1. Merseyside Family Doctor Association WELCOME GP Federations & AGM 27 November 2014

2. GP Federations : What really works? Dr Stephen Cox, GP Clinical Chief Executive NHS St Helens CCG

3. Briefly about me GP St Helens Started as educator – GP Tutor and Trainer PCT 2002 Board Medical Director of RCGP Innovation Unit Elected RCGP Council 2005,6 and Faculty Board MD Halton and St Helens PCT MD Merseyside Clinical Accountable Officer NHS St.Helens CCG Managing concerns, clinical commissioning, quality matters.

4. Federations What are they? Why bother? Have they worked so far? Risks of not federating? Conclusions

6. Star Trek The United Federation of Planets, usually referred to as "the Federation", is an interplanetary federal republic composed of planetary sovereignties depicted in the Star Trek science fiction franchise. The planetary governments agree to exist semi-autonomously under a single central government based on the Utopian principles of universal liberty, rights, and equality, and to share their knowledge and resources in peaceful cooperation and space explorationplanetarysovereignties Star Trekscience fictionspace

7. RCGP definition A Federation is a group of practices and primary care teams working together, sharing responsibility for developing and delivering high quality, patient focussed services for their local communities.

8. RCGP RCGP Roadmap 2007 Lord Darzi Review APMS ‘Aspiring to Excellence’ Ideological Common purpose

10. As the coalition government moves forward with their plans for clinical commissioning, the Royal College of General Practitioners (RCGP) commissioned an online resource to support GP practices forming federations. Developed by The King's Fund in partnership with the RCGP, the Nuffield Trust and Hempsons Solicitors, this toolkit provides advice and support to practitioners and managers in primary care who are thinking about, or have already embarked upon, developing a federation to provide and develop services collaboratively.

11. Federations key building blocks in developing a federation deciding on a federation’s legal structure federation governance involving patients and the public engaging the wider primary care workforce improving quality and safety education and training developing and redesigning services tackling public health issues sharing back office functions working with an external partner

12. Legal Form Private company limited by shares (CLS) Private company limited by guarantee (CLG) Community Interest Company (CIC) limited by shares or guarantee Industrial and Provident Society (IPS) Charity Limited Liability Partnership (LLP)

13. WHY BOTHER? Federations

14. Why bother? – RCGP survey 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

15. Why bother? Recruitment issues Retirement issues Income dropping High % GP income will not come from GMS/PMS Need to bid for contracts e.g. LES’s New GP Contract Need leads for ‘everything’ CQC requirements Fragmented community services need focus Safety in numbers?

16. HAVE THEY WORKED SO FAR? Federations

17. Examples Ideological Geographical Business focussed

18. Ideological - example Federation of St Helens Training Practices Formed 2007 Share training resources Induction of staff incl. registrars Education events CQC registration

19. Geographical - example Out of Hours Providers : StHelens Rota Opt in borough High % local GP’s working

20. Business focussed Share staff : PM PN Salaried Gp’s Share HR resource Other front or back office functions Share clinical resource – QOF areas etc Vehicle for bids for practices Bids for other services : Sunset West Social Enterprise, Washington, Tyne and Wear

21. Research Evidence – Kings Fund and Nuffield – 10 lessons 1.The motivations for practices to federate vary. 2.Function affects form 3.Independence from the statutory sector accords longevity. 4.Involving doctors is relatively easy – it is harder to be more inclusive. 5.Primary care organisations are good at planning and developing services within primary care and community settings

22. 10 lessons continued 6. Primary care organisations are more likely to make substantive change where they have direct control of budgets and where there are direct financial incentives for professionals. 7. Clinical leadership and engagement are essential 8. High quality management and infrastructure support is critical

23. 10 lessons continued 9. Primary care organisations increase transaction costs within local health economies 10. Major service transformation will require highly organised primary care as a bedrock.

24. RISKS OF NOT FEDERATING? Federations

25. Risks Actual sustainability : wage costs, reduced funding… 25% retirement rate in next 5 years urban areas Succession planning Continue to attract LES monies To protect independent contractor status NHSE Five Year View : Specialist Community Providers

26. CONCLUSIONS Federations

29. Conclusions One size doesn’t fit all One model doesn’t fit all Federations are part of a journey What is your journey? Safety in numbers Sustainability