Dr Chris Mimnagh: We need to be clear what federations are for

The idea of federations as a panacea for primary care is less clear cut and simple than STPs seem to think, says Dr Chris Mimnagh.

I was reading some STPs the other day, I know that's probably enough to qualify me for early retirement, but some are a good read.

I suspected they would be light on primary care and, whilst a few had reasonable plans and obviously had been written with GP input, most focussed on the gains to be made through secondary care efficiencies - either clinical pathways, back office, or usually both.

The one constant was the idea that primary care at scale meant federation.

The trouble is that's usually where the detail stopped.


Just google it for meaning and the definition outlines the problem.

It means both loss of independence and maintaining independence. It means working together and still working alone. It means something and nothing.

Let me suggest we stop talking about federations without a qualifier.

We should at least get an idea of a federation’s function, be it educational, shared services, shared provision, or super partnership.

In that way, the idea of federation as a panacea for primary care will be understood to be less clear cut and simple than the STPs make out.

Above all it needs be understood that federation is something practices do themselves and not have done to them. Top-down implementation of a federal approach is not going to work, just look at the hunger games for an example of that.

  • Dr Chris Mimnagh is a GP in Liverpool and head of clinical innovation liaison and deployment at The Innovation Agency, the academic health science network for the north-west coast.

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