hospital trusts to deliver services and bring new income to member practices.
  • The more practices that join the better the local CCG, particularly as they contract with the Federation as this will reduce transaction costs and put money back into patient care.
  • A Federation also provides both a vehicle and the required skills to successfully bid for services - it is the only way to bid for some contracts, especially AQP and ITT.  This also helps to keep out the private competition.
  • A Federation will support member practices in providing quality services for all patients.
  • It will be locally run to meet local needs - improving local service and providing a vehicle to establish integrated care with increased collaoration.
  • Strengthen clinical governance, quality and safety.
  • Delivers significant economies of scale and efficiency savings.
  • Develops training and education capacity.
  • Generates new savings and income opportunities.

The RCGP defines federating as "Practices working together to share resources, expertise and services." In effect this means a group of practices collectively:

  • Developing new services
  • Tendering for services 
  • Jointly gaining efficiency savings and economies of scale
  • Improving local service integration
  • Being able to better compete with private providers
  • Strengthening clinical governance, quality and safety
  • Developing training and education capacity.

Developing a Federation is NOT about merging practices, but rather how you come together and by combining make it easier to address the challenges faced by General Practice.

There are 4 typical stages to form a Federation.  Our experts have a proven track record in supporting the formation and the on-going development of a number of GP Federations across the country. (references are available)

Stage 1: Initial exploratory meeting
Stage 2: Development workshop
Stage 3: Project Group workshop(s)
Stage 4: Launch meeting

To find out more information regarding the various stages, contact us for a copy of our 'Exploring the development of a GP Practice Federation' guide.

Our service offering includes expert GP Federation support from Scott McKenzie, specialist medical finance advice from Keith Taylor and specialist healthcare legal advice from Alison Oliver at Wardhadaway.  We are aware of the pitfalls to avoid and have the experience to ensure that the federations we support will be successful in achieving their objectives.  There are a number of so called 'professionals' and 'consultants' who claim to be able to provide GP Federation support, few have any track record of delivery and certainly don't seem to be able to provide evidence of work delivered.  Scott is so confident in his ability to generate income for GP Federations, where the Federation is engaged and working with us, he will work at risk! 

Consider your options carefully...

  • Do you have the required skills to be successful?
  • Do you have the right support?
  • Cutting corners tends to cost you in the long-run in both time and money!
  • If you are running blind, there could be serious financial & legal consequences.
  • Do your homework, research your advisers, ask for a number of references!
  • 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.

    GP Partner
    GP Practice, Newcastle
  • We had no hesitation in moving to BW Medical Accountants.  For any business your accountant is integral, and for us one of the most important factors to this relationship is to have a personal and trusting approach, which BW have undoubtedly achieved. 

    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.

    Jackie Rotherham, Practice Manager
    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.

    GP Partner

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