GP Federations – Personal Observations 21 st January 2016.

GP Federations – Personal Observations21st January 2016

Dr Russell MuirheadGP 1989Chairman ‘Shropdoc’ 2001Director Your Practice Plus Federation 2013-15Non-Exec STW Provider Federation 2013

YP+ STW Provider

Services LtdNot an Expert

Why Federate?

SCALE!

Why Federate? SCALE

Scale to designScale to deliverScale to influenceScale to negotiateScale to build relationshipsScale to saveScale to supportScale to risk share

Has the scale now been determined?

STW Provider Services Ltd

YP+

‘The Engine Room’

• Shropshire Doctors Cooperative; Formed 1996 – 290 GP members – 250 staff - £12m turnover No longer an OOH Co-op – now 24/7 urgent care and beyond

• STW Provider Federation 61 Practices – 500,000 population – turnover <£20,000 Lifestyle services contract – PMCF partner – CEPN lead

• YPP Federation 12 out of 29 practices across 2 CCGs We didn’t get it right -> Dissolved!

The RCGP PrinciplesGetting together Which Practices?

Demonstrate credibility.Clear communication.

Leadership Overall leader.Board of Directors.

Building a common purpose Clear vision.Commitment to that vision.

Getting external support Identify and engage key stakeholders.Key stakeholders understand the vision.

Developing the organisation Agree an organisational model.Develop a governance model.Develop a financial model.

Internal governance Documented approach.Agreed decision making process.Formal agreement in place.

Conflicts of interest Documented approach to how conflicts of interest will be addressed.

Developing our staff Who do we have?What do we need?

Legal Indemnity & Providing services Register with CQC Be an Any Qualified Provider NEW MODELS OF CARE

Workforce Development

Recruitment, training and employment of; Post MRCGP registrars – 1/2 year contracts with additional education in

Urgent +/- Elder care ST 0&4 doctors with educational component via University/HEE Advanced Nurse Practitioners/Physician Associate/Advanced

Paramedics Primary Care Physiotherapists – direct and GP referral Advanced Pharmacist training Additional roles & training for existing GPs and clinical staff

Opportunities?• Specialist services; room rental income, very few GPwSI• Shared care pathways – unsuccessful• AQP contracts – limited • CCG support – variable• Joint Ventures – caution!• Back office support – not happened yet • Virtual reception – growing

Opportunities?• Primary Care “Its our bread and butter and we do it well” Play to your strengths - Stop chasing services which give a small return BUT do it at scale ‘New Models of Care’ ‘Primary Care Home’ Requires culture change – how/who provides services

Achievements to date?• Primary Care Lifestyle Services contract – activity not outcome payment Buying Consortium – now nationwide >2,000 practices et al Telephone network -> Virtual Reception Community Education Provider Network £50,000 pa PMCF £4.2m; Workforce development

IT and information systems Services – AVS, Extended Access, Direct Physio

DEMENTIA & FRAILTY

Health Education West Midlands

West Midlands Deanery/General Practice

Stafford & Surrounds CCG, Telford & Wrekin CCG, Shropshire County CCG

Badger Group (Urgent Care Cooperative)

Universities of Keele, Birmingham, Wolverhampton & Worcester

EMIS & Endeavour Health Charitable Trust

LETC

British Geriatric Society

St Giles Hospice

Palliative Care Solutions

Closing thoughts• You need resources – and not just money• Get your Vision right -> buy-in and cohesion -> ownership• Sell the Vision – internally and externally• Chase the big honey pots; New Models of Care – Primary Care Home (National Contract?) Education & Training PH/Local Authority

Contact details•[email protected]•Mob: 07971245220