How can multiple organisational models co-exist to deliver quality care?

As part of the RCGP Supporting Federations programme, RCGP and the Nuffield Trust created two surveys which were circulated to CCGs and GPs in England which sought to find out more about whether practices are forming at scale organisations, and if so how they are doing this. An interim analysis of responses, undertaken by the Nuffield Trust, has indicated what the top five actions are that federations undertake after forming. We were interested in finding out how existing federations have achieved these actions; this article explores how Haxby Group in York have developed their organisational strategy.

Dr Mike Holmes
RCGP Clinical Lead for Supporting Federations

One of the key issues to emerge from the RCGP’s recent Supporting Federations survey was that of the legal organisational format of federations. The survey shows that many federations are simply networks of practices without a legal connection, whilst others comprise of merged practices with a single partnership agreement or practices retaining individual partnerships and linking themselves via a corporate vehicle.

One could be forgiven for thinking that any given practice or group of practices must choose a single structural solution if they are to move forward. However at Haxby Group this has not been a major concern – we have not considered the organisational vehicle to be a barrier at all and in fact we have adapted the vehicle or indeed created new vehicles to meet our needs at any given time.

Haxby Group began as a GMS partnership in York. In 2007 we began to recognise the uncertainty in primary care and looked to grow and diversify our organisation. We decided to bid for 3 APMS practices under the Equitable Access to Primary Care Scheme in Hull – a city 40 miles away with significant public health challenges. We were unable to bid for these as a partnership so we created a limited company to do this – all partners were shareholders and all shareholders were partners. This vehicle contributed to our successful bids for each of the three contracts.

We began to develop the practices with a focus on patient care and training and education. In 2012 a neighbouring GMS practice approached us in order to work collaboratively, rather than forming a network or a simple alliance a decision was made that HBG Ltd would join the partnership as a corporate partner. This has since evolved and now HBG Ltd holds two partnership shares in a three partner practice.
In parallel to our growth in Hull, Haxby Group began a diversification into the area of community pharmacy. We formed another limited company vehicle with a local pharmacist and have grown a chain of three pharmacies in York and the East Riding of Yorkshire – Haxby Group Pharmacy Ltd.

Despite these developments the original GMS practice has continued to thrive and has recently undergone a merger with another large neighbouring practice. This has resulted in an increase in the number of partners to 22 and the total number of patients registered with the group in both York and Hull to 50,000.

Throughout this period of expansion two key issues have been paramount in our thinking: patient care and organisational development. The growth of the footprint has been accompanied by an expansion of staff numbers and the continued creation of an environment with a focus on learning, training and education. Furthermore performance in terms of QOF has remained high and patient satisfaction surveys continue to improve.

In 2015 there has been a desire from Haxby Group to be involved in further collaboration with other practices. This has resulted in the formation of a multi-practice organisation in York with three other practices covering 126,000 patients again under the umbrella of a limited company – NimbusCare Ltd. Having formed, we are providing both clinical (an integrated care team in the city of York) and non-clinical (telephony services for practice in Vale of York CCG) services. NimbusCare is keen to improve services for patients in the city and to this end is proposing becoming a Multi-speciality Community Provider (MCP) with a focus on collaboration and innovation and is proposing to use the Primary Care Home Framework provided by the NAPC.

An online learning network is being created to support those working in federations as well as those who are not yet working at scale but want to find out more. Registered users of the site will be able to access useful resources and case studies and make contact with colleagues on the topic of working at scale. Users will also be able to take part in a series of webinars designed to tackle some of the issues faced when working at scale. To find out more please visit our website or contact the team at:

The first in our series of webinars will explore the process of scaling up and likely ‘crunch points’ organisations might face as they grow.

When: Wednesday 9 December, 13.00 – 14.00
Panel: Naresh Rati (Executive Partner, Modality Partnership), Caroline Kerby (Director of Management, Harness Care Cooperative) and Chris Ley, (Network Director at Poplar & Limehouse Health Network, Board Director of the Tower Hamlets GP Care Group CIC).

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