GP federation funding plan unclear, warns expert

NHS England should slow down reform in London and set out more detail on how it would fund proposals to federate practices in the capital, a legal expert has said.

Dr Michelle Drage: GPs should not be coerced into federating (photo: Jason Heath Lancy)
Dr Michelle Drage: GPs should not be coerced into federating (photo: Jason Heath Lancy)

Lawyer Edwina Farrell, who advises practices on partnership and integration agreements, called on commissioners to slow the pace of change following the launch last month of a reform blueprint by NHS England's regional office for London.

Under proposals set out in the reform plan, practices could be forced to federate to expand patient care and offer seven-day services.

NHS England’s report, Transforming Primary Care in London, warned that a growing population and ageing GP workforce meant general practice in the capital was not sustainable.

Officials have said practices could be forced to federate to reduce back-office costs and offer more services such as diagnostics, as well as seven-day primary care services.

But DAC Beachcroft associate Ms Farrell said while the aims of the proposals were good, her clients, particularly small and single-handed practices, were concerned by the pace of change and lack of funding and support.

‘You have GPs being squeezed anyway, they are being asked to think about effective ways of working, they are also being asked to take on more responsibility with the named GP for elderly or frail patients. We are not entirely sure where the investment will come from or the form it will take. We talk a lot about investment in primary care, but the report doesn’t give any inkling as to how that will come about.’

Ms Farrell said the pace of change in primary care should be slowed and GPs given time to consider the various options and models of federation.

‘Practices need the opportunity to explore what they are being asked to provide, to explore with their neighbouring partners and colleagues what they might be able to provide together, and look at whether that can be achieved.’

NHS England, she said, should provide more information, support and training for small practices about the benefits of federation and how they can do it.

‘I think if GPs see they can make savings, they may feel that’s something they want to explore. That’s why I say the pace of change may be an issue. Because a lot of single-handed GPs are trying to operate in the old cottage-style model, they haven’t had time to explore various models of federations,' she said.

Londonwide LMCs chief executive Dr Michelle Drage has backed incentives for practices to federate but warned against coercion.

‘Let’s incentivise practices to work together,' she said last month. ‘Start with what needs to work on the ground. Practices need to be released from the pressures of excessive and inappropriate demand. They need a better supply of community, mental and social services, centred around practices.’

At the launch of its report, NHS England made clear that practices would come under pressure if they did not federate. It is currently conducting a review of premises to identify NHS locations that are under-used and could house practices, or be sold to fund investment in premises.

A spokeswoman for NHS England said: 'General Practice – A Call to Action outlines the potential benefits of practices working together in networks, and there has been widespread support of this from key stakeholders. No practice would be "coerced" into forming networks but there is an emerging case which supports their development. 

'NHS England will be working collaboratively with CCGs to spread learning from areas where networks have been successfully established. We recognise that this development journey does and will require investment. Funding for this needs to come from many places, and NHS England is working with CCGs and others to produce 5 year strategic plans which will be underpinned by investment.'

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