Around half of practices are part of a federation

Around half of practices are part of a federation, according to a Pulse PCN survey.

The survey, run in collaboration with our sister titles Pulse and Management in Practice, found that 48% of the 738 GP partner and practice manager respondents said their practice was part of a federation.

Ben Gowland, director and principal consultant at Ockham Healthcare, said that originally federations were delivering enhanced access after the Prime Minister’s Challenge Fund was announced to help improve access to general practice.

‘This was the main source of their income,’ says Mr Gowland. ‘Then when PCNs came along, federations provided support functions to PCNs (hosting staff, bank accounts etc).’

Mr Gowland added that when responsibility for enhanced access shifted from commissioners to PCNs, that federations started to work for PCNs in the delivery of this, though some PCNs took it ‘in house’.

But now, the main benefit of them is that they are limited companies, whereas PCNs who have not incorporated are not.

‘This allows practices to sidestep the liability issues of PCNs,’ he added.

However, last week, it was revealed that a quarter of PCNs have now formed a company.

Ruth Rankine, director of primary care at NHS Confederation, said that GP federations provide a ‘valuable function of at-scale general practice’.

‘Not only do they support general practices and PCNs, they also enable many services to be delivered at a bigger scale, so are perfectly placed to address variation and support population health, pooling the resources of their members to create a more efficient centrally-managed service,’ she said.

‘The federation model can also help reduce duplication and support the growth of primary care infrastructure, coordinating service delivery at pace and a round-the-clock primary care service that is fully integrated with member practices. We saw a real strength of this approach during the pandemic and in the delivery of the Covid-19 vaccination programme.’

She added that though they pre-date PCNs, many have provided a ‘useful infrastructure’ to support PCNs and they can reduce the ‘operational burden’ on networks and allow services to benefit from economies of scale.

‘Federations and PCNs are not and should not be in competition with each other,’ said Ms Rankine. ‘Both have a valuable role to play in supporting patients to access general practice as well as contributing to a wider system agenda to support the organisation and delivery of neighbourhood health and a shift of care closer to the community.

‘Many are working together to develop primary care collaborative arrangements, not just around general practice but to encompass wider primary care – community pharmacy, dentistry, optometry and audiology. This is a good model for the future as a means to strengthen the role of primary care in the system.’

Mr Gowland added that in practice, these relationships look different across the primary care system.

‘In some places (not all) PCN clinical directors (CDs) form the Board of the federation, so that they can directly control what the at-scale entity is doing for the PCNs,’ he said. ‘But often CDs don’t have the time, so those running federations and those running PCNs tend to be different people, although by now most federations have at least some PCN representation on their boards.

 ‘Some federations still deliver some other contracts (ie not just enhanced access), mainly directly from contracts awarded by commissioners. These tend to be contracts still going from pre-PCNs.  In a very small minority of places the federations even run out of hours.’

He added that in some areas federations operate as the ‘route’ by which all PCNs have a voice into place-based partnerships. But in others, both PCNs and federations will attend system meetings.

‘There is no common way of feds being organised, particularly in relation to PCNs, as federations generally existed pre-PCNs and have since had to adapt and evolve and find a way of making things work locally,’ he said.  

‘Obviously, the next opportunity for federations might be in the potential to hold the “integrator” function for the integrated neighbourhood teams (INTs), as referenced originally in the Fuller report, for an organisation operating at a bigger scale than any individual PCN.’

A recent report suggested that the GP contract needs to provide a more ‘flexible approach’ to developing new models of care in order to help the formation of INTs. 

This survey was run with our sister titles Pulse and Management in Practice and was open between 19 September and 18 October 2024, collating responses using the SurveyMonkey tool. After removing duplicate entries from the same practice, GP partners and practice managers from a total of 738 GP practices in England responded to these questions. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a £200 John Lewis voucher as an incentive to complete the survey. The survey was unweighted, and we do not claim this to be scientific – only a snapshot of the GP and practice manager population.