Introduction
As a network of federations, the Primary Care Federation Network prides itself in the range of support and services it offers primary care and the wider system. We are at-scale primary care providers, routed in the NHS and our local populations. As networks of GP practices and primary care networks (PCNs), we can have different names including alliances and networks of networks. We use our knowledge of the primary care landscape, our relationship with practices, PCNs and other system partners and our ability to quickly mobilise to meet emergency demand to deliver and improve care for our location populations.
As most federations have developed organically, so too have the services and support they offer. This means that not all federations look the same and the services they offer differ based on local need.
To help provide a better picture of what federations are doing, we have developed this directory. The directory offers a snapshot of the services federations are delivering across the country, from extended access and developing primary care collaboratives to elective care redesign and education and training. This live resource will help you better understand what federations do and how these services add value to the system and improve care. The directory also aims to show the art of the possible for federations that are growing and diversifying their offer to the system.
We encourage you to look through this document. Do get in touch if you have any questions about the case studies, or if you have another service to add to the directory.
The role of federations in the primary care system
As integrated care systems grow, collaboration between primary care providers and their wider system partners is growing too. Many primary care providers are taking advantage of the independent layers of scale to deliver for patients, reducing duplication, improving equity of access and delivering the right care at the right time in the right place. There is not a one-size-fits-all model and there is still a long way to go for many primary care providers. But we are beginning to see robust primary care systems that benefit from the different expertise and opportunities available at neighbourhood, place and system.
As providers at place and system, PCNs, federations and networks of networks are important if care is to be delivered at the appropriate scale. Federations are working to create the at-scale provider infrastructure to allow general practice and primary care to flourish, either through direct delivery or through the support of members. They are working to ensure primary care takes advantage of the unique offer provided at neighborhood, place and system. This document gives some insight into how this is working in practice.
Directory list
These are examples of services that federations can provide, but this may not be appropriate to all systems.
Enhanced services
Delivering services at scale that integrate at the interface between core GP and wider NHS and social care provision, aligning to place partnership and ICS objectives and the integration of secondary care, social care and communities with primary care team.
Extended access
Federations offer additional out-of-hours capacity in their locality. Providing extended access above neighbourhood-level improves equity of access across a place and reduces pressure on practices.
These services are not only integrated with core general practice, but also provide wider-system resilience and reduce pressure on A&E departments and other parts of the urgent care system. Through their scale, federations are best placed to bridge the gap between continuity of care in-hours and access to urgent primary care 24/7. Some federation are connecting extended access, out-of-hours services, urgent and intermediate care. Examples of these services are also included in this directory.
Improving access for vulnerable communities
Improving access to primary care continues to be a top priority for the health and care system. Unfortunately, when demand increases in primary care and accessing services becomes more difficult, it is often the most vulnerable in society that are impacted the most.
Federations are able to provide tailored access schemes at scale to help target vulnerable communities and support practices to develop services specific to local need and work with system partners to provide an approach that ensures every contact counts, with numerous services, healthcare checks and support options available at one time.
Supporting elective recovery
Cross-system integration is vital to managing the elective backlog and recovery. Primary care has an important gatekeeper role and supports large lists of waiters to ‘wait well’. Working alongside system partners, federations are also helping to redesign and deliver integrated services that reduce waiting times and improve care pathways. This includes, but is not limited to, cardiology, dermatology, general surgery, gynaecology, audiology, orthopaedic and pain management.
Using existing relationships between federations and secondary care has helped create more joined-up care with stronger integration of strategies, services and staff, which is essential to the COVID-19 recovery.
Integrated urgent care
Many federations are working with their local system partners to create an integrated urgent care service which brings together local primary care services with urgent care and therefore helps to develop stronger care pathways.
Federations are able to bridge the gap between primary and secondary care by working with practices and PCNs to ensure primary care collaboration; using their insight to help develop streamlined clinical pathways to improve patient experience and offer clinical leadership for both strategic and operational elements of services. This helps to improve patient access, takes pressure off other areas of the system and helps ensure every contact counts.
Ambulatory ECG service
Federations are enabling GPs to directly access ambulatory ECG monitoring within a neighbourhood area. By delivering this at scale, federations can centrally manage referrals across PCNs and determine best use of staffing resources to support the delivery across a bigger area.
In addition to managing staff, federations often manage their own estates across each PCN, and are able to determine where patients would benefit from accessing a central hub managed by the federation, making efficient use of estates and staff.
Social prescribing link worker service
Federations are working with system partners to deliver integrated social prescribing services, which helps to tackle many of the underlying issues that can result in a person accessing primary care. Social prescribers are embedded within PCNs to empower people to take control of their health and wellbeing. They give time to focus on what matters to patients and help to build trusted relationships with people to create a shared personalised care and support plan, connecting them to local, diverse and culturally appropriate community groups, voluntary, community and social enterprise (VCSE) organisations and services.
Federations are able to deliver this at scale across numerous PCNs and practices and create opportunities to have a diverse range of health and wellbeing groups based on local interest.
