Practices Working Together

Informal Arrangements

There have always been informal arrangements where practices in a neighbourhood work together to their mutual benefit. This can be simply to provide cover during periods of holiday or sharing staff such as practice managers or practice nurses. Practices have also been grouped together for the purposes of business continuity in the event of a major incident.

Sometimes smaller practices want to take their collaboration with each other to a higher level perhaps with an eye to eventual merger. The LMC is happy to work with practices that want to go down this route.


The concept of practices joining together in a “federated” way is being championed by the Royal College of General Practitioners. The College argues that it is the best way to preserve the GP Practice as the basic unit of care in the health care system whilst allowing for expansion of primary care services to meet patient needs and deliver care closer to home. The College argues that this “organisational development” is essential to meet the challenges of the future.

The College is not definitive on what federation means for general practice, describing it as practices working together in a variety of models, ranging from informal cooperation to formal legal entities, offering an opportunity to meet the clinical needs of patients. Practices could be the normal unit of care but work within a federation of care providers that could include social care. Although practices will be separate entities, by collaborating in federations they may be able to provide enhanced services such as extended chronic disease management and ambulatory care. A key feature is that they will be championed and led by primary care clinicians.

The LMC has produced a discussion paper on the concept of federation. setting out key issues and considerations for practices.

Independent Practitioners Associations

There are currently a number of initiatives being explored to develop independent practitioner associations to provide an extended range of primary care services in local communities. It is argued that such organisations will place practices in a stronger position when competing against external providers for new NHS business. It is generally acknowledged that more care can be provided in a primary care setting than currently but this requires a shift of resources and infrastructure out of secondary care providers.

There are proposals in some of these IPA initiatives to provide centralised back office functions for practices and advise on specialist areas. The LMC is ideally placed to work with such associations to provide specialist advice and support.

Integrated Care Pioneers

A parallel stream of work is being pursued through the Dept. Of Health Integrated Care Pioneers whereby GP practices are being encouraged to link with community services and social care to provide “integrated care organisations accountable for the quality of services they provide”. Added impetus is being given to such models by the removal of local community services from local control to large community or secondary care trusts.

LMC Advice

In challenging economic times practices will have to look to work as efficiently as possible and this may mean sharing resources. Whether this is through a contractual merger, or a more loose federation, or just a simple Memorandum of Understanding is a matter for the practices involved. Often, however, it is better to start with a looser arrangement and as time passes formalise the arrangement as the parties become more comfortable with each other. We would advise against a contractual merger going ahead without a considerable amount of thought. It is far better to have an overarching body that holds more than one contract.

If you are thinking about changing the way you work, and need advice, particularly on contractual matters please do not hesitate to contact us.

Guidance on collaborative GP alliances and federations and sharing staff

The GPs’ Committee has produced guidance for practices considering forming alliances or federations. It gives advice on what practices should explore before taking decisions, possible structural and legal models and provides case studies on the different organisations some GPs have already created.

Related to the guidance on alliances and federations, the GPs’ Committee has also produced advice on sharing staff, including secondments, joint employment, VAT considerations, alternative arrangements and managing change. Both guidance documents can be found on the GP practices pages of the BMA website.