About the Toolkit
An explanation of the purpose, background and
scope of the Federations Toolkit.
Background
The concept of a primary care Federation was
first set by the Royal College of General Practitioners in
September 2007. Its publication, The RCGP Roadmap, focused
on a model where practices would work together more closely to
share resources, expertise and services. A Federation, whilst
not typically part of the day-to-day language of NHS general
practice and primary care, has however gradually come further to
the fore, usually in relation to practices grouping together for
either commissioning or service provision activity. Indeed,
prior to recent policy announcements, it had been mooted that
Federations might be both providers and commissioners, taking
advantage of the GP’s position as a provider, co-ordinator and
commissioner (via referrals) of care (e.g. The Nuffield Trust and
NHS Alliance, 2009).
The reasons why practices might choose to
federate, aside from forming a commissioning organisation, have
been revealed in a national survey of members of the RCGP carried
out in May 2010 as part of the development of this toolkit.
These reasons include:
- Strengthening the capacity of practices to
develop new services out of hospital
- To form an entity that can tender for
services offered by a future GP commissioning consortium
- To make efficiency savings/economies of
scale, for example in back office functions or the procurement of
practice services
- To improve local service integration across
practices and other providers
- To enhance the capacity of practices to
compete with external private sector companies
- To strengthen clinical governance and improve
the quality and safety of services
- To develop training and education
capacity
This toolkit aims to help practices fulfil
each of these ambitions by describing how federating can help,
providing examples from existing Federations, and links to
resources that can provide practical advice and support.
The NHS White Paper Following the election of
a new Coalition Government in May 2010 and the subsequent
publication of an NHS White Paper Equity and Excellence:
liberating the NHS in July, it has become clear that primary
care groupings will fall into two broad categories – statutory
commissioning consortia that will become the main purchaser of care
for a local population, and provider groups or organisations that
will deliver an extended range of community-based health services,
under contract to GP commissioning consortia or other commissioners
such as local authorities and the proposed NHS Commissioning
Board.
This toolkit
This toolkit focuses on providing advice and
support to those practitioners and managers in primary care who are
thinking about, or embarked upon, developing a Federation
for the purposes of providing services in a collaborative
manner. This approach is taken for pragmatic
reasons, given that the form and function of proposed new GP
commissioning consortia are still in development.
It should be noted, however, that this toolkit
draws heavily on the experience of existing practice-based
commissioning consortia and on the extensive research evidence
about different forms of primary care-led commissioning. This
is in order that the toolkit can benefit from some of the most
relevant evidence on the workings of primary care organisations,
and because a reading of research from both provider and
commissioner bodies reveals very consistent messages about issues
such as clinical engagement, management support infrastructure,
governance, and ownership.
The toolkit seeks to draw on the practical
experience of existing primary care organisations or Federations,
to inform local clinicians and managers seeking to establish a
Federation in their own area. Where appropriate, research
evidence is also used to inform the advice given, and there is a
strong focus on signposting practical resources developed by a wide
range of management, academic, national and international
experts.
What the toolkit is not
This guidance does not explicitly address the
establishment of statutory GP-led commissioning consortia although
this has been a core ambition for many groups of practices.
However, some of the guidance may be useful to the development of
consortia and many of the examples we use are Federations that grew
from practice based commissioning (PBC) consortia.
Nothing in this toolkit constitutes legal or other professional
advice. It is made available on the basis that the Royal
College of General Practitioners, the authors of the toolkit and
their respective organisations do not accept any liability for any
fact, error or opinion that it may contain. You should always
obtain suitable legal or other professional advice before applying
information in this toolkit to particular circumstances.
The toolkit contains links to websites and to material contained in
other resources and websites. The Royal College of General
Practitioners, the authors of this toolkit and their respective
organisations are not responsible for the content of the resources
and websites which you may be able to access from this toolkit.