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It’s federate or die – but how?

With GPs being told to start forming federations or face having collaborative groupings forced upon them, it seems there is no escaping the new model of working – and GPs urgently need advice on how to take the first steps

GPs must federate – or be federated. That was the message at an RCGP policy debate last week, and while federations might sound like something out of Star Trek, they're not intended as a vision of a far-off future. Leading figures at both the college and the NHS Confederation stressed repeatedly that GPs needed to begin discussions over forming federated structures right away. They gave three key reasons for the sudden urgency – that only federations could cope with the rush of workload heading into the community, that GPs who did not federate would be at a huge disadvantage under the new Government's commissioning plans and, as the trump card, that primary care organisations are determined to ensure GPs federate anyway, like it or not. The choice is stark – be a clinically led federation, or be a PCO-led polysystem.

So, let's assume for a moment that the case for GPs to federate is made. Certainly, Pulse has uncovered ample evidence that PCOs are indeed pressing ahead with aggressive plans to consolidate practices, so the dangers of inaction are real enough. But if GPs are to take the lead on the federation agenda, the next question must be, what does a federation look like? And here, disappointingly, there is less clarity.

The NHS Confederation believes federations should be the holders of the GP contract – effectively a merger of practices, rather than simply collaboration. There is talk that GPs and practice staff could be shareholders under a corporate or social enterprise structure.

And RCGP chair Professor Steve Field suggests it should be federations, rather than PCOs, that take responsibility for disciplining underperforming GPs.

The ambitions for federations appear to have expanded, but with that, the gap between where GPs are now and where they are being told to go has grown. GPs urgently need advice on how to take the first steps.

The RCGP argues, understandably, that it cannot be too prescriptive, because federations by their nature will vary from place to place, depending on local circumstances and needs. But the college underestimates the sense many GPs have of isolation from policy initiatives, of uncertainty over how to proceed and of being overtaken by events. GPs may well need to urgently reconfigure the way they work, but in practice many will struggle to do so while so busy with their jobs as they are now.

The college is drawing up a toolkit with the King's Fund, based on an analysis of what kinds of federated structures work best in general practice. That could be a huge help, but it is not due to be published until October, and that's not soon enough. GPs need interim guidance on how to form the first collaborative links, how to use their joined-up working to fend off PCO-imposed plans, and how to begin the process of taking on care from hospitals. Even if the final destination for federations is not yet clear, GPs must have advice on how to find the path.

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