Should our Federation become a SuperPractice?
Justin Cumberlege, a healthcare specialist at law firm Cripps, looks at the reality of establishing a SuperPractice.
In theory it is easier to form and run a SuperPractice than a Federation. All you have to do is to get all participants to sign a partnership deed, and then it is like running any other practice.
In reality there are a number of obstacles to overcome before the GP practices merge, and the more practices there are to merge, the more obstacles there are.
The reason for this is because every practice operates differently, meaning there has to be a real willingness to compromise and adapt to different ways of doing things if the merger is to happen successfully. Once this happens the solutions will follow, but early advice is vital to identify the issues and ensure the willingness to resolve them – or find an alternative solution – is there.
The merger is also about more than the GPs working together: the staff also have to be able to work together well in the larger organisation, as do the IT systems.
When it comes to premises, there are further questions: Who is going to own them and are they all still wanted? What if one of the premises is turned into a hub? Who will own the new property and receive the rents?
You probably cannot merge the contracts without strong backing from NHS England and the Commissioner. It can be a high risk strategy to attempt to bring all your General Medical Services (GMS) and Personal Medical Services (PMS) contracts into one, as they would probably all have to go out to tender. It is also possible you will no longer receive a GMS or PMS contract, but an Alternative Provider Medical Services contract (APMS) or one of the ‘new style’ NHS contracts instead, which don’t have the same security.
Therefore, to keep the benefits of GMS and PMS contracts you may end up with a number of contracts that are managed centrally. It is actually beneficial for the Commissioner to have a number of contracts managed by one contractor, and so they are likely to help you to move towards a single merged contract over time.
Almost three quarters of GP surgeries are now part of some form of collaboration with other practices, with half of those formed in 2014/15. The two commonest reasons for forming were to ‘achieve efficiencies’ and ‘offer extended services in primary care’.
Given the great change a merger brings, it may be a wise first step for the GP practices to form an alliance, then a Federation, as this will allow you to learn as you start the process of working together. Should some practices find they are too different, it allows them to drop out, with the like-minded ones moving forward.
Working together is not always easy, so forming a Federation is a sensible first step even though it is unlikely to have the efficiency and effectiveness of a single organisation to which everybody is wholeheartedly committed.
First published in Practice Management, May 2017.