GP federations - a new way of working

GP Federations – new ways
of working in primary care
James Gleed
Dr Deborah Kearns
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
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
Different Models
Simple alliance
Shared premises
Partnership mergers
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
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
Thank you
and now over to you!
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
3. What support would practices need in order to establish

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