HSJ has collated the most comprehensive picture so far of England’s GP networks, federations and super practices.

Our analysis shows four-fifths of clinical commissioning groups have at least one of these organisations operating in their area, and suggests 75 per cent of the population is covered by one.

This article explores:

  • variation in the size of the groups – showing the biggest and smallest;
  • organisations’ geographical spread; 
  • the legal form they take.

The chart below shows the spread in population size of the 178 GP groups for which HSJ has this information. The average is 153,450.

The smallest group identified by HSJ was Dorset based Providence, Strouden and Crescent Surgeries, with a list size of 11,750. The largest, Alexin Healthcare, operates across Staffordshire and south Derbyshire, covering 796,000 patients.

The five biggest groups by patient list size

FederationCCG areaGP practices coveredTotal patient list size
Alexin Healthcare South East Staffordshire and Seisdon Peninsular 93 796,096
Devon Health  Northern, Eastern and Western Devon 74 550,000
Suffolk GP Federation Ipswich and East Suffolk 61 540,000
Principal Medical Nene 56 530,000
Primary Care Sheffield Sheffield 82 500,000


Our analysis shows the majority of CCGs have at least one group within their area. HSJ estimates 75 per cent of the population is covered by a group. However, CCGs in parts of Nottinghamshire, north western Surrey and coastal regions of the North West said none were currently operating on their patch.

Most of the 37 CCGs that said no large scale groups operated in their area told HSJ that closer collaboration between practices was under discussion, or planning was taking place to create them.

A spokesman for Knowsley CCG, in the North West, said: “The CCG’s member practices are implementing a collaborative locality model, which they have been instrumental in developing as part of the CCG’s strategic approach to primary care.

“[This] includes scaling up and investing in primary medical services among others. Inevitably there are conversations taking place among some practices about the potential to establish federations, however at the time of writing the CCG has not been made aware of any being established.”

Several CCGs told HSJ some of their practices operated in local clusters, but not in formal networks or federations. These included North and West Reading and Wokingham CCGs.

Lewisham, Walsall and Nottingham City CCGs were among those which told HSJ new federated bodies or networks were in the planning stages.

GP groups operate in a number of different legal forms. While some are informal networks, others have created companies.

The majority of the 192 GP groups for which HSJ has this information have been created as companies, limited by either guarantee or by share capital.

The chart shows the breakdown:

Phil Yates, chair of the National Association of Provider Organisations, which represents GP federations, and of Bristol based provider GP Care, said limited liability partnerships were an unpopular choice because of tax implications for GP members.

Dr Yates said: “My understanding is that [for an LLP], even if any profit that is made is reinvested in the company, those profits are attributed to individual partners and they become liable for a share of the tax. [This is] singly unpopular with GPs who haven’t seen any dividend or direct benefit.”

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