1. GP Federations – new ways of working in primary care James Gleed Dr Deborah Kearns

2. Why do we need to change the model of primary care? Ageing population with more long term conditions Imminent retirement of GPs and practice nurses Training and recruitment challenges in primary care Premises not fit for purpose No expected growth in investment in core primary care Practices will need to be positioned to compete with larger independent sector organisations for new services Improve access and quality of care Provide continuity of practitioner when it is important Need to ensure high quality sustainable primary care for the future

3. What is a Federation? Federation is a loose term to describe collective arrangements between two or more parties. Essentially a group of practices and primary care teams sharing responsibility for delivering high quality services for their local community (RCGP) Such organisations may be characterised by having: centralised control smaller constituent groups with some degree of internal autonomy

4. Different Models Simple alliance Shared premises Partnership mergers Cooperative These models may have one of the following legal arrangements Traditional GP partnership agreement Private companies limited by shares Community interest companies and social enterprises Charity or charitable incorporated organisation Limited liability partnerships (LLPs) Private companies limited by guarantee

5. What differences might be seen if practices were to form federations? Practice managers with new dedicated specialist roles e.g. employment or quality improvement across practices Stronger support networks for clinicians A single point of access for patients across practices Shared back office administrative functions Order clinical stock and equipment in bulk across practices Greater capacity to bid for and provide new additional services Certain services provided by one practice on behalf of others e.g. extended hours or more specialist treatments Opportunities for practice nurses to shadow colleagues and rotate

6. Thank you and now over to you!

7. Please discuss on your tables the following questions: 1. What would be the advantages of federations for patients and GP practices? 2. What do you think could be the risks of working in this way? 3. What support would practices need in order to establish federations? 7