Moving forward

Partnership Models – Levels of Collaboration Merged Practice e.g. ‘super-partnership’ (control maintained within one organisation but many partners = limited individual autonomy) ‘Hard’ Federation More sophisticated federal structure, includes provider companies with restricted autonomy for practice members ‘Soft’ Federation Shared goals, for wider purposes (still preserving max autonomy e.g. service company) Loose Association For limited purposes, using service led (e.g. sub-contracting – SLA/MoU) Networking Peer support and information sharing

Hybrid Federation Structure Federation operating structure Hybrid Federation Structure Federation Board Locality cluster of GPs Locality cluster of GPs Locality cluster of GPs Locality cluster of GPs Locality cluster of GPs Locality cluster of GPs Federated structure Facilitator Delegated responsibilities to federated clusters who are semi-autonomous Maximum flexibility for clusters to advance their collaboration ambitions Supports clusters of GPs who share services Contract coordinator

The Future Hybrid Federation structure 6 Localities? Integrated Locality Teams / Primary Care Home / Multi Speciality Community Providers Accountable care system Facilitator / ‘honest broker’ Support emerging hubs Voice Provider Resilience Transformation

What will it be like? ELR GP Federation Where are we now (From) New operating structure where do we want to be? (To) Few contracts Significant contractor / service provider on behalf of members Partner with limited influence on Integrated Locality Teams (ILT)/ STP Federation as enablers of ILT/ STP (active partnership engagement) Loose Federation More clustered Federation with central support Limited impact on the local agenda A key player / partner in mutual shaping the place based agenda Evolving clarity on Federation purpose Key voice / provider and facilitator of cluster working Evolving relationship between CCG and Federation Clear strategy and identified roles between CGG and Federation Limited offer to members More integrated role in supporting GP resilience / back office support and facilitating joint working – both clinical & administrative.

Joint working & transformation fund

Joint working Hub and spoke working Sub-specialisation across a network of practices Inter-practice referrals Joint walk-in clinics Community health teams built around GP practices Share specialist staff - MSK, wellbeing advisor Out of hours services Improving access to diagnostics Outreach clinics Back office – policies, IT, HR, payroll, purchasing etc

Transformation Fund £400K per year Joint working between practices – hub development Facilitator and fixer ‘Honest broker’ Toolkit Support for applications Consistency of approach Project management support

Tool kit Joint working Joint working between practices Hub development Mergers between practices Opportunities for working with Federations Multispecialty Community Provider (MCP) new care model and contract issues Primary Care Home model

Community based urgent primary care

Community based urgent primary care (1) Community based urgent care Easy to understand Integrates with the wider LLR UC system Supports practices In hours – practice led Out of hours – 5 (?6) sites Integrated with 111 / Clinical Navigation Hub October 2018

Community based urgent primary care (2) Key opportunity – for resilience and sustainability Ongoing long-term project Ensure key partner Collaboration Voice GP’s best interests Innovation / best use of the available resource

Demand management

Demand management Stimulate utilisation of the best pathway option for patients GP led, integrated team working between practices Drive innovation and Identify areas for further investigation and/or joint working. Positive debate and challenge between practices Sharing of solutions, skills and best practice

Winter access

Winter access 4 months Build on last year Out of hours? Hubs? Full coverage 5,000 appointments Single rate? Better opportunity to forward plan

Summary Facilitator / Enabler / Provider Strengthened locality focus Clear strategic plan with CCG defining commissioning and provider roles with the necessary support Significant opportunity to shape and improve

Moving forward…… Your Federation; Enabling and facilitating joint working and innovation james.watkins@elrgpfed.com 07805 515782