1. A Federated Model
Dr Ben Gatenby

2. The Model 30 practices, 230,000 patients Company limited by shares
Shareholders can only be practices
Non-profit (CIC-style) articles
Initial 50p per patient investment (20p shares, 30p loan)
Agreement of additional 50p per patient if required
Board of Directors, Primary Care Development,
Practice Managers, Clinical Pharmacy/IT/Project Leads

3. Engagement Recognised huge cultural and behavioural shift
Put OD/relationship building upfront both before company formed and since
Provided headspace
Placed-based health - locality leadership next step
Intranet
Website

4. Benefits for practices/GPs
Representation
Practice Support
Taking on a contract
Help with CQC failures and contract defaults
Recruitment
Stronger relationships – “unit of permanence”
Extended primary care team/integrated locality groups
Provide services and schemes across practices
IT, Wi-Fi, Clinical Pharmacists, Domiciliary Phlebotomy
Project management, staff training, staff sharing

5. Pitfalls/lessons learned
Everything takes longer than you think it ought to
If forming a company consider carefully who you are going to invite to be a part of it – attitudes of CCG/NHSE team may be relevant
Leadership support
Governance is important but structure should follow need/outcomes
What is your offer – to practices, to patients, to system?
“Our federation”
Citizen engagement

6. Final thoughts
Be outcome led when setting up and when planning your work
It takes time – not necessarily a long time, but dedicated time
Be realistic over progress and the scale of cultural shift you face
What is your unit of permanence?
Communicate
Make it make more sense to more people
Embed your values