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GP federations: The silent partner in the NHS’s response to Covid and a key building block for future primary care strategy


By Fiona Adamson and Dr Andy Hilton
21 June 2021

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It’s high time GP federations are acknowledged for what they bring to the primary care table, argue Fiona Adamson and Andy Hilton from the NHS Confederation’s Primary Care Federation Network

We are emerging from the biggest health crisis of our generation, but the real challenge facing primary care has barely begun. Rocketing demand for services, a weary workforce, confused national policy, and the true impact of the pandemic on the nation’s health and well-being are yet to be determined, leading to a daunting and seemingly impossible task for the sector.

Primary care has proved its mettle more than ever before over the past year. It has transformed at rapid pace to meet the needs of its local communities at a time of uncertainty, forging new relationships and innovating on a scale that, pre-Covid, would have been deemed inconceivable. The mass vaccination programme, in particular, has been the shining example of success and a testament of the possibilities of economies of scale.

We are at a critical juncture in both how and where patients choose to access healthcare and in how these services are configured and work with one another locally to deliver. The learnings from the pandemic must be realised as the NHS navigates through these murky waters and as integrated care systems are to be put on statutory footing through the imminent Health and Care Bill where it is vital that primary care has a voice.

Perhaps seen as a silent partner in the national discourse on how the NHS has adapted and responded to coronavirus, GP federations have been an integral component of its achievements. Whether that has been in supporting coronavirus testing for primary and community staff, providing ‘hot’ and ‘cold’ Covid hub sites, delivering home-visiting services for those who were shielding, coordinating and bulk-ordering PPE, or building practice resilience by supporting vaccination efforts, federations have been an essential bedrock for the sector.

Alongside their individual practices and primary care networks, they have brought direct benefits to patients and commissioners and have created a more efficient use of existing resources. Their management capacity, scale, and system-level engagement have offered practices and PCNs a supportive infrastructure in managing an integrated response across primary care and with local partners.

As we begin to recover from the pandemic and influence future primary care strategy, the NHS Confederation has launched a new network for leaders of GP federations to give them a collective voice in the wider health and care system. Its Primary Care Federation Network will support federations to work collaboratively with PCNs and other local partners to provide better-integrated, innovative, and responsive care for patients, to reduce health inequalities and improve the health of the local population.

At neighbourhood level, through their infrastructure and scale, federations can facilitate PCNs to work in an integrated way with their partner organisations to deliver improved population health outcomes and start to tackle health inequalities. At ‘place’ level, federations can offer a unified voice for primary care, developing population-based strategies, coordinating service delivery, providing governance and assurance, and sharing innovation and best practice. They are uniquely placed to coordinate a 24/7 primary care service that is fully integrated with member practices delivering care in hours and, also with wider system partners, potentially being accountable for enhanced primary care delivery on behalf of the integrated system.

If primary care is to have a fighting chance of overcoming the challenges it faces, these interdependent layers of scale must be recognised. As integral constituents of their ICSs, it’s time for GP federations to have greater recognition as we shape the development and delivery of these new models of primary care for our patients, while making the most of our multidisciplinary teams and protecting staff welfare.

Fiona Adamson is chief executive of Hartlepool and Stockton Health and chair of the NHS Confederation’s Primary Care Federation Network

Dr Andy Hilton is a GP, chief executive of Primary Care Sheffield and vice-chair of the NHS Confederation’s Primary Care Federation Network.

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