A third of clinical commissioning groups with control of their primary care budgets plan to fund member GP practices to get them to form federations, HSJ has found

  • Twenty-two out of 63 CCGs with power to incentivise GP practices to federate plan to
  • In 15 CCG areas the majority of practices are already in federations
  • Some commissioners have concerns about conflict of interest

HSJ asked all 63 CCGs that have taken delegated responsibility for general practice in 2015-16 whether they had in place, or plan to introduce, measures to incentivise or facilitate GP practices forming federations.

Encouraging practices to scale up is a priority for NHS England under the new models of care programme.

Among the 60 groups that responded, 22 said they did have plans, while 23 said they did not. In 15 CCG areas, all or a significant majority of practices were already federated (see box below).

Some commissioners that were not incentivising their members said it was due to concerns about conflict of interest.

Which CCGs are incentivising member practices?

CCGs planning to incentivise practices

  • Sunderland
  • North Durham
  • Durham Dales, Easington and Sedgefield
  • East Lancashire
  • Greater Preston
  • Chorley and South Ribble
  • Bradford City
  • Bradford Districts
  • Rotherham
  • Halton
  • Wigan Borough
  • Birmingham CrossCity
  • Sandwell and West Birmingham
  • Rushcliffe
  • Southern Derbyshire
  • East Leicestershire and Rutland
  • Leicester City
  • West Leicestershire
  • Fareham and Gosport
  • South Eastern Hampshire
  • Portsmouth
  • Eastbourne, Hailsham and Seaford

CCGs not planning to incentivise practices

  • Blackpool
  • Fylde and Wyre
  • Calderdale
  • Scarborough and Ryedale
  • Vale of York
  • St Helens
  • Liverpool
  • Knowsley
  • South Warwickshire
  • Dudley
  • Birmingham South and Central
  • Telford and Wrekin
  • Shropshire
  • North Derbyshire
  • Newark and Sherwood
  • Nottingham North and East
  • Nottingham West
  • Nottingham City
  • South West Lincolnshire
  • South Lincolnshire
  • Tower Hamlets
  • High Weald Lewes Havens
  • Oldham

CCGs with most/all practices in federations already

  • Blackburn with Darwin
  • Harrogate and Rural Districts
  • Wakefield
  • Barnsley
  • South Worchestershire
  • Hardwick
  • Mansfield and Ashfield
  • Erewash
  • Castle Point and Rochford
  • Waltham Forest
  • Redbridge
  • Barking and Dagenham
  • Havering
  • West Hampshire
  • Gloucestershire

Among the 21 groups that plan to incentivise federations, Rushcliffe, Fareham and Gosport, and South Eastern Hampshire CCGs have already been selected as a multispeciality community provider (MCP) vanguard sites by NHS England to develop new care models.

In North Durham CCG, practices are expected to sign up to an agreement to “deliver a number of key areas and priorities in order to achieve an agreed level of financial support”, a spokeswoman said, including developing a legal entity and “[providing] assurance that effective and reasonable governance arrangements” are in place. They must also provide an organisational development and business plan over two years, and share the delivery plan for year one with the CCG to “demonstrate federated working”.

Waiting room

Some commissioners were concerned incentivising practices to federate could pose a conflict of interest

She added that practices must “articulate clearly how the federation will engage with its representative practices and other partners” and “actively engage in the development of new models of care”, with the aim of having an MCP in place by the end of year one. Practices also have to agree to “develop and administer a primary care extended access scheme for the frail and elderly population”.

Wigan Borough CCG has introduced “inter-practice referral” of locally commissioned services in areas such as anticoagulation and joint injections to encourage practices to collaborate or subcontract to existing federations.

East Leicestershire and Rutland CCG will pay practices £2.50 per patient to help cover the GP time, management support and costs incurred in establishing federations over two years. This will partly be paid up front. The funding for year one will be paid once surgeries present a plan to the CCG “showing the geography, leadership, visions, objectives and governance”, a spokesman said. For year two it will be paid “on formal legal set up and delivery of the plan”.

Birmingham CrossCity CCG is using an external development partner to help practices develop new models of collaboration, such as corporate partnerships, federations and GP provider companies.

Rotherham CCG “provided some small financial resource” to practices in 2014-15, before it took on delegated primary care responsibility, “to release GP time to support the development of a limited liability partnership” involving its 36 member practices.

However, Vale of York CCG expressed concern that incentivising practices to federate could pose a conflict of interest. “Because of the commercial sensitivities around awarding contracts, the CCG does not feel that it should preferentially incentivise or facilitate the formation of GP federations, which could then bid, against other potential providers, for CCG contracts,” a spokeswoman said.

This story was updated to reflect new information from a clinical commissioning group on 2 July.