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'Think like a company' - Federation leader who got London GPS back in business
4 July 2018
Necessity has proved a very fruitful mother of invention for GPs in a particularly diverse area of inner London.
Faced with local health and public health commissioners seeking to contract with a single organisation in 2014, the City and Hackney Local Medical Committee’s then chair, Dr Deborah Colvin, toured the area’s practices to build support for a GP federation.
Today, Colvin chairs the City & Hackney GP Confederation CIC. The organisation has won a string of contracts which has produced additional income for its member practices, improved access and seen City and Hackney Clinical Commissioning Group (CCG) transform performance against key Quality and Outcomes Framework (QOF) indicators (see box).
Federation chief executive Laura Sharpe says that those successes are part of a wider cultural transformation.
“We have been really successful in securing work. Indeed, people come to us now more and more and we are seen as the place to discuss primary care development ideas. We have 100% population coverage so if a practice does not want to provide a particular service that is fine but we tell them that we have a duty to makeit available to their patients through another practice – or, occasionally, by providing it ourselves. From a commissioning point of view that is amazing because they can commission for an equitable service across all practices.”
Although by no means the first GP federation, Sharpe and her colleagues faced the challenge of developing a structure, constitution and ethos for an organisation whose very nature was a novelty to its GP members and stakeholders.
“The main challenge is to think like a company rather than the NHS. Our first decision was our ethos about profit.
We are now a community interest company but we are not averse to making a profit which goes back into patient care and service development.
That was a very overt first principle discussed with our member practices early on.”
Such thinking permeated decisionmaking on other issues – including the make-up of the board.
“We proposed a GP chair and a GP majority – after all the GP partners are our shareholders – but we also wanted the voice of practice management and practice nursing on the board, as
well as lay input and specialist finance input.
“We had to be very clear from the beginning that how we assess payments to practices was robust and free of conflict. Our finance director chairs both our audit committee and ultimately they are in charge of payments to practices after reviewing all practice performance at the end of each year. Our GP board members are nowhere near those decisions.”
Sharpe is one of four executive level employees, each of whom works three days a week. There are five other staff, including a business development manager, a contract manager and a
practice support manager.
The constitutional and structural niceties sorted, Sharpe and her colleagues started winning contracts from both the CCG and the London borough of Hackney before running
into what, at times, seemed like a brick wall in the form of the NHS pension scheme.
Much of the organisation’s paperwork had to be re-done after it was discovered that by allowing four ‘corporate’ practices to be shareholders the organisation had effectively barred
its employees from membership of the scheme.
“We had to ask those practices to resign as shareholders – although they remain members and have full access to our contracts,” Sharpe explains.
Almost simultaneously, the federation realised that the income practices receive through the federation’s contracts was not pensionable.
This time the federation, working with solicitor Hempsons, took on the law and won.
“We lobbied NHS England after persuading the practices to give us a year to sort it. We threatened a very public closure of our organisation and eventually they actually changed the
NHS pensions regulations.”
With such painful teething problems behind them, the confederation returned to winning contracts and supporting member practices to deliver them.
“We needed to prove that we could deliver. Our role supporting and advising practices can be culturally tricky because it is not what they are used to doing. We do it in a supportive
way so they see us as part of the primary care landscape and on their side – which of course we are.”
However, despite having secured a change in the law and won and delivered on many contracts, Sharpe and her colleagues know that in today’s NHS, change is a constant.
“The GP confederation is currently the right thing for the City and Hackney.
However, we are now starting to work with our practices around the 30,000 to 50,000 population models and I can see that things will change. They are willing to be guided by us about how
to stay strong and viable to provide an excellent quality and wide range of services to their patients.”
QOF health gains: City and Hackney national ranking
anticoagulants 29 2
CHD BP control 35 1
CHD BP control 35 1
BP control 128 1
Stroke BP 50 1
control 78 1
cholesterol control 30 2
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