As GP practices are charged with increasingly-pinched budgets in the face of an accelerating ageing population, the discussions around future provision of primary care in the community will continue to rage.
One of the most-obvious choices for transformational change is from the singular, independent GP practice to establishing some form of shared relationship with other practices in the same area.
There are, of course, other options, including horizontal integration with another community-based provider or vertical integration with a hospital, but these are topics for another day.
Commonly, the shared relationship takes one of three routes; practices can become 'super practices', they can become federations, or they can become super practices and also part of a federation.
The ongoing recruitment and retention crisis impacting General Practice is making it ever harder to remain a standalone and viable business, which, in turn, is driving partners to look to the future and what their options might be
The essential difference between the super practice - best exemplified across Birmingham and Sutton Coldfield - comprised of 35 practices, serving 275,000 people, and the GP federation is the fact that a super practice is a full merger. As a result, the practices involved entirely lose their autonomy; they do not get to pick and choose areas they can opt in or out of.
Alternatively, practices that federate have a little more flexibility and can operate largely autonomously as practices, but with a shared common interest. The company that is formed to enable the federation to operate does so independently from the practices day-to-day operation. As a result, if there are areas individual practices want to stay away from they can, but they can still benefit from the advantages working to scale brings retaining a little more freedom.
What is clear is that the time is here and now for all general practices to step back and look ahead three to five years and then act now to try and ensure long-term viability by taking action to federate or merge
List sizes have grown by 28% since 2002, with the number of single-handed practices plummeting, creating its own pressures. This change is now being tackled by practices either merging or becoming federations, giving them a better platform to negotiate contracts with the health economy, partners such as the CCG or foundation trust; or the provision of more-specialist services to its patients; clinical staff with a special interest for example, and more security in planning. According to Pulse magazine, NHS managers have recorded a 500% rise in merger or close requests from practices in England.
The ongoing recruitment and retention crisis impacting General Practice is making it ever harder to remain a standalone and viable business, which, in turn, is driving partners to look to the future and what their options might be.
What is clear is that the time is here and now for all general practices to step back and look ahead three to five years and then act now to try and ensure long-term viability by taking action to federate or merge.
In the end, the difference between super practices and federations comes down to emphasis. Both are trying to achieve the same thing in terms of viability, improved services and a significantly-improved negotiation platform for contracts with NHS partners, community groups, and voluntary services; but with federations individual practices are still able to retain some control over their own destiny.
By Scott McKenzie, NHS management consultant/GP federation specialist.