1. Moving forward

2. 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

3. 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

4. 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

5. 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.

6. Joint working & transformation fund

7. 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

8. 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

9. 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

10. Community based urgent primary care

11. 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

12. 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

13. Demand management

14. 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

15. Winter access

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

17. 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

18. Moving forward…… Your Federation;
Enabling and facilitating joint working and innovation