Should GP Practices Consider Forming Alliances or Federations?

March 7, 2014

GP Alliance - NEWFederated Working

As part of  group of Practice Managers in our local Clinical Commissioning Group (CCG) we are looking at working federately. There is an acceptance in General Practice that workloads, bureaucracy and stress have reached unacceptable levels so our main purpose to work together is to provide a means of sustainability of general practices and to protect our position in the market place.

The General Practitioners Committee (GPC) recently produced guidance entitled Collaborative Working and GP Alliances and this endeavoured to point out to GPs the opportunities that working collaboratively could bring to practices under the pressure of workload and over burdensome bureaucracy.  This guidance mainly applies to practices in England, but the principles of collaborative alliances and federations can also be applied across the UK.

What is a Federation?

Alliances and federations are broad terms used to describe collective arrangements between two or more parties. They are often established to maximise effective working in the pursuit of one or more common aims. A Federation is exactly what a group of practices want it to be, it can be a loose arrangement with a number of like minded practices or it can be an organisation that has formed a legal entity.  The latter is something that will only be brought about following collaborative working and a desire to take forward a company/organisation, however structured, to deliver/protect services. It is necessary though to have a driver otherwise the federation will not maintain momentum.

How does it work?

As a group of practices we are considering the different skills of Practice Managers and look to undertake pieces of work which will allow all of us to share in it without everyone having to do it.

Examples of avoiding duplication of work at management level are:

  • A manager has particularly good IT skills and a good understanding of the various business rules associated with QoF etc. This manager could design the templates for all practices within the federation to use to ensure excellent data capture, consistency in coding and an excellent mechanism for ensuring all elements of good clinical practice are covered.
  • CQC is a burden in itself but a manager with an interest in clinical governance and quality can develop Standard Operating Procedures (SOPs) for a range of activities that would be within the scope of CQC outcomes and share these with all of the practices for their use, joint training across the practices can facilitate this in a more efficient way.

At the moment managers in all practices are independently doing the same pieces of work; this is not necessary and working together can reduce workload and stress.  As the federation matures, there could be consideration to share back office functions to avoid further costs and duplication.  The GPC document has links on being able to share staff without falling foul of either the Revenue or Employment Law.

Federation Development

The various  models already in place across the country could enable organisations to bid for services as a group and  from a commissioners point of view it is preferable to work with just a few provider organisations rather than multiple individual practices.


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Alison Lowerson

GP Specialist


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