Local reasons to federate are varied and different; however, joining together in a federation can help GPs and their practices share expertise, reduce costs and adopt common approaches in the way in which they run services. Federating can also help practices win Any Qualified Provider (AQP) work.
So what exactly is a federation?
A federation is best described as group of people united in a relationship and having some interest, activity, or purpose in common. In relation to healthcare it’s no different; here the key relationships lie in the commonality of delivering services; in essence developing mature relationships for more effective working between GPs, healthcare professionals and practices. A federated model will also allow for easier partnership working between the member practices and other local providers, e.g. Foundation Trust, Community Services, the private sector etc.
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Great leaders have a vision and share it often. Whoever is leading this project must be able to articulate that vision and encourage others to come forward and get involved. Unless people can see the ‘WIFM’ (what’s in it for me) they will be unlikely to engage at any level.
The 7 key steps
Step 1 - An initial exploratory meeting will allow you to understand your options locally, and what will and won’t work for you. It will also provide the opportunity explore how locally you ensure vital primary care infrastructure does not become threatened at a time when services are routinely being switched into primary and community settings, with little or no funding. Having a strong local General Practice is an essential part of securing high quality services, and this meeting will start the process of ensuing that.
Step 2 - From the exploratory meeting, assuming you progress, you will need to appoint a small workgroup of seven to ten people, who will be responsible for developing the principles for what will become your company.
The principles will in time be passed to the legal advisors who will then develop the articles of association and shareholders agreement for the new company, whether that is a for profit or not for profit organisation.
The key in these meetings is to always start with your end in mind and develop the appropriate structures and governance to ensure you deliver the required local outcomes.
Step 3 - Your launch meeting allows every interested practice to hear the outputs from the workgroup. It provides the opportunity for the documents to be shared and the practices to question the workgroup about any aspect of the company and the plans for the future.
Step 4 - On leaving the launch meeting the practices then have time, usually two weeks, to review the documentation and to seek legal and accountancy advice on the best approach for them individually, before making a decision on whether or not to sign up.
This time also allows for those who may be interested in becoming directors of the company to come forward to seek election.
Interested practices can also ask further questions of the workgroup, in order to help them reach a decision.
The key point here is that this is an individual decision for practices. It does not require consensus amongst the group of practices, and you therefore do not need further meetings. Practices either accept the design principles and the requirements of running a legal entity, or they choose to remain outside of the process.
Step 5 - At the point of sign up you then quickly need to finalise the board nominations and hold the election. Up to the point you get the board in place you will be unable to instruct the lawyers to commence the process of registering the company and developing the shareholders agreement and articles of association.
This also means you cannot register for AQP or tender opportunities.
Step 6 - In order to elect board you might want to seek help with the process from the LMC which, in our experience, are usually more than happy to help.
For those seeking election you will require them to recognise the skills required, and of course the legal duties and responsibilities becoming a director entails.
Becoming a director is not something to be entered lightly; however, for the right people it will be a highly rewarding experience. Those coming forwards should provide a pen picture to go out as part of the election papers. You can seek as much or as little information as you believe necessary as part of this process.
Step 7 - The final step lies in the workgroup guiding the initial board meeting, by setting the agenda to get them started.
Key items include instructing the lawyers and accountants, developing the initial risk register and the leads for each area of risk identified, appointing leads to get the company registered with the CQC and completing the registration around information governance. There is a lot more than this; however, these are essential.
Do the CCG leads or board members have a conflict of interest in exploring the development of a federation?
The development of a GP Federation can and should be viewed as an integral part of the CCG’s proactive approach to market management. When defined in this context the project does not constitute a potential conflict of interest. The role of the CCG here is simply to enable GP practices to further explore the issues and opportunities raised and to facilitate the discussion of potential options for cooperation. Everyone, including CCG board members can be involved as, up to the point a company is formed, it is about exploring options.
- Scott McKenzie, NHS consultant and Keith Taylor, head of medical services, BW Medical Accountants Ltd www.bw-medical.co.uk