GP Federations

Introduction

To provide the best possible healthcare for the people we serve, it is essential that GP Federations attract and retain staff who are appropriately qualified, professional in the service they deliver, happy and productive in their work and committed to lifelong learning and developing in their role.

This information pack is designed to provide you with a brief overview of the role of GP Federations and the terms and conditions of employment within GP Federations and information which should assist you in the completion of your application form.

Thank you for your interest in applying for a position within GP Federations and we look forward to receiving your application.

Northern Ireland GP Federations

Evidence from both the Royal College of GPs and the Kings Fund points to the fact that it is vital that GP federations, are uniquely placed at the centre of the primary care arena, and that they can pave the way for greatly improving quality standards and accessibility to care.

GP Federations not only provide better outcomes for patients but will also result in significant and sustainable efficiencies for the service.

As well as this priority objective, Federations will act as a catalyst for better outcomes in the other major strategic objectives of our service namely; GMS PLUS/SHIFT LEFT/TYC/Donaldson/GP recruitment/Federation alignment to trusts and other key stakeholders/out of hours/7 day working/potential gains/improved efficiency/better patient outcomes/sustainability/reform.

In Northern Ireland, the creation of the federation model has been both led and funded by GPs themselves.

Key Components of the Northern Ireland GP Federation Model

  • An average size of a GP federation is circa 100,000 patients with 20
  • practices.
  • Their boundaries are in line with the current boundaries for Integrated Care Partnerships.
  • Each Federation has been established as a Community Interest Company
  • Limited by Guarantee in the not for profit sector.
  • Currently there are 17 Federations incorporated covering 1.8 million of a patient population.
  • Northern Ireland is the only part of the United Kingdom that has a unified model of Federations governed by a unified Members Agreement covering its entire population.

Governance arrangements are as outlined in Fig 1.

gp-federations

Within this organisational model the GP practice is sovereign with the number of “Member Directors” being one per practice. Member Directors have formed a Members’ Committee in which the major governance authority of the organisation in vested. The Members’ Committee have the authority to appoint “Directors” in line with the rules of the Members Agreement. It is these Directors that form the “Board of Directors” who are charged within the delegated authority of the members to take responsibility for the managing of their own Federation.

The Federations exist in the following locations:

  • Belfast: North, South, East, West.
  • South East: North Down, Down, Lisburn, Ards
  • Western: Derry, South West
  • Southern: Armagh & Dungannon, Craigavon, Newry & District
  • Northern: Causeway, East Antrim, Mid Ulster, Antrim & Ballymena

The Southern Federation Support Unit (FSU), is a community interest company and has the following organisational attributes:

  • CIC Company in the Not for Profit Sector.
  • The company is “owned” on a share basis by each of its constituent federation membership (companies); this eliminates the necessity for individual named members.
  • Any surplus created by the FSU will be reinvested in the shareholder’s federations for the good of the community they serve locally or by agreement can be used for wider projects of greater scope.
  • The creation of the company is governed by a shareholder’s agreement giving “exclusive rights” to the shareholders.
  • The shareholder’s agreement has sufficient flexibility to allow if required for an extension of membership.
  • The FSU will have a recognised management structure employed by  the FSU.
    The FSU has been designed to provide federation members with excellent, affordable support initially in the provision arena. Some examples of a FSU functions include: central management expertise and specialists, planning, accounting, contracting, communication both internal and external and human resources. It is envisaged that the FSU will outsource as many of these services as possible.
    The core purpose therefore of the FSU is to ensure that clinicians are “Free to focus on ensuring they provide the best clinical outcomes for their patients while improving the quality of care patients receive”
  • GP Federations are groups of practices who have come together to help each other provide services for patients in a more efficient way. They can do this by:

1) Compete and apply for central funding which they can spend on new and innovative ways. Eg: practice based pharmacists.

2) Come together as a block group which helps create savings by purchasing at scale. Examples of this in Southern Area are: recent payroll software/accountancy services, waste management and potentially the purchase of phone lines/contracts.

3) Power to work to rule as a group. ie: if secondary care wishes GPs to perform certain tasks it is easier for us as a block group to say “no”.

Public money cannot be spent without accountability.

Unfortunately this creates a layer of beurocracy which becomes very inefficient and difficult to get round. The endless additional services (LES and DES) end up being seen by GPs as a chore and more time is spent justifying why the services were put there in the first place.

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