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Ben was CEO of Nene CCG for 8 yrs. He was a Director of an acute trust and has run national improvement programmes. He is a founding director and Principal Consultant of Ockham Healthcare, which he describes as ‘a platform for change’.

GP Federations: creating the future or protecting the past?

Many practices are joining GP federations so that they do not have to change - a defensive manoeuvre that in many places is preventing the changes that are required.

Up and down the country practices are choosing whether or not to join one of the federations of practices that are forming locally. 

Such a move is generally being encouraged nationally, as it is seen as a signal of the change that is required in general practice actually taking place.  But do these new federations really signify a positive development?

On the surface it would seem that they do.  The idea of practices working together, creating economies of scale and inter-practice efficiencies, as well as developing new service offerings, appears to be very much in line with the development of Accountable Care Organisations (ACOs) as described in the 5 Year Forward View (5YFV).

The reality, however, is that the development of federations is largely a defensive move.  Practices are joining primarily because of the problems they face (finances, workload, recruitment, etc). 

These problems signal to even the most recalcitrant of practices that something has to change.  But the mindset is one that if the new federation can create an additional source of income for the practice, and provide some form of respite from the current pressures, then the individual practices can continue on pretty much as they are at present.

The leaders of the new federations need new practices to join, primarily because they require funding from each practice. 

As such they are reluctant to put any requirement to change or to do things differently onto each new practice that joins.

The transaction that ends up being done is that the practice agrees to join the federation on the basis of what the federation will do for the practice (provide extra income, support recruitment etc), but rarely on the basis of what the practice will do for the federation.

This is the nub of the issue. If the new federations are to be successful, they need to influence the way that core general practice is carried out. 

They need to be able to set and adhere to minimum standards, and to consistently apply change across every member practice. 

If they cannot do this they are set up as toothless, unable to exert any more influence on the system than the practices operating individually were in the first place. 

Many practices are joining federations in order that they do not have to change.  It is a defensive manoeuvre that in many places is preventing rather than accelerating the change that is required in general practice. 

The mindset is one of ‘what can we take from the system?’, rather than ‘how can we make the system better?’.  And with this mindset they are destined to fail.

There are, however, some places that are doing the hard yards of change.  They agree common standards across all practices, and put processes in place to ensure that they are maintained. 

They actively tackle individuals that cannot, for whatever reason, be part of the new system.  They meet inter-practice funding discrepancies head on, and don’t leave issues festering beneath the surface.  It is hard work, and it takes time, but it can be done.

GP federations are not a magic bullet.  They are a platform that can enable some of the change that is required to be delivered, and for solutions some of the problems general practice faces to be developed. 

But if they are used by practices as another reason not to change, then they are not creating the future but simply an attempt to protect the past.

Ben Gowland was Chief Executive of Nene CCG for nearly eight years. He left in April 2015 to set up Ockham Healthcare, a healthcare management consultancy he describes as a “platform for change”. Ben joined Nene as its CEO and first employee when it was first forming as a practice based commissioning (pbc) organisation.  Within two years it had become the leading pbc organisation in England, and Ben went on to establish it as one of the largest CCGs in the country. Ben hosts RealityBites – The National Healthcare Conversation, a weekly online podcast.

This column was first published in The Information Daily April 2015

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