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Federations

Everybody seems to be talking about GP Federations. Solution or buzzwords?

Given the challenges faced by all GP practices in the current NHS climate, there is much talk about GP federations as the only solution. 

‘The traditional small business model of general practice is unsustainable.’  So said the BMA in March 2009.  Now  the accuracy of this statement seems even more evident, with GP practices, whether small, medium or large, coming under increased administrative and financial pressures. 

The Association has produced four factsheets outlining what to consider before forming a GP Federation.  The factsheets are written by Andrew Lockhart-Mirams at Lockharts Solicitors. 

  1. Facsheet #1  The Basics of Federation <free to download>
  2. Factsheet #2 Formal Federation Arrangements <Free to Members or £20>
  3. Factsheet #3 Practice Mergers  <Free to Members or £20>
  4. Factsheet #4 A reality check <free to download>

The Family Doctor Association commissioned these factsheets in response to requests from members.  Full of tips for the unwary based on the collective experiences of other GP practices who have gone down the federation route.  In this edition, Andrew shares his experiences of federating.

Simple federated working: three stages

Whilst the third article in this series examines the mechanics of merging practices, we start here with the simple proposition that practices have to work together in order to obtain the benefits of the economies of scale that are available.  This is achieved through federated working.

Sharing “back room” administration

Possibly the simplest example of federated working arises where two or three practices share a ‘back room’ administrative resource, such as bookkeeping.  This does not involve one practice being the employer and then seconding the bookkeeper to another practice.  Instead, practices simply agree that they will use the same bookkeeper at different times of the week, with each practice making a separate arrangement with the bookkeeper.  This arrangement offers the advantage of advertising the position jointly.  It also permits the practices to offer what is in effect a full-time working week, rather than part-time working arrangement, and is likely to attract a higher calibre of candidate as a result.

Staff sharing — slightly more complex

Staff sharing, in contrast, constitutes a slightly more complex example of federated working.  Here, one practice employs, for example, a nurse, who is used by the practice but also ‘hired’ out to another practice.  This allows a great deal more flexibility than having two separate contracts, as set out in our bookkeeper example above.  However, it also requires a certain amount of management, particularly if things go wrong. 

 The main problem that can arise when sharing staff occurs where, for example, a nurse employed by ‘practice A’ is seconded to ‘practice B’ and is subject to a discriminatory act.  This discriminatory act will be attributed to something said or done by a staff member at ‘practice B’; the employment claim, however, will be made against the partners in the employer ‘practice A’.  In order to tackle this potential issue, ‘practice B’ will need to indemnify the partners in ‘practice A’ against employment related liabilities.  The provision of such indemnities and the terms upon which staff are seconded must be properly recorded in written documentation.  Where clinical staff members are seconded, care must also be taken with regard to clinical negligence cover.

Sharing premises and facilities—a lot more complex

The most complicated form of sharing is probably the sharing of premises and facilities.  Often, two or more practices will occupy the same health centre, taking their own consulting suites, but sharing a nurse treatment room or, for example, a minor surgery facility.  The terms on which this sharing takes place require very careful consideration, as do the proportions in which the costs of sharing are spread between the two practices.  In very simple terms, a practice with 6000 patients might be expected to pay two thirds of the cost, as against a practice with only 3000 patients.  There are, however, a number of variables, as the demographics within each practice might be very different.  It may also be that, for other reasons, the smaller practice, for example, does not use 33.3% of the facility but say 43.3%.  The costs of running a shared facility can be quite substantial and cost sharing mechanisms, however complicated, should therefore be properly recorded. 

Two further factsheets are available free to members here

  

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