There is much discussion within the current health policy landscape about how general
practice can be delivered ‘at scale’ through a GP network. At its most basic, a GP network
is defined as a number of GP practices who have entered into some kind of collaborative
arrangement with each other. GP networks go by many names: federations, collaborations,
joint ventures, alliances or clusters.
Some practices are embracing or considering GP networks as a means to alleviate workload
pressures, or to share costs and resources (for instance, workforce or facilities). Some
practices are using these new collaborative arrangements as a way to bid for enhanced
services contracts. Government health policy, for instance, as a part of NHS England’s Five
Year Forward View, is also increasingly compelling practices to consider new models of care
and the delivery of general practice at scale.
This paper has been produced by the General Practitioners Committee for those practices
actively establishing, or joining, a GP network, or those who are considering it. The paper
should be regarded as headline ‘best practice’ principles that established or emerging GP
networks should use to guide their setup and operational activity.
Guiding principles for GP networks (PDF)
Guiding principles for GP networks
The list is non-exhaustive and is not ranked according to importance. Not all points will apply to every GP network.
Promoting and preserving high quality general practice and improved care across the
local health economy should be the basis of every GP network.
A prime function of GP networks should be to support and facilitate collaboration
between member practices, including those which are struggling. This could include
peer support, workload management and the sharing of staff and expertise.i
Membership within the GP network should be open to all practices in the area (i.e. they
should be geographically based).
GPs, as the patient’s advocate, must retain the right to freedom of expression within
the new organisations. Medical professionals’ duty of candour should be reflected in
all GP networks, which should cultivate a culture of honesty.
GP networks should be primarily focused on local provision of local services.
The size of the GP network should be determined by practices.
GP networks structured as a companies guaranteed by share should operate on a ‘one
practice one share’ basis, where this relates to ownership or voting shares. Secondary
shares purchased by practices may reflect patient numbers.ii
GP networks should promote good employment practice across their organisations.
Good employment practice should extend beyond GP engagement to include other
staff including specialist colleagues.
GP networks should involve employed staff, including GPs, in the management and
development of the organisation. Sessional GPs should have equal opportunity to have
a critical role in influencing the development of the GP network.
GP networks should, where possible, involve patients in their structures or at Board level.
GP networks should strive to preserve and protect all local and viable GP contracts.
LMCs should be involved in decision making on founding principles around GP
networks and in ongoing key decisions.
GP networks should be for the delivery of NHS care and not for sale.
GP networks should have robust governance arrangements which address possible
conflicts of interest and therefore maintain the trust of patients and commissioners.
GP networks should endeavor to collaborate with other similar organisations, and
be receptive to potential alliances across health care in general.
- There will be an increasing need for practices in each locality to provide mutual
support and networks may play a key role.
A company limited by share is a logical and relatively simple network format.
Experience has shown that the best solution for such companies is that each practice
holds one owning share. This gives every practice a “stake” in the organisation, limits
their liability, and makes it clear that its purpose is the provision of services and not
that of control or direction of practices.
Dividend paying shares are also issued, and these are purchased by practices
depending on the number of patients within each. It is this investment which
gives the company its initial capital.
More information about company limited by shares can found in the GPC guidance
covering the different legal structures.
Note: Each GP network must obtain its own legal advice from advisors familiar with
general practice and networks in order to determine which corporate structure is
Basic legal structures
Setting up a GP network