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Part two: Collaborating – what works best for you?

Details

In part one we set out the drivers for GP collaboration and the push for primary care at scale.  Here we describe what ‘federating’ means, and as may be expected, it has different meanings for different people.

The General Practice Forward View sets out an intention to increase the recurrent funding for primary care, aiming to exceed 10% by 2020-2021, with a rise in overall investment in general practice by a minimum of £2.4 billion a year by 2020-2021. The new drive for integrated models of care is also aimed at general practice, encouraging the formation of collaborative primary care structures or federations.

There are now many more pressures on practices which are encouraging them to work more collaboratively in larger groups.

So how in practice do GPs work together effectively and collaboratively? What model of collaboration should and do GPs adopt? How do GPs keep their primary contracts and create integrated structures that can work across boundaries and areas? What are the obstacles and how can GP practices overcome them? 

What is federating?

‘Federating’ essentially describes a group of general practices coming together in one of many possible organisational structures, to work within the local health community.

There are many ways that GPs can organise themselves to work together so the reality is; it is not as simple as ‘just federating’ or ‘just merging’, because each area and each practice is different. Naturally, concerns arise around risk and desired outcomes. Each practice is set up and managed uniquely in response to the conditions out of which they were formed. The model for profit sharing, governance, internal processes, IT infrastructure and even the size of the practice can all have an impact on the model of collaboration chosen, and will play a role in how you set up the decision making structure and how you iron out the risks in your new chosen structure and model.

The first important step is for GPs in a locality to get together at the beginning of the process and define their common goals, and the functions they would like their federation to perform, as well as agree the desired outcomes which are hoped will be achieved by working together. Working out your aims and goals at an early stage will help gain traction within the group and will facilitate the collaborative process.

Only once this has been clearly articulated, should you start to think about which model of collaboration or vehicle will best meet your needs and requirements. The model should follow from the functions which you would like it to perform. If you move too quickly into selecting a vehicle, this can cause delays, disputes and additional taxation issues and other unnecessary costs associated with needing to rethink or redesign the structures at a later date. 

The most commonly selected structure for a federation is a company limited by shares or a company limited by guarantee. Below we have set out two common structures in a diagram:

Example federation structures

Want to move forward?

An appropriate federation structure to help you work in collaboration with other GP practices will be essential if you wish to participate effectively in place based models of care (which are emerging through the new care models and the Five Year Forward View). The reality is that many of the challenges to the system will not be resolved in the short term. However, through new collaborative approaches across populations, practices which have united to work together and who also work collaboratively with secondary care providers are seeing benefits for patients as well as their own practices.

Our next articles in this series will look at mergers, super-partnerships, joint ventures and more and will highlight the issues and considerations for you and your fellow GPs and help you make informed decisions about the crucial points that will need to be cleared between you and your peers on the journey to a successful collaboration.

How we can help?

We have developed model documents to assist our clients to form federations no matter which structure you wish to use. For our clients, we have:

  • options appraisals with ‘pros and cons’ for the most appropriate structure for you, dependant on the desires and expected outcomes for the federation
  • tailored advice regarding: the corporate structure, governance, board, employment, property, liabilities, procurement and contract reviews, as well as comprehensive advice on how the federation can achieve success within new integrated care systems
  • model articles, board minutes and shareholders agreements if it’s a company you wish to go for, which can easily be tailored to meet your needs
  • model joint venture agreement, or super-partnership agreements, which we can tailor to meet your needs

We are growing our commercial healthcare teams and have recruited Christiana Demetriou, Bethany Gore and Ruth Griffiths, who are all experts on primary care issues, corporate forms and federation structures and solving the issues our clients are grappling with around primary care at scale.

Read part one: Collaborating – what works best for you?

Read part three: Collaborating – what works best for you?

Read part four: Collaborating – what works best for you?

With a team of over 250 lawyers, we are one of the leading firms providing legal advice and support to national and international healthcare and life sciences organisations.

From NHS bodies to private providers and practitioners to insurance practices, our multi-disciplinary legal expertise covers the full spectrum of healthcare law including, litigation, commercial, regulatory, employment, investigations and inquests, real estate and disciplinary law. As a full-service international law firm, we take a scalable approach to service delivery, providing immediate access to high-quality legal advice across the full spectrum.

We are committed to working in partnership with our clients, fostering philosophies that are mutually beneficial. Our expertise and experience mean that we understand the issues you face and the clear and practical advice that you require, especially as services and systems become more integrated. We can help you manage risk and obtain better value for money enabling you to improve services and outcomes.

You can also access our webinar resources that are designed specifically for our health clients - covering topics that may affect you.