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GPs told, federate now or miss boat

By Gareth Iacobucci

Exclusive: GP practices will need to form federations focusing on providing services at the same time as they link up in commissioning consortia, or they could go to the wall as funding is squeezed, RCGP experts are warning.

A major guidance document from the college published later today urges GPs to come together in provider federations as soon as possible to take advantage of a ‘window of opportunity' while PCT pump-priming is still possible.

The guidance says it will be much more difficult for GPs to obtain financial support when GP consortia are in place, because of the potential conflict of interest in one group of GPs funding another.

An RCGP leader who set up one of the first federations warned practices they could fold in the face of growing pressure on their contracts unless they joined a federation – and that some would need to merge completely.

The college's federation tool-kit, obtained exclusively by Pulse, offers a step-by-step guide to setting up federations as a blueprint for transforming general practice. The toolkit advises federations should be provider organisations, quite separate from commissioning consortia. It says federating will strengthen GPs' capacity to tender for out-of-hospital services, help them compete with private firms, aid integration of care and improve training and clinical governance.

But the document makes clear there is a cost involved in set-up, and says successful ventures have often been pump-primed: ‘Until PCTs are abolished, there is a window of opportunity for GPs. Once GP consortia are established that may be more difficult.'

Candace Imison, toolkit co-author and deputy director of policy at the King's Fund, said: ‘It's hard to see how GP consortia would be able to support federations. So GPs should be thinking about it now.'

The document says GPs who aren't funded will need to ‘generate resources internally or through working with an external private provider'.

Just over a third of 1,637 respondents to an accompanying survey – the majority GP principals – considered themselves in a federation already, although many of these actually focused on commissioning.

Only half had a legal structure, with the remainder ‘loose' associations. But the college said any federation set up to bid for services must have a legal structure.

Its report says different legal options are suitable – including private companies, charities or limited liability partnerships – depending on the federation's role and structure.

The survey found a wide variation in federation size, with around 20% having five or fewer practices, and just over 15% more than 20.

The toolkit advises federations should be reasonably large to generate back-office savings, although Dr Maureen Baker, the RCGP's federation lead, said they should be smaller than GP consortia: ‘Given the need to differentiate between commissioning and providing, I'd imagine two or more federations would relate to a GP consortium. You can then bid against each other and avoid conflict of interest.'

One-fifth of survey respondents saw no benefit in federations. But Dr Agnelo Fernandes, leading RCGP member and chair of the Croydon Federation of General Practices, warned: ‘Some PMS practices have lost hundreds of thousands in growth money. They may not be viable and could close – I could see merging happening.'

Read the full RCGP toolkit here

Dr Maureen Baker Lessons from pioneer federations

A ‘supracluster' provider organisation formed from nine federations in Somerset. Currently has no legal status. ‘Informal structures work very well in localities that are inherently co-operative,' said Dr Harry Yoxall.

First attempt to federate abandoned when divisions formed over a bid from a for-profit organisation. ‘What really matters is developing the culture of collaborative working,' said Dr Andrew Liston.

Active support from PCT has helped all 36 practices form eight federations, which are beginning to form legal structures. ‘Strong clinical leadership, agreeing common aims and a close working relationship with the PCT have been very important,' said Dr Victoria Tzortziou Brown.

Group of seven practices with
an emphasis on clinical quality and safety. Improvements in areas such as hypertension. ‘This is about the day job, making sure we deliver as we should,' said Dr Sunil Hindocha.

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