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Federate or face forced restructure, GPs told

By Ian Quinn

Exclusive: GPs must begin talks with colleagues about working under federated models immediately or face new structures being imposed on them by primary care organisations, the RCGP and NHS leaders are warning.

The college's chair, Professor Steve Field, insisted GPs should have begun to set up collaborative structures five years ago and that the formation of a Conservative-led Government made it ‘massively urgent' practices began to establish federations.

GPs were warned that plans for GP commissioning groups covering up to 150,000 patients – outlined by the Government last week – would threaten the survival of practices that did not come together, and that many would be forced to do so by PCOs desperate to transfer care into the community.

But the call to action, backed by the NHS Confederation and the King's Fund, has met resistance from the GPC, which claims the federated model is not a universal solution.

The RCGP is working with the King's Fund to draw up a toolkit, due in the autumn, to include legal advice on forming federations and guidance on how to persuade PCOs new groupings can avoid conflicts of interest in awarding contracts. But the college also wants urgent action and is to write to all its 34,000 members this week asking what moves they have made to work collectively.

The college wants practices to consider moves including:

• formal consultations with patients and the wider public on service provision

• giving GPs and practice staff the chance to be shareholders

• federations taking responsibility for disciplining poorly performing GPs

• taking on care from hospitals of patients with comorbidities or conditions such as COPD with high admission rates.

Professor Steve Field, chair of the RCGP, told a policy debate at the college last week: ‘There is massive urgency. Gone are the days that practices can work in splendid isolation. There will be some that will not want to move on this – and they will have to justify their performance.'

Nigel Edwards, NHS Confederation director of policy, said GPs would soon face fierce competition from rival commissioning groups, some led by private firms: ‘Unless you have a corporate formula in place where GPs come together, you will be at a significant disadvantage. There is the potential for external threat.'

Mr Edwards said new federations of practices should be merged to the degree they could hold the GP contract: ‘The biggest safeguard against [imposed] reorganisation is for federations to find some kind of concreteness, so they become a vehicle for holding the GMS contract, capitation and commissioning budgets.'

Dr Victoria Tzortziou Brown, a GP in Tower Hamlets, east London, where the federated model was pioneered, said after initial reluctance all practices were working together: ‘The progress in diabetes indicators is amazing. The results are very positive.'

But Dr Richard Vautrey, GPC deputy chair, said he did not agree on the need for urgent action, or that federations would suit every area: ‘The situations facing GPs vary tremendously and while federated models may work well in some areas, in others – such as rural areas – it may not be the right solution.'

First steps to forming a federation

• Meet with all practice staff to discuss how to work in a group while retaining own identity
• Convene meeting with all local practices – even ones historically difficult to work with
• Consider best practice, clinically and in terms of education
• Take legal advice on your contract with your PCO and employment issues
• Assess areas of hospital care that could be provided in the community by pooled GP services
• Draw up plans to include GMS contract work and commissioning
• Convince PCO that conflict of interest can be avoided
• Do not wait for PCO to act or impose its own system first

Source: RCGP/King's Fund

Dr Victoria Tzortziou Brown Watch a video of the debate here