Building a successful GP federation – top five questions

16 May, 2016

Many GP federations have formed in recent years. Some have been enormously successful, gaining the advantage over other healthcare providers, and others are winning contracts and helping to retain GP incomes. However for many, since forming a company, not much has happened to change the way primary healthcare is delivered or which benefits the GP practices.  


So how do you make a difference? Through my experience working with pioneers and forerunners of federations, I have identified the following questions that I would expect a federation to be able to answer confidently.


1.  Why do you want to form a federation?

An essential part of setting up a federation is understanding what you want to achieve. Visualise what it will be like for a patient in your area in five years’ time if the federation is running healthcare services. Then work out how you can achieve that, or at least some of it.


2.  Is the reach of the combined practices wide enough?

You will need to be able to cover a sufficient population to be a credible contender to provide some of the services.


3.  Have you got membership buy-in?

Few federations have thrived where one or two people have done everything and expected everyone else to follow. The demands on time and initial lack of funding mean that it is a truly joint effort in which many people must participate actively, playing to their strengths. Practices with a similar ethos find working together a great benefit. You may have to consider going ahead without all practices being on board at the start.


4.  Is the board strong and suitably skilled for the task at hand?

A federation is more than just a GP practice on a larger scale. Knowing the role of the board is important. The people that put their hands up to join it aren’t necessarily the right people for the job. Do GPs have the skills? Think about how other companies operate. For instance, Boots is a chemist, yet years ago it stopped being run by pharmacists. You should look for people to sit on the board (even if only part time) who will bring a fresh perspective and be innovative.


5.  Is your structure robust?

Good governance ensures everyone knows what they are doing, instils purpose and confidence, and creates efficiencies. It avoids duplications, re-work and wasted resources. Ensuring your constitution and rules are pertinent and aligned to the culture of the company will provide the foundation on which to build the organisation.

There is no simple formula that fits all – and there are many more things to consider – but there are certainly ways of ensuring you are starting off in the right direction. Having prepared the ground, your federation should be on track to thrive.


Justin Cumberlege is a partner in our healthcare team and has particular expertise with GP federations. Contact him at or call 01732 224027.