The New GP Contract


Which is the right model for a Primary Care Network?

Following our last post on the New GP Contract announcement, we had an inbox explosion of questions from Practices and CCGs, mostly centred on the various models for Primary Care Networks.

What's clear is there is no one model that's going to be right for everyone. In the past week alone, we have had four different models to work with in our support workshops for General Practice:

  1. A standalone network that wants to work autonomously

  2. Three networks that want to operate through their GP federation (we also have five and seven networks wanting to do exactly the same)

  3. Two networks that want to operate as part of a Primary and Acute Care System (PACS) and build on the Vanguard work they delivered together

  4. One network that wants to explore what working through the local Community Service provider might look like

All are possible, all have different challenges and all look set to progress.

Within our workshop sessions with Practices and CCGs, we are finding people focused on the possibility of the local GP federation supporting the Primary Care Networks by hosting each as a separate cost centre. What we mean by that is the federation will hold the Network Contract on behalf of the Practices within it and at the same time will ensure a ring-fenced budget that only the Network can spend (there are some suggestions that the Network Clinical Director would be required to sign off any spending).

If the PCN wants to purchase additional support from the federation it can of course do that, assuming the federation wants to deliver and the Network has the budget to support the purchase.

The employment of staff via the federation is naturally a firm focus, particularly with the new roles coming into General Practice over the next three years, including:

  • Pharmacists, Social Prescribers (both in 2019/20)
  • Advanced Practice Physiotherapists and Physician Associates (both 2020/21)
  • Advanced Paramedic Practitioners (2021/22).

Clearly the federation model will be well suited to that employment. At the same time we are hoping the Network Contract will enable the NHS Pension Scheme to be made available.

While we find some people dismissing the need for a GP Federation, we believe that is a potentially missed opportunity. A GP Federation offers scale to General Practice and provides one voice for General Practice across a whole health economy.  This makes the evolving Integrated Care Systems easier to develop. Primary Care Networks of 30,000 to 50,000, overarched by a GP Federation, look like an excellent model and it is one we have worked with a number of times.

This kind of approach is quickly coming to the fore in preference to legal entity Primary Care Network, or a lead practice model. The lead practice model, in our experience, is by far the least popular.  However, what is also clear is that, where a GP federation has been established but hasn’t yet matured into a delivery model, this needs to be rapidly addressed if the federation is to successfully take on the role outlined above.

If you would like to know more about how we can support GP Federations to achieve that rapid development, please contact us. The same applies if you have any questions about forming a Primary Care Network; please don’t hesitate to make contact.

The Primary Care Team in SCW will continue to provide unrivalled support and direction to Practices, Primary Care Networks and Federations in working to successfully implement the required changes.  We will help you to develop your links and work with your Integrated Care System to realise the best possible outcomes from this opportunity. For more information on our support packages, or if you have any questions,  please email:

Director of Primary Care