How GP federations fit the new NHS

The emergence of GP consortia as the latest means of organising the NHS might lead some to think that GP federations have had their day. But the RCGP believes that groups of federated practices still have a prominent role to play in the future NHS.

Dr Maureen Baker: 'Most federations will resist becoming too big because part of the attraction is working with colleagues that you want to work with' (Photograph: James Bolton)

The concept of practices coming together in federations to provide a bigger and better range of services was first suggested by the college in 2007.

Since then, the model has developed as GPs have taken up the idea around the UK.

Effective service delivery
Dr Maureen Baker, the college's lead on federations, says there was nothing in the government's NHS White Paper to prevent GPs coming together in this way.

'There has been no official view on federations and certainly no discouragement.

'Indeed, the concept of working together and involving patients, and the concept of integrated care, seem to fit with the way that the government would like to see primary care develop.

'It could be argued that federations would deliver the White Paper more effectively than individual practices, so I cannot see why there would be any political opposition to them.'

Dr Baker says the federation concept had been informed by the work of GP out-of-hours co-operatives: 'Practices came together in larger entities, provided a service, performed very well, run to very tight budgets and very effectively.

'It made us think that general practices had the skills to come together for the purposes that they decided would be useful.'

The college will shortly be launching a toolkit of advice for practices wanting to explore federated working.

A wide range of models have emerged over the past three years, involving commissioning of services as well as provision.

In health secretary Andrew Lansley's NHS they will only exist as providers, but could possibly focus on GMS and non-GMS services, and work with private companies or compete with them for contracts.

Smaller groupings
With consortia expected to cover 500,000 patients each, federations are likely to involve much smaller groups of practices within a consortium, or crossing the boundaries of different consortia.

'We are reluctant to take a one-size-fits-all view on this. Practices know locally what they need and what works for them and they have to build on their strengths,' said Dr Baker.

'Size will not be as important as it will be for consortia, and I imagine most federations will resist becoming too big because part of the attraction is working with colleagues that you want to work with.'

The GPC has suggested small GP consortia should form 'federations' to manage financial risk.

In guidance issued last month, the GPC said consortia covering populations of less than 500,000 will struggle to manage financial risk.

Consortia are likely to cover populations of between 100,000 and 750,000, the report says. Those at the bottom of this range should federate with neighbouring groups.

Federations of consortia could share services, pool financial risk and benefit from economies of scale, it adds.

Dr Baker believes the benefits of group working include improved services for patients, more effective local organisation, co-ordinated CPD and training and, possibly, research, as well as the streamlining of shared management functions and support staff.

She added: 'I could see a win-win situation for federations and locum GPs, for example. It would be very useful for federations of practices to have an intermittent workforce that they could trust.

'And for locums it would be easier to communicate with one person at a federation than 10 people for 10 different practices. It would also be easier for locums to engage with clinical governance, CPD and peer support.'

She believes the profession will be keen to take on the new challenges ahead, in both federations and consortia.

'Historically GPs have been extremely good at working the system for the benefit of their patients, and this is the next iteration.

'But in this one you could argue that GPs will have more control, and hopefully there will be enough players in the system so that those who do not want involvement on a day-to-day basis will not need to do so.'

Time for action
GPs who are considering forming federations should keep a close eye on political developments, says Dr Baker.

'If colleagues are going to be interested in bidding for work and providing new services they do not want to be late to the party.'

She added: 'It would be sensible to start getting together before consortia have their feet on the ground.

'I would also urge practices to be very proactive in organising their patient voice and public input, for example through their local council.

'It is the government's intention that these people will be driving developments, so practices and federations with good methods of capturing patient and public input are going to be much stronger as a result.

'And the time to be organising that input is now.'

The future of federations


  • Federations are likely to be smaller than consortia, and may cross consortia boundaries.


  • Federations could co-ordinate, research, CPD and training across practices and develop shared management and support staff.


  • Locums, in particular, may benefit from federations by communicating with one federation rather than a large number of practices.
  • Federations may also allow locums to engage more easily clinical governance and peer support.

College backing

  • The RCGP originally proposed the federation model in 2007.
  • The college is now developing a toolkit of advice for practices wanting to explore the benefits of federated working.

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