Merseyside Family Doctor Association WELCOME GP Federations & AGM 27 November 2014.
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Transcript of Merseyside Family Doctor Association WELCOME GP Federations & AGM 27 November 2014.
Merseyside Family Doctor Association
WELCOME GP Federations & AGM
27 November 2014
GP Federations : What really works?
Dr Stephen Cox, GPClinical Chief Executive NHS St
Helens CCG
Briefly about me• GP St Helens• Started as educator – GP Tutor and Trainer• PCT 2002 Board• Medical Director of RCGP Innovation Unit• Elected RCGP Council 2005,6 and Faculty Board• MD Halton and St Helens PCT• MD Merseyside• Clinical Accountable Officer NHS St.Helens CCG• Managing concerns, clinical commissioning, quality matters.
Federations
• What are they?• Why bother?• Have they worked so far?• Risks of not federating?• Conclusions
Star Trek The United Federation of Planets, usually referred to as "the Federation", is an interplanetary federal republic composed of planetary sovereignties depicted in the Star Trek science fiction franchise. The planetary governments agree to exist semi-autonomously under a single central government based on the Utopian principles of universal liberty, rights, and equality, and to share their knowledge and resources in peaceful cooperation and space exploration
RCGP definition
A Federation is a group of practices and primary care teams working together, sharing responsibility for developing and delivering high quality, patient focussed services for their local communities.
RCGP• RCGP Roadmap 2007• Lord Darzi Review• APMS• ‘Aspiring to Excellence’• Ideological• Common purpose
As the coalition government moves forward with their plans for clinical commissioning, the Royal College of
General Practitioners (RCGP) commissioned an online resource to
support GP practices forming federations.
Developed by The King's Fund in partnership with the RCGP, the Nuffield
Trust and Hempsons Solicitors, this toolkit provides advice and support to practitioners and managers in primary care who are thinking about, or have already embarked upon, developing a
federation to provide and develop services collaboratively.
Federations• key building blocks in developing a federation• deciding on a federation’s legal structure• federation governance• involving patients and the public• engaging the wider primary care workforce• improving quality and safety• education and training• developing and redesigning services• tackling public health issues• sharing back office functions• working with an external partner
Legal Form • Private company limited by shares (CLS)
• Private company limited by guarantee (CLG)
• Community Interest Company (CIC) limited by shares or guarantee
• Industrial and Provident Society (IPS)
• Charity
• Limited Liability Partnership (LLP)
WHY BOTHER?Federations
Why bother? – RCGP survey• Strengthening the capacity of practices to develop new services out of
hospital • To form an entity that can tender for services offered by a future GP
commissioning consortium • To make efficiency savings/economies of scale, for example in back
office functions or the procurement of practice services • To improve local service integration across practices and other providers • To enhance the capacity of practices to compete with external private
sector companies • To strengthen clinical governance and improve the quality and safety of
services • To develop training and education capacity
Why bother?• Recruitment issues• Retirement issues• Income dropping• High % GP income will not come from GMS/PMS• Need to bid for contracts e.g. LES’s• New GP Contract• Need leads for ‘everything’• CQC requirements• Fragmented community services need focus• Safety in numbers?
HAVE THEY WORKED SO FAR?Federations
Examples
• Ideological• Geographical• Business focussed
Ideological - example• Federation of St Helens Training Practices• Formed 2007• Share training resources• Induction of staff incl. registrars• Education events• CQC registration
Geographical - example
Out of Hours Providers : StHelens RotaOpt in boroughHigh % local GP’s working
Business focussed
• Share staff : PM PN Salaried Gp’s• Share HR resource• Other front or back office functions• Share clinical resource – QOF areas etc• Vehicle for bids for practices • Bids for other services : Sunset West Social
Enterprise , Washington, Tyne and Wear
Research Evidence – Kings Fund and Nuffield – 10 lessons
1. The motivations for practices to federate vary.2. Function affects form 3. Independence from the statutory sector accords longevity. 4. Involving doctors is relatively easy – it is harder to be more
inclusive.5. Primary care organisations are good at planning and
developing services within primary care and community settings
10 lessons continued
6. Primary care organisations are more likely to make substantive change where they have direct control of budgets and where there are direct financial incentives for professionals. 7. Clinical leadership and engagement are essential 8. High quality management and infrastructure support is critical
10 lessons continued
9. Primary care organisations increase transaction costs within local health economies
10. Major service transformation will require highly organised primary care as a bedrock.
RISKS OF NOT FEDERATING?Federations
Risks
• Actual sustainability : wage costs, reduced funding…• 25% retirement rate in next 5 years urban areas• Succession planning• Continue to attract LES monies• To protect independent contractor status• NHSE Five Year View : Specialist Community Providers
CONCLUSIONSFederations
Conclusions• One size doesn’t fit all• One model doesn’t fit all• Federations are part of a journey• What is your journey?• Safety in numbers• Sustainability