All practices in Northern Ireland are set to form not-for-profit provider companies ‘within six months’ to carry out the work involved in moving services from secondary to primary care, under radical plans formulated by the Northern Ireland GPC.
The practices will form federations covering 100,000 patients, each including around 20 practices, which together will own and manage a not-for-profit social enterprise.
Under the plans, practices will maintain their current GMS work and the social enterprises will be able to employ staff to carry out the extra work that will result from the shift of care from secondary to primary care, as detailed in the Northern Ireland Government’s Transforming Your Care’ (TYC) programme.
The plans are in response to the Northern Ireland Government’s lack of willing to invest in GP services because ‘they regard investment as profit for GPs’, chair of the NI GPC Dr Tom Black said.
No practices have yet opposed the plans and all practices in the three areas where pilot schemes have been set up – Derry, East Belfast and Downe – have signed up.
Dr Black said: ‘I think we need to be a non-profit organisation because it is very clear that the system will not invest in general practice. We have had no investment in Northern Irish general practice for the last eight years because they regard investment as profit for GPs. So we need to disconnect investment from the profit stream.’
He added: ‘Essentially we are creating a parallel structure, that will be not-for-profit, where the health board will be able to commission and invest without the accusation that they are increasing GP profits. Also, and this is important, GPs feel that their workload at the moment is unsustainable and they don’t want extra work coming into their practice. If there is extra work to be done, they want this to come through the federation model in parallel to the GMS model… This is really a “GMS+” model.’
An NI GPC report said: ‘NI GPC has committed itself to developing a network of federations of GP practices throughout Northern Ireland with the majority of these being in place within the next three to six months. It is expected that there will be up to five federations in each of the four LMC areas.’
‘The need for GP practice federations became evident with the uncontrolled shift of work out of hospitals into primary care as part of TYC. Federations aren’t just a way of protecting practices from external threats, they will also co-ordinate and empower the work of practices enabling them to work in a more effective and integrated manner and enable GPs to provide a better service for their patients.’
Referring to the three pilot schemes, NI GPC added: ‘All practices have signed up to the concept of federations in these areas. The company model (social enterprise model) is being chosen and legal agreements are being drawn up. Some potential work streams are already being identified and under review.’
A spokesperson for the Northern Irish Department of Health said: ‘The Department is aware of the proposals by [NI GPC] and is considering how these developments can contribute to the delivery of the objectives of TYC and work alongside the existing structures such as LMCs and integrated-care partnerships.’
Wessex LMC chair Dr Nigel Watson said the English legal landscape made the process of forming social enterprises less simple in England, which meant that there was not a ‘one-size-fits-all’ option for England. But he did stress that being not-for-profit was still a very interesting route.
He said: ‘There is a lot of interest in these provider companies being not-for-profit because if we were to set them up to make money off them, and sell them off, that is for many of us not how we go about protecting general practice. There are problems with social enterprises and if you are going to set up a company it has to be a company limited by shares rather than anything else because otherwise you can’t join the NHS pension scheme. So there are all sorts of legal barriers to do with those things and you have to look at individual circumstances for each area.’
It comes as the GPC in England launched a survey of GPs last week to assess the formation of federations in England. It has suggested in its plans for the future of general practice that GPs federate to alleviate cost pressure.