At the heart of Newham’s newly launched federation of practices, First 4 Health Federation, is an innovative recruitment and retention scheme to support the career-development of young GPs working in the borough, while ensuring succession for those looking to retire.
Close collaboration between the three practices already federated this year, and the six that plan to join by 2014, mean staff and salaried GPs can move between practices, gaining new experiences and skills.
In addition, salaried GPs are receiving training that will equip them to work in single-handed practices, to support succession planning for retiring GPs. This gives the existing GPs peace of mind, as they know they can reduce their clinical sessions, and that patients will be managed, providing continuity of care. ‘It is really important to them that their patient’s are left in safe hands,’ explains First 4 Health, project director Karen Stubbs.
She explains: ‘The option before had been for them to use a range of locum GPs but consistency and continuity of care cannot be provided within this model and, when something more attractive or lucrative came along, some locums would move on. What retiring GPs need and want is a pool of well-trained young GPs who they can mentor and with whom they can achieve a robust handover.’
Among the GPs to benefit so far is Dr Abrar Hussain, who has been a salaried GP for the last four years at the E12 Health Centre. This was one of the first three practices to federate, along with the Stratford Village Surgery and the single-handed Leytonstone Medical Centre.
Under the federated model, he cares for the patients of Leytonstone Medical Centre where a GP had recently retired. He also leads training sessions involving staff from across the federation in one of his areas of expertise: creating paperless practices.
‘Another benefit is for the practice staff, who get to work with different geographic groups and models of practice,’ he says.
This flexibility of staff moving around practices minimises locum use and reduces temporary staffing costs. Locum costs have been further reduced through a deal negotiated with the federation’s regular locums, adds Ms Stubbs.
‘We have negotiated quite hard with regular locums to reduce rates from around £95 an hour to £85 and this includes some paperwork. For that, they gain access to the practice education and clinical meetings, which helps with their appraisal and revalidation,’ she says. They have access to senior clinicians who are able to provide mentorship and support. For many newly-qualified GPs, this is an attractive package and one which they can also combine with local work, and training to progress in specialist roles.
The federation operates under a structure whereby larger, ‘hub’ practices, currently the Stratford Village and E12 practices, stage meetings, training and co-ordinate patient care and management functions.
Two other surgeries will be fully federated by the end of the year, when they formally adopt First 4 Health’s terms and conditions. These are Dr Prasanta Bhowmik’s single handed surgery (see case study) and the Cumberland Medical Practice, also run by a single-handed GP.
Royal Docks Medical Practice, Green Gate Medical Centre, East End Medical Centre and Lord Lister Health Centre have agreed to federate by early 2014.
Growing the federation
This will complete the first phase of federation, but the ambition of First 4 Health is for more practices to join in further phases. ‘There has been so much demand from other practices that our original ambitions have grown and we are still having conversation’s at board level about how big the organisation will be,’ says Ms Stubbs.
Federation chairman Dr Ashwin Shah explains that a key challenge has been persuading staff of the value of the federated way of working.
‘We have made it clear that no one will lose their job because of the change, but they may have to work differently, such as working at different surgeries,’ he says. ‘That is a big change for them.’
Implementing the process smoothly has involved ensuring practices within the first phase join the federation in waves so that there is time to consult with staff and explain clearly the benefits of the new model, he adds.
To join the federation, practices put in £1 per patient, which covers start up costs, including the project management costs. The combined patient list of the first nine practices to federate is 55,000. A loose agreement exists which binds the first and second wave practices together.
Savings are made around training as practices swap expertise and also deliver on site, in-house courses. In addition, IT costs have been reduced as all practices involved use the same system, EMIS Web.
All those federated have signed a formal data-sharing agreement and work is now in progress to create a ‘virtual surgery’ model. This will mean patients register with the federation once, so when they move elsewhere within the borough and want to join another practice in the federation, they do not have to re-register.
Ms Stubbs explains this will benefit both patients and practices in the federation as Newham has a high proportion of patients who move within the borough each year; patient turnover for practices can be as high as 40%.
Meanwhile, expertise and resources can be combined to allow First 4 Health to bid for public health and research contracts.
So far, the federation has been awarded pilot status for an integrated care contract involving multi-disciplinary teams with complex and high risk patients. Ms Stubbs hopes that, as the federation expands and more staff and skills are brought into the group, First 4 Health will win further contracts.
She acknowledges, however, that further investment may be required to create a team to specialise in bidding for such contracts and to develop capacity for research bids.
Case study: Dr Prasanta Bhowmik - handing over to a salaried GP
Dr Prasanta Bhowmik, who is planning to retire next year, jumped at the chance to join the First 4 Health Federation, having been impressed by the clear succession plan it promises Newham single-handed GPs such as himself.
‘It is very important to me know that when I retire next year that the practice is going to be well run and that there will be a real focus on quality of care for patients,’ he says.
The salaried GP who shares sessions with him ‘is less keen on the management side of the job’ so the federation is seeking a salaried GP who can take over the practice.
‘There are few interested; one has a diploma in management and a real interest in that so I’ll be talking to him soon,’ says Dr Bhowmik. ‘I’m confident that the right person can be found through the federation.’
But he says that, after working in Newham for the last 38 years - 33 of which at his single-handed practice in Corporation Street - such co-operation between local practices is not new.
‘We have a long track record of co-oporation over the years, through GP fundholding and also through practice manager and GP forums, sharing ideas and helping each other out,’ he says.
His faith in this ethos meant he was fully prepared to invest the required £2,400 in the federation to help with start-up costs, based on its £1 per patient levy.