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Will Marlborough area GPs form a ‘federation’ of practices?

Marlborough Medical PracticeMarlborough Medical PracticeGPs in the Marlborough area have been discussing whether they should link together to form a ‘federation’ of practices.  

In the May issue of Great Bedwyn Parish News, Dr Tim Ballard ends his column with these words: “On a local level our five local practices have been involved in discussions about joining together in a federation.  More of that in June…”

Marlborough Medical Practice has acknowledged that there have been ‘informal discussions around the local practices working together more closely’:  “Marlborough Medical Practice would look to be involved in any such scheme.  But there are no specific plans and certainly no timetable for anything to happen.”  

It is assumed that the five practices in these discussions are the members of the east section of Wiltshire Clinical Commissioning Group’s (CCG) NEW (for North and East Wiltshire) Group: Marlborough, Great Bedwyn, Pewsey, Burbage and Ramsbury.

These informal discussions stem from NEW Group’s constitution where the Group’s aim is stated as being: “To co-ordinate working between GP practices in and around the Group area and thereby extend and enhance the clinical services jointly provided and commissioned by these practices to the local population.”

Whether these informal discussions will lead to a formal ‘federation’ is now a matter only for speculation.

The idea of GP federations were first proposed in 2007 and now sometimes goes under the jargon name of ‘family care networks’.  

But they have been given fresh impetus by the widely accepted policy that offering more care and treatment closer to home – rather than in hospitals – is the answer to better care, especially necessary for the ageing population and for declining budgets.

Federation may also be becoming popular because of the declining amount of NHS money going to GPs.  In 2013 the King’s Fund, Britain’s pre-eminent health think tank, published a report on these ‘networks’.  

One of its authors, Chris Ham, wrote: “At a time when NHS budgets are increasingly under pressure and the proportion spent on general practice is in decline, these proposals could bring money into general practice if GPs take responsibility for providing and co-ordinating a wider range of services.”

An article last month in the British Medical Journal stated baldly that “…GPs cannot deliver modern services without a bigger footprint. Merging with other practices is unattractive, so the alternative is to form networks or federations, shedding some independence in order to gain weight.”

In April fifty GP practices across Shropshire launched the country’s first GP Federation in a bid to save money and improve patient care on the back of economies of scale and shared admin costs.

Shropshire's formal federation intends to bid for local services put out to tender by clinical commissioning groups and if successful the federation would offer such services to all its practices.

This obviously involves conflicts of interest. GPs run the Clinical Commissioning Group which puts services out to tender, the GPs’ federation bids for the services and the GPs in the CCG decide who gets the contract.

You would need a ‘Chinese wall’ the size of the Wall of China to convince the public something funny wasn’t going on.

The other problem is that formal federation may not be a ‘one-cap-fits-all’ solution.  If the clinical and financial risks for federations demand populations of between 25,000 and 100,000 as the King’s Fund believes, they may suit urban rather than rural areas.

The Shropshire federation obviously goes much further than the intent in the Marlborough area for practices ‘to work more closely together’.

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