Exclusive Practices in one CCG will be told they have to federate or face the removal of local enhanced services worth up to 15% of their practice income, Pulse can reveal.
Leaders from Newham CCG – which has one of the largest numbers of single or double-handed member practices among CCGs in London – told Pulse that providing extended primary care services ‘cannot be sustained by a small practice’, and that practices who do not federate will continue only with ‘shrinking resources’.
There is a push from the professional bodies and NHS managers to encourage practices to federate, but this is the first time a CCG leader has issued warnings that a failure to do so could lead to a loss of income from April.
GP leaders estimate that LESs account for around 15% of a practice’s income, and warned that practices will need to start to federate across the country if they want to provide LESs.
Under the new competition regulations, CCGs will need to procure LESs from April, unless they can prove that the services can only be provided by a single provider.
Speaking to Pulse at NHS England’s ‘Call to Action’ event, Newham CCG chair Dr Zuhair Zarifa said that the CCG has started to consider how it will commission the LESs, but added that the CCG felt the services cannot be sustained by a small practice.
He said: ‘I think primary care as it stands cannot carry on working under the current arrangement. We need to work together and we need to work very quickly. The message that will be going out from the CCG to the practices now, primary care now, is that you have to belong to a federation, some arrangement [of working together]. You have to start to talk.’
‘We are being asked to commission extended primary care services and that cannot be sustained by a small practice. That really has to be supplied by a bigger organisation, a bigger practice which can take care of bidding and have the infrastructure and the facilities to sustain this… Unless you federate you can carry on, but you will be doing so within a shrinking resource and your financial situation will continue going down – for you and your patients.’
The CCG will kick-start discussions between practices on the issue of federating in February, when it has enrolled the LMC to act as a neutral body to enable talks, Dr Zarifa added.
‘We are holding a meeting in February, where the LMC will be guiding the discussion as a neutral [entity], and we will be working to spread the idea that everybody should be working together in some form of federation. We hope to bring them all together to start to talk about commonalities, because I really think that our differences are very, very small compared to our commonalities.’
Dr Richard Vautrey, deputy chair of the GPC, said that LES income ‘amounts to around 15% of funding, but this may vary in some practices’, and added that it was looking increasingly likely that practices would need to federate if they want to start providing LESs.
He said: ‘If practices want to be able to win contracts to provide services over and above those currently provided by typical practices then working through bigger practices or groups of practices will make this more likely. However for many of the enhanced services currently delivered by practices, that depend on a registered lists to deliver them properly, both CCGs and local authorities should not fall in to the trap of assuming competitive tendering or AQP are the only options, or that big is automatically beautiful. Patients want services local to them and in their own practices.’
Dr Clare Gerada, former RCGP chair who is now chair of NHS England (London’s) primary care clinical board, said: ‘It´s very sad, but I do think small practices are unsustainable now. We need to relook at the general practice offering, particularly in London. It´s important for practices to come together under a single structure for reasons of economies of scale, rationalisation and so on. Let´s all start to talk to our neighbours. Its a massive opportunity for us. Tinkering at the edges of general practice is no longer an option.’
Note: This article was amended on 2 January to reflect accurate statistics regarding the number of single-handed practices in Newham. According to a spokesperson, the legacy Newham PCT was sixth highest in London for both the proportion of single (28.79%) and combined single or double handers (53.03%), and the 10th highest in London for the proportion of double handers (24.24%).