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Spotlight: GP federation in Exeter

Spotlight: GP federation in Exeter

4 September 2014

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GPs in Exeter have formed a federation to improve services for patients 
As all commissioners and providers of primary care services are aware the health procurement landscape has changed beyond recognition over the last 18 months. In April 2013, commissioning and procurement passed from primary care trusts (PCTs) to clinical commissioning groups (CCGs), local authorities and NHS England area teams. 

GPs in Exeter have formed a federation to improve services for patients 
As all commissioners and providers of primary care services are aware the health procurement landscape has changed beyond recognition over the last 18 months. In April 2013, commissioning and procurement passed from primary care trusts (PCTs) to clinical commissioning groups (CCGs), local authorities and NHS England area teams. 
From April 2014 they were required to comply with European procurement rules and put them out to tender (ITT) or offer them to any qualified provider (AQP). There will be no general practice or NHS exclusivity and individual practices will find it very difficult and costly to comply with the supplier accreditation requirements. 
In Devon all of our commissioners have indicated that all new services will have to be bid for and that over time they would prefer to reduce the number of providers with which they have contracts. 
There are 16 personal medical services (PMS) practices in Exeter, a sub locality of a Northern, Eastern and Western (NEW) Devon CCG. The managers of these Practices work closely together and so were well placed to identify the threats and opportunities the commissioning changes posed. Between July and October 2013 a working group of five practice managers and a GP investigated the options available to us – talking to other GP groups in Devon and around the country, potential provider organisations, local commissioners and Devon local medical committee (LMC). In November representatives of all practices met with Nigel Grinstead of Open Junction and unanimously agreed that with their support we would develop proposals for a GP provider organisation for presentation to GP partners. 
Why federate?
There are many benefits of federating, which include:
 – Providing a vehicle and skills to successfully bid for services – only way for some contracts.
 – Supporting practices in providing high quality services for all our patients.
 – Meet local needs because it is run locally.
 – Protecting GP income streams.
 – Economies of scale in provision.
 – Enabling practices to act and work together.
 – Providing a force to represent practices at board level with other organisations.
 – Enabling practices to influence and even control development of primary care provision, eg. through development of pilots.
Why Exeter?
Exeter is a discrete healthcare market with 148,000 patients living within five miles of the city centre, 16 GP practices with a history of working together and a strong presence of non NHS providers.
Exeter Primary Care Ltd (EPC) will focus on the particular needs of Exeter patients, enhancing our ability to influence the development and delivery of local primary care provision; but with the intention of working with other providers as and when appropriate, for example to bid for contracts that cross discipline or geographical boundaries.
Why a new company?
 It was decided to start EPC as a new company to provide:
 – Limited by share for profit.
 – Any surplus can be returned to practices to use as they think best.
 – ­­No personal risk for partners or practice managers.  
 – No existing liabilities.
 – No due diligence requirements.
 – Support of experienced consultants in development, who provide access to best value advice and resources, including shared learning and proforma documentation.
 – Clear corporate and financial governance, developed by members with advice from specialist lawyers. 
 – Access to corporate Care Quality Commission (CQC) registration, Statement of Compliance for Information Governance (IGSoC), N3 license, initially through partner organisations.
 – Run by and for Exeter practices and their patients.
On 6 February we held an engagement event for all of the GP partners and practice managers of the 16 PMS Exeter practices. More than 50 people attended and all practices were represented. Having heard the rationale and alternatives the working group were given a mandate to form EPC.
The share offer was made in April and all eligible practices signed up. On 2 May 2014 at an extraordinary general meeting the shareholders’ trustees approved the company’s articles of association and business strategy, appointed the accountants and elected the board. EPC, a GP provider organisation owned by the practices of Exeter was formed, enabling us to compete for any primary care services that the commissioners decide to put out to tender.
Who are EPC?
There are 12 members on the executive board, comprised entirely of GPs and practice managers from member practices. It was a conscious decision to have an unusually large board to facilitate involvement and ownership and to share responsibility and workload. It does require good communications to avoid gaps and overlaps, particularly as it is difficult for everyone to meet regularly, but so far it is working well.
The five GPs and seven practice managers have a huge range of skills between them from both healthcare and commercial sectors. These include senior management experience in the NHS and private sector plus specialists in finance, IT and marketing. Our GPs bring a wealth of clinical and organisational knowledge themselves and are building links with their GP colleagues in other member practices.
The CEO of EPC is Elizabeth Deasy, who comes from an NHS hospital management background, where she worked at senior management level both in London and the South West. Elizabeth has worked in general practice since 1993 and thoroughly enjoys the variety and challenges of the changing NHS environment.
Our CMO is Dr Sally Ewings, a GP partner in Exeter with many years’ experience both in Practice and on PCT and CCG committees. A leadership course at Exeter University Business School provided Sally with interesting insights on how we can improve the way the NHS is run and she has been a key influence in the formation and ambitions of EPC. 
We are delighted to have secured the support of Andrew Williamson CBE as our non-executive chair. Andrew has extensive experience in Health and Social Care. He was the Chair of NHS Cornwall and Isles of Scilly PCT until it was disbanded in 2013. Mr Williamson has spent over thirty years working within social services. He was director of Social Services for Devon County Council in 1990 and honorary secretary of the association of directors of social services from 1996 – 1999. In June 1999 Andrew was awarded a CBE in recognition of his services to social work in the UK. In 2000 he was appointed as Chair of North and East Devon Health Authority and in 2002 he joined South West Peninsula Strategic Health Authority as a non-executive director. Andrew continues to work on a consultancy basis for the Ministry of Justice and advises the Minister for Health and social services in the States of Jersey.
The process of recruiting the rest of the non-executive directors is at an early stage and the intention is to appoint people with a commitment to excellent healthcare provision plus skills and experience that complement those of the executive board. It will include a patient representative and we are working with the Exeter Locality Patient Participation Groups  (PPGs) to make this appointment.
What next?
We are aware of at least two services for which specifications are about to be published and we will be looking closely at these to determine whether we can offer a high quality service at a fair and competitive price. 
In the meantime we are working hard to build good relationships with the commissioners and other providers of healthcare for our patients so that we are ready when opportunities arise to work with them to deliver improved or new services. As well as responding to bid invitations we will be seeking to initiate service improvements through our unique understanding of the Exeter healthcare market.

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