Should our Federation become a SuperPractice?

14 November, 2016

In theory it is easier to form and run a SuperPractice than a Federation.   All you have to do is get all the participants to sign a partnership deed, and then it is like running any other practice.


But that is just a theory! There are a number of obstacles to overcome before practices merge, and the more that there are to merge, the more the obstacles.  The reason is that every practice operates differently, and so there has to be a real willingness to compromise if you want your practice to merge, and to be able to adapt to different ways of doing things.  Once that happens, the solutions follow, but get advice early to identify the issues and ensure that the willingness extends far enough to resolve them, or an alternative solution is found.


It is not just the partners who have to work together, and get used to being in a much larger organisation, it is also the staff and IT programmes which have to get on together!


There is also the question of the premises – who is going to own them and are they wanted. What if it is proposed to turn one of the premises 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 GMS and PMS contracts into one contract as it is probable that all the contracts would have to go out to tender. Also it is quite possible that you will not receive a GMS contract or PMS contract, but an APMS or one of the “new style” NHS contracts instead. Therefore to keep the benefits of GMS and PMS contracts you may end up with a number of contracts but they can all be managed centrally. In fact it is beneficial for the current Commissioner to have a number of contracts managed by one contractor and therefore they are likely to help you to move towards a single merged contract over time.


Given the great change a merger brings, it may be a wise first step to form an alliance and then a federation to start with, where you can learn to start the process of working together. You may find that some practices are too different and decide to drop out, with the like-minded ones moving forward.


According to the Nuffield Trust[1], almost ¾ of general practices are now in some form of collaboration with other practices, and half of those formed during 2014/15. The two commonest reasons for forming were to “achieve efficiencies” and “offer extended services in primary care”.


Working together is not always easy. Forming a federation is a sensible first step, even though it is unlikely ever to have the efficiency and effectiveness of a single organisation to which everybody is wholeheartedly committed.


If you have any questions, please contact Justin Cumberlege on or +44 (0)1732 224 107.


This article first appeared in the Best Practice Show 2016 guide.

[1] Rebecca Rosen et al (2016) Is bigger better? Lessons for large-scale general practice Nuffield Trust