Health checks
NHS health checks can be delivered at scale by federations to enable primary care locally to target bigger populations and provide this important screening and early intervention services to groups with different needs while reducing pressure on practices.
The federations are supporting practices to deliver the service and offer equity of access across place.
Supporting the vaccination programme
Federations have played a vital role in the COVID-19 vaccination programme, often leading the programme on behalf of their local area, setting up vaccination centres at short notice and offering workforce support and solutions. This involvement has enabled local systems to benefit from at-scale service delivery and reduce pressures and risk on other primary care providers.
Federations’ role included:
- Facilitating greater collaboration
- Using established partnerships at all levels to deliver a coordinated programme.
- Helping to bring together a collective voice for primary care to engage with others in the system.
- Using the expertise of the local system to truly understand patients and local community need for vaccination uptake.
- Providing workforce solutions
- Providing logistical support for the hosting of workforce and volunteers.
- Recruiting and training volunteer workforce.
- Reducing workload pressures on PCN and practice staff.
- Supporting PCNs and practices
- Providing back-office infrastructure including data capture, finance and HR.
- Supporting business-as-usual services to reduce pressure on PCNs and practices.
- Offering communications and publicity support to encourage vaccination uptake.
- Finding innovative ways to target local communities
- Coordinating and delivering at-home vaccinations for practices.
- Integrating systems and introducing new software to plan routes that increase efficiency and time to care.
- Coordinating managing pop-ups vaccination clinics and vaccination buses in areas with low uptake.
COVID-19 PCR testing service
Federations have developed PCR testing services for their local communities to help quickly respond to pandemic demand. They have worked with the volunteer and community sector to build infrastructures and workforce and also to ensure vulnerable adults and children has access to at-home services.
Supporting primary care
Back-office support for practices and PCNs
Practices and PCNs are small provider units that do not always have the business support and human resource capacity of larger organisation’s. Federations offer services to their members to reduce administrative pressures on staff, this includes HR, finance, training, communication and data sharing support. As federations operate at a larger scale, they are able to offer business expertise, reduce duplication and mitigate financial risks.
They are responsive to the changing needs of their practices and PCNs. As PCNs grow and mature and as patient needs change, federations can be a contact point for practical guidance, support and to help test new ideas, develop business cases, and manage projects.
These support packages make local primary care systems more efficient, resilient and cost effective. Freeing up capacity so PCNs and practices can focus more on service delivery, improving population health and reducing inequalities.
Data sharing and system synchronization
Integration across practices is key to the success of PCNs however without the infrastructure to support this, practices can find it difficult to build relationships and collaborate.
While there remains a need for national-level support and funding, federations are working with practices to improve digital capabilities to enable better integration. Alongside digital partners, they support practices and PCNs so their systems are able to ‘talk to each other’ and share data where appropriate. Federations help train staff to use new systems and provide any additional support needed.
HR support
Federations offer employment support to practices and PCNs, this includes developing job specifications, recruitment tools, supporting interview processes, managing the onboarding and HR requirement of employing staff and even completing hosting roles for PCNs and practices.
Federations can support multiple PCNs and practices with similar issues, preventing duplication of resources. They work closely with primary care leaders to provide impartial advice, guidance, and support to improve their local primary care workforce now and in the future.
Communications support
It is important for PCNs and practices to be able to engage with their local communities and patient populations. Good communication allows primary care teams to, for example, keep their patients up to date with new services, help patients feel connected with their local practice staff and, particularly during COVID-19, helps inform patients quickly and clearly about changes to services such as location, safety precautions. A good communication and online presence for a practice or PCN also helps improve recruitment processes as jobs can be advertised to a wider audience. While primary care teams often see the value of good communications this can be time consuming. Some newly formed PCNs also find it difficult to know where to start as there is such a variety of communication channels and opportunities available locally. Federations provide education and training, communication toolkits and resources and many have communication leads within their own organisation to support primary care teams.
This support can help reduce workload pressure, build confidence and ensure patients are receiving up to date and relevant information from their care providers.
Using data to optimise service delivery
Across the health and care system, local intelligence is vital to understand and optimise how, where, why and when care is being delivered. It is more complex to capture data within primary care, compared to other parts of the system however good quality data informs service planning. This will be more important than ever as we move into integrated care systems.
Due to their scale and expertise, federations are able to conduct research across place and system to help provide a better picture of what is happening across primary care services. They work with their members to improve local intelligence, use evidence to fuel local innovation and help future proof their local primary care systems.
Workforce
Hosting training hubs
Training hubs deliver training, education and workforce development projects to support recruitment, retention, and upskilling of the primary care workforce. Working with partners, training hubs hosted by federations facilitate placements, support education programme development, deliver workforce projects, enable resource sharing and empower practices to consider their own workforce and skill-mix needs.
