Step 1: Agree roles and schedule meetings
This is very straightforward; you need to agree the board roles for all directors and schedule board meetings ahead.
The key here is about setting and then managing expectations. The company will need to be very lean in its approach, as it will have very limited resources at this stage, and even if the company grows quickly, you will not want to be spending a significant percentage of income administering the company and board.
Your ultimate aim will be to run on around 5% of total turnover.
Step 2: Develop your risk register
You absolutely must develop the initial risk register and appoint leads for each area of risk identified. This is about protecting the company, the directors and the shareholders.
Being part of a company will be a very different way of working and you must manage your identified risks. The key here is to be able to identify how catastrophic an event could be if it happened and at the same time weigh up the likelihood of such an event occurring.
You will need to work to identify events that could be catastrophic right down the scale to minor level and at the same time assessing if these events happened, whether they would be a rare occurrence right the way through to almost certain to happen.
Working this way allows you to identify the risks that need your immediate focus to mange.
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Step 3: CQC registration and Information Governance
You will need to appoint leads to get the company registered with the CQC and complete the registration around Information Governance.
CQC require the company to be registered and to notify the sites it will work from. You are also required to be compliant with the information governance requirements of being an NHS provider.
Failure to comply with either of these will eliminate the company from holding NHS contracts.
Step 4: Business plan
Your next step is to develop your business plan. We recommend you consider four areas initially:
- Horizon scanning for possible bids and tenders, as well as considering services you could develop.
- Getting the finances moving with some internal trading between practices, possibly with input from the CCG.
- Work to support the practices to reduce overheads e.g. insurances, utilities, phones, consumables etc. You will be amazed at how much buying power a federation has when purchasing on behalf of a number of practices.
- Start to explore opportunities to federate your back office support functions where possible, as there are significant opportunities within this area. This is and should be an evolution not a revolution, and of course needs careful management.
There are many other items you can work on and indeed in time will work on, however, this gives you a starting point. You do need a robust business plan and the focus of developing it will set you off on the right lines and make you think carefully about what you want to achieve and how.
Step 5: Develop relationships with stakeholders and commissioners
You will need to set up initial exploratory and introductory meetings with CCGs, foundation trusts, public health, local authority, community providers, community and voluntary sector, other local federations and other local stakeholders.
These meetings will allow you to understand how you can work locally with other providers and also start to establish a relationship with your commissioners.
One of the key areas for discussion is likely to be around some of the new contracting options for prime, alliance and principal contracting.
Step 6: Agree how board meetings will work
You will need to agree the reporting lines for board meetings and how the information will be gathered and reported.
The board will have a number of standing items including finance, audit, clinical governance and quality, corporate governance, and of course risk. You will have expectations of those who deliver services to report activity, incidents, complaints and patient feedback to name four of many items, and will need to agree a standard format for all of this, and how it will be collated for the board meetings.
As part of the reporting I recommend taking a skills audit of all member practices, as well as training needs analysis for all members and directors.
Step 7: Consider new models of delivering primary care
The key driver for the initial formation of a federation is to allow general practice to respond to the challenges it currently faces, both immediate and future. As part of the approach, rethinking the delivery model and, where appropriate, developing new models of general practice will be key. You need to start to develop your ideas around:
- Ensuring sustainability, as there is a real risk that some practices will become unviable.
- How you will help, support and encourage the membership to engage and work with you. The NHS needs high quality general practice to be successful and the current funding and income pressure is growing and will not go away.
- How you build on the strength of general practice (more than just protect) as the home of primary care – what services can you introduce as a result of federating?
- How you offer a strong future to your current workforce through a workforce development plan for the short, medium and long-term. The federation offers a long-term solution to avoid redundancy for both clinical and administration teams, and you need to establish this quickly.
- Integrated services in community.
- How you plan to deliver long terms and sustainable change through a shift in mindset and work practices to deliver the new outcomes required, underpinned by high quality training and education.
- How you will focus upon on improving outcomes.
- How ultimately you will deliver your business plan.
Scott McKenzie, NHS consultant and Keith Taylor, head of medical services, BW Medical Accountants www.bw-medical.co.uk