Is this the end of GP Federations?
I recently saw an article predicting the death of GP federations. Having reflected I have to say I disagree. It’s worth defining that I think there are 2 types of federation one is a for profit outward looking federation that was originally setup to bid for AQPs - I don’t have any problem with these but I think most have struggled. The other type was setup more to help practices where the federation usually spends its time trying to help practices deliver their GMS contract better. This might be advice, setting up at scale back office or patient facing services. This is the type of federation I helped setup and still exists. Most were setup at whole CCG level with participation voluntary but often due to FOMO most practices joined.
As PCNS came along federations almost died. Everything was suddenly 3-5-10 practices covering 20-80K. Patients. CDs like me were appointed and apart from vaccine centres delivering IIF and the DES took priority. Size was about right for this. A CD doing a couple of sessions a week can get round 5 or so practices know them well. Help them, cajole them. ARRS funding was generous and some PCNS built a central team and infrastructure while some devolved the money to practices and ran lean only spending the bare minimum.
However smallish size has issues.
Governance can be an issue - a lot of money goes through the PCN books.
Power can be odd despite network agreements and voting schedules in a small group often 1 practice can dominate or can veto things.
Many PCNs are made up of not natural bedfellows and PCNs have perhaps stopped some practices that aren’t geographically coterminous but who have similar ethos from working together. Headspace is a problem. The management team at a PCN are often running to deliver and don’t have time to develop services. Now some of this is generalisation some are developing amazing stuff and some are huge - I know one of over 50 practices.
My PCN and all the local PCNS use our existing GP federation for governance. They have a team of people who watch the money - track it and make sure it’s not being misappropriated. The federation team help provide project management for local PCNs. Some of our most successful schemes locally have happened at federation level.
Our original federation was setup with a director being from each Area - each area turned out to be a PCN in the end. Some PCNs have looked at incorporating. Personally I think this is a mistake - often driven by accountants and lawyers who stand to charge large fees. It works for some but adds complications. Some have merged into one, which can work, though often these are at the low 10s of thousands.
It strikes me as we move forward as money gets tighter - as perhaps more roles need to be shared as management resource is squeezed - that working at scale is the way. That PCNs should be thinking about how they join together to deliver scale but retain their local focus and identity and projects. Keen to hear your thoughts!