Training hubs hosted by federations have a local focus while also reflecting wider system workforce priorities. As networks of networks, federations are well placed to support and plan for the introduction of new roles within primary care, particularly those being introduced as part of the Additional Roles Reimbursement Scheme (ARRS). PCNs and practices can feel confident that their local workforce needs are not being overlooked by top-down structures and therefore they are able to focus on care delivery and patient need.
Multidisciplinary teams and ARRS support
Primary care offers more than a single approach to patient care, and this is reflected in the teams that deliver it. The future of primary care requires multidisciplinary teams (MDTs) with diverse skills, experiences and expertise. The Additional Roles Reimbursement Scheme (ARRS) helps supports PCNs to increase their non-GP workforce. As set out in the ARRS guidance, each PCN is allocated an Additional Roles Reimbursement sum, based upon the PCN’s weighted population share. PCNs can recruit from within the reimbursable roles as they require to support delivery of the network contract DES.
For the average PCN this means around an additional seven full-time equivalent staff. This offers significant opportunities for PCNs but does not come without its strategic and operational challenges. PCNs have found it challenging to recruit into ARRS roles, have highlighted issues with supporting and retaining staff and have found hosting staff across a number of practices challenging.
Federations help PCNs grow multidisciplinary teams through ARRS roles by hosting roles within the larger federation structure. This means staff can be supported, deliver services at a bigger scale and still support service delivery at practice level. They also help PCNs to maximise the benefits of the ARRS by working with PCN leaders to identify workforce needs and support MDT workforce planning.
Federations help primary care make the best use of ARRS roles, helping to improve services for practices, PCNs, systems and most importantly patients.
Additional training and education packages
Federations provide a variety of education and training packages to their PCNs and practices based on local need. Packages are developed by working closely with primary care team leaders to help understand current need and longer-term requirements for future care needs. Federations can deliver education and training packages at scale across numerous providers and they differ in size based on local need. This includes toolkits, webinars, peer support, mentoring and working with external training providers.
PCNs and practices can be offered support so they can take greater ownership over their staff development without the practical resource and capacity pressures that would be created if managed independently.
Shared workforce pool
Flexible workforce pools support PCNs to increase capacity in general practice and create an offer for local clinicians wanting to work flexibly. Practices and PCNs can benefit from reduced burden in accessing temporary staff and the opportunity to build better relationships with pool members.
Federations manage the administrative pressures that come with developing and maintaining a shared workforce pool and means practices and PCNs can be reassured that all clinicians accepted into the pool have undergone appropriate HR checks.
These workforce pools have been particularly valuable during the COVID-19 vaccination programme and as part of the extended access services delivered across the country. Through federations, primary care workforce pools can increase resilience, respond to short-term demand quickly and reduce expenses from locum and agency staff.
Visa sponsorship
Many federations are licensed sponsors under the tier 2 visa scheme. This means they are able to offer certificates of sponsorship for tier 2 migrant workers seeking to work as GPs within practices or within medical services supported by their organisations respective PCNs.
Federations are able to take the risk and administrative pressures away from practices and PCNs when they are recruiting GPs. Not all employers are accepted as licensed sponsors andthe scale of federations means, where they do hold licenses, they can support multiple primary care providers at once.
Primary care leadership
Primary care leadership is defined as coordinating GP leadership, bringing together the collective voice of general practice provision and wider primary care. It also influences system change and strengthens the voice of primary care by bringing together practices and PCNs with wider health and social care partners.
Developing primary care leadership at system level
It is important to acknowledge the interdependence and interrelationships between practices, PCNs and federations. Without a shared voice and vision for primary care, it’s not always clear how other system partners can engage with primary care at place or system level. Federations are working to bring PCNs, practices, federations and other local primary care partners together to develop a collective voice.
Federations have built relationships over many years with primary care providers at place and system and therefore many have been able to build accountability and representation for primary care at neighborhood, place and system.
This is allowing systems to work more closely with primary care and primary care can then make strategic and service planning decisions collectively at an appropriate level.
Improving integration between different parts of the health and care system
Integration is far more than provider trusts talking to provider trusts – vertical integration with PCNs and federations is a critical component of joined-up care. Breaking down barriers between primary and secondary care for the benefit of patients must be a priority if the ICS is to succeed.
Many federations are already working closely with their secondary care, local authority, community and voluntary sector partners to build integration and ensure quality care pathways for patients.
Many services federations deliver benefit from integration with system partners. This means that there is a joined-up approach to care delivery, providers can share learning and patients can receive the best and most appropriate care.
Improving primary care service models for the future
Federations are well placed to help redesign service models and ways of working to improve patient care in primary care and beyond. They work closely with their members and many work in collaboration with national health and care organisations to support local innovation and improvements in primary care.
At a member level, they work with organisation leaders to identify concerns or goals for the future, help evaluate current services and areas for improvement and work with members to make necessary changes for local growth.
At a national level, due to their scale, federations are able to work with national organisations to pilot new schemes, engage with primary care research and provide local insight on primary care services to inform guidance, frameworks or service specifications for the wider primary care community.
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