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Practices given tens of millions of pounds to support them in federating

Exclusive CCGs around England have already spent tens of millions on helping practices form larger organisations, a Pulse investigation has revealed.

Across the 92 CCGs that responded to a Pulse media enquiry, almost £15m has been spent on helping GP practices to federate to work in networks or clusters.

The news comes as NHS England said in April's General Practice Forward View that it will ask CCGs to provide £171 million of 'practice transformational support... to stimulate development of at-scale providers'.

But if Pulse's figures are extrapolated across England's 209 CCGs, this could mean commissioners have already spent some £30m or more in total. 

However, some commissioning leaders have said that there are potential conflicts of interest.

The figures do reveal that CCGs are financially supporting practices to federate. For example: 

  • NHS Warrington CCG has spent £268,000 specifically towards practices moving towards seven 'clusters' with patient populations of 30,000 to 'enable' the rollout of 'extended primary care, mental health and secondary care';
  • NHS North Staffordshire CCG and NHS Stoke on Trent CCG set up a £300,000 facility under which practices could claim 60p per patient to set up GP federations;
  • NHS Portsmouth CCG has spent £227,000 on the development of an alliance including all 21 members practices to 'help develop clinical leadership roles, provide business support and funding for them to investigate how they and our community provider can work more effectively together'. 
  • NHS Leeds South and East CCG made £3m worth of 'resilience' funding available on the condition that practices work 'collaboratively'.
  • NHS Oxfordshire CCG spent some £5m on the setting up of three federations, including £125,000 towards evaluation of the new models. However, this was also linked to projects for delivering offering 'extended access and avoiding a defined number of A&E visits and hospital admissions'.

But not all CCGs felt comfortable with direct funding of member practices' federation efforts, expressing concerns over conflicts of interest.

A spokesperson for NHS Aylesbury Vale CCG, which has not provided direct funding, said: 'As a CCG we would be uncomfortable with taking a lead in the facilitation and direction of a federation and also with the ideas of financial support.

'We would be guilty of funding and shaping a provider to whom we then contracted. We have always recognised a clear line between GPs provider and commissioner responsibilities. They need to make the decision themselves as a business decision and have the value for provision.'

And NHS Castle Point, Rayleigh and Rochford CCG stated: 'We don’t incentivise the establishment of other local service providers, so we could not do so for local GP federation. The local GP federation formed without any approach to our CCG for funding.'

NHS Clinical Commissioners co-chair Dr Graham Jackson - who is also chair of NHS Aylesbury Vale CCG - told Pulse in a Big Interview published in May: 'I think it depends where the money is coming from and what the money is. Absolutely that needs to be carefully looked at.

He added that 'if there is money that is facilitating the change in behaviour and it is provider-led innovation, then it is creating the right environment for that healthcare community' but that 'giving money directly to a provider organisation, to a federated group – for their legal framework for example – would be inappropriate'.

Pulse reported in January that practices in the south-west were being offered up to £40,000 to form larger practices and offer secondary care services for more than two million patients.


Readers' comments (17)

  • Not heard of any funding being given to Medway CCG or Practices? Are we located beyond English borders?

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  • The Suffolk CCGs have given us absolutely nothing other than lots of cups of tea

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  • Here where we have shedloads of feds/superpractices and the like (aka Brum) we all pay through our own noses for the privelege. (Bless you!)

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  • Norfolk and Waveney CCG's (and ultimately NHS England) haven't given a single cent to help set up ours. Practices had to pay shares to set up our area-wide Federation.
    This inequity is disgraceful.

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  • Whilst I can see the fiscal advntages in economies of scale for GP's forming federations - I would be interested in hearing more about the advantages for the patient.

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  • Peter Swinyard

    It really is not enough to "set up a federation". It has to pass the "So what, who cares?" test - in other words to have a positive impact on workload, job satisfaction and the bottom line of income - otherwise it fails. In different parts of the country it should look different. What works in a megalopolis would look pretty stupid in rural Cumbria. Think of the function, let the form follow and you may plan for success, not another cash cow for the lawyers and accountants.

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  • Managing a startup Federation through conflict of interest and NHS Contracting constraint, coupled to commissioners misunderstandings of procurement law has at best been challenging. There are all the challenges of a startup, coupled to the regulatory frameworks, and governance - before you can even start to think about the delivery of federal services (Back Office, Booking, triage and integration) to have the impacts voiced above - you have to have sustainable revenue streams on which to carry the cost of change. Federations have to be both providers and an "Inclusive Club" in the same instance - and until that challenge is understood (and all of its nuances)- we wont see the reduction in workload, the increase in income and the stability of General Practice that can only come with Primary Care at Scale

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  • 'Primary care at scale' costs more, according to a recent study. The most economical practices have 2-3 partners.

    So there are not even savings to be had from this. So why are the government pushing for this unwanted move ?

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  • exactly - all data I have read throughout my career points to smaller practices having better satisfaction/lower referrals etc. The only reason the current model is failing is because of neglect and underfunding.

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  • At scale working won't produce stability or increased income. It will produce demoralised salaried slaves. As I have said before be very very wary of people extolling the virtues of at scale working.

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