A tale of two cities, two federations and one practice

Dr Mike Holmes, RCGP Clinical Lead for the Supporting Federations Programme
GP Partner, Haxby Group York & Hull

There is no doubt that we are living in an era where general practice is feeling pressure from a multitude of angles. As GPs we are working very hard to provide high quality care for our patients whilst having to consider a shift of work from secondary care, a ‘new deal’ and a significant workforce challenge. One solution to these issues is for practices to work together. We are already seeing successful examples of this in the UK (King’s Fund, 2013) and the Five Year Forward View (NHS, 2014) would suggest that the future direction of travel is dependent on collaboration. Practices that choose to do this will undoubtedly face new challenges together and will require support and guidance.

RCGP, working with the Nuffield Trust, has been funded by NHS England to undertake a piece of work designed to deliver such support and we are asking for your assistance. The RCGP Supporting Federations programme seeks to learn from all primary care organisations undergoing transformation throughout England and use this learning to support general practice networks of all types.

We are seeing the emergence of many different models of federations across the country (King’s Fund, 2013). In the context of this programme of work the RCGP is clear that the term ‘federation’ is being used to cover a variety of different configurations such as: networks of practices, super-partnerships (practices with c.50,000 patients), regional or national multi-practice organisations, community health organisations and would certainly include vehicles emerging as a consequence of the Five Year Forward View. The aim of the programme is to create a resource that practices can use as they find the path to their own model of federation.

I have been appointed as the Clinical Lead for this programme and am very much looking forward to being part of it. My background is as a GP and a partner at Haxby Group – a practice that has now evolved, over a short period, into an example of how several different models can exist simultaneously within the same organisation. Seven years ago Haxby Group was a large practice in the city of York serving 20,000 patients, having recognised the future challenges the practice began to look at how it could change.

Its partners formed a limited company and won tenders for three new APMS contracts in the neighbouring city of Hull. Over the five year contract it grew from zero to 17,000 patients and on the way the limited company became a corporate partner in a GMS practice in the city. Now, having undergone a merger with another large practice in York, it qualifies as a super-partnership with 50,000 patients from 10 sites in two cities.

The next logical step was for the organisation to form federations in both cities. In York it has formed another limited company with three other practices, serving a total of 126,000 patients, and in Hull is working closely with two other practices serving 40,000 patients. In parallel to this transformation the practice has diversified into community pharmacy and holds a 50% stake in a chain of community pharmacies.

Two key cultural constants have guided this growth; an obsession with standards with an aspiration to improve quality of care, as well as a desire to be a learning organisation with training at its centre and an ethos of learning from failures (of which there were many!). This cultural fixation has enabled the organisation to grow rapidly and respond in a measured way to all challenges faced such as CQC registration, contractual changes and recruitment difficulties. The result is a super-partnership that has formed multi-practice organisations in two distinct geographical locations.

Being part of this organisation has given me experience in working with dedicated teams of professionals and allowed me to develop a sense of what is possible. What is clear however is that different models are required for different situations and that flexibility and adaptability will be key for practices as they move forward.

In order to support practices to deliver at scale general practice, we recognise that input from GPs across England is essential. We have created a survey which will enable us to understand your needs and tailor our support to meet them. We would be grateful if you would take part in the survey, it should take no more than five minutes to complete and your participation is voluntary.

Results from the survey will be used to inform national analysis and debate about the development of new models of primary care. In addition, the programme will produce a comprehensive resource database for use by practices who wish to deliver services at scale.

If you have any queries please get in touch with the team at supportingfederations@rcgp.org.uk.

All responses to the surveys will be completely confidential and anonymous. Any data collected will be stored securely in accordance with the Data Protection Act and only accessed for the purposes of this work.      


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