1. GP Federations – Personal Observations 21 st January 2016

2. Dr Russell Muirhead GP 1989 Chairman ‘Shropdoc’ 2001 Director Your Practice Plus Federation 2013- 15 Non-Exec STW Provider Federation 2013 YP+ STW Provider Services Ltd Not an Expert

3. Why Federate? SCALE!

4. Why Federate? SCALE Scale to design Scale to deliver Scale to influence Scale to negotiate Scale to build relationships Scale to save Scale to support Scale to risk share Has the scale now been determined?

5. STW Provider Services Ltd YP+ ‘The Engine Room’

6. Shropshire Doctors Cooperative; Formed 1996 – 290 GP members – 250 staff - £12m turnover No longer an OOH Co-op – now 24/7 urgent care and beyond STW Provider Federation 61 Practices – 500,000 population – turnover <£20,000 Lifestyle services contract – PMCF partner – CEPN lead YPP Federation 12 out of 29 practices across 2 CCGs We didn’t get it right -> Dissolved!

7. The RCGP Principles Getting togetherWhich Practices? Demonstrate credibility. Clear communication. Leadership Overall leader. Board of Directors. Building a common purpose Clear vision. Commitment to that vision. Getting external support Identify and engage key stakeholders. Key stakeholders understand the vision. Developing the organisationAgree an organisational model. Develop a governance model. Develop a financial model. Internal governanceDocumented approach. Agreed decision making process. Formal agreement in place. Conflicts of interestDocumented approach to how conflicts of interest will be addressed. Developing our staff Who do we have? What do we need? Legal Indemnity & Providing servicesRegister with CQC Be an Any Qualified Provider NEW MODELS OF CARE

9. Workforce Development Recruitment, training and employment of;  Post MRCGP registrars – 1/2 year contracts with additional education in Urgent +/- Elder care  ST 0&4 doctors with educational component via University/HEE  Advanced Nurse Practitioners/Physician Associate/Advanced Paramedics  Primary Care Physiotherapists – direct and GP referral  Advanced Pharmacist training  Additional roles & training for existing GPs and clinical staff

10. Opportunities? Specialist services; room rental income, very few GPwSI Shared care pathways – unsuccessful AQP contracts – limited CCG support – variable Joint Ventures – caution! Back office support – not happened yet Virtual reception – growing

11. Opportunities? Primary Care “Its our bread and butter and we do it well” Play to your strengths - Stop chasing services which give a small return BUT do it at scale ‘New Models of Care’ ‘Primary Care Home’ Requires culture change – how/who provides services

12. Achievements to date? Primary Care  Lifestyle Services contract – activity not outcome payment  Buying Consortium – now nationwide >2,000 practices et al  Telephone network -> Virtual Reception  Community Education Provider Network £50,000 pa  PMCF £4.2m; Workforce development IT and information systems Services – AVS, Extended Access, Direct Physio DEMENTIA & FRAILTY

13. Health Education West Midlands West Midlands Deanery/General Practice Stafford & Surrounds CCG, Telford & Wrekin CCG, Shropshire County CCG Badger Group (Urgent Care Cooperative) Universities of Keele, Birmingham, Wolverhampton & Worcester EMIS & Endeavour Health Charitable Trust LETC British Geriatric Society St Giles Hospice Palliative Care Solutions

14. Closing thoughts You need resources – and not just money Get your Vision right -> buy-in and cohesion -> ownership Sell the Vision – internally and externally Chase the big honey pots;  New Models of Care – Primary Care Home (National Contract?)  Education & Training  PH/Local Authority

16. Contact details Russell.Muirhead@shropdoc.nhs.uk Mob: 07971245220