FAQs

1. Who and what is Assura?

Who is Assura?

Assura is a division of the Assura Group, one of the countrys leading investors in primary health care services and premises. The aim of the company is to form partnerships with groups of GPs to provide credible high quality health care services out of hospital and closer to the patients home. The purpose of the partnerships is to build on the opportunities presented by PBC, but to operate as GP Provider Companies which are separate from PBC groups.

Each local Assura GP Provider Company is a 50:50 joint venture between the GPs, clinicians and Assura.  Assura operates nationally and aims to have a network of GP Provider Companies covering on aggregate at least 10% of the UK population by 2010.

What does Assura do?

Assura provides all the necessary support in the way of funding, clinical and contracting expertise and the supporting resources to enable GPs to become providers of health care services separate to their existing GMS/PMS and core GP roles. Assura underwrites all financial risk of the partnership for the GPs and provides the start up capital to develop it, as well as subsequent working capital as required.

Assura provides clinical pathway and service redesign expertise to support the development of new services and community based pathways, central business services (bid and contracting expertise), IT systems (N3, Choose and Book, etc), training, HR, payroll and financial support. In addition, it can help with premises ownership and development (if needed).

Specifically Assura:

• provides each local GPCo with start up capital and access to working capital to fund the development and ongoing operations of each partnership;
•  provides experienced people and professional resources to assist in the compilation and subsequent delivery of a clinical service business plan;
• provides effective analysis of health outcomes which will help identify population need and assist the development of the Business Plan;
•  use nationwide expertise to interact with PCTs and SHAs to ensure effective commissioning at the local level, maximising the opportunity for PBC initiated services to be delivered by the GPCo;
•  lend money to each GPCo to further develop its range of services until that business is profitable;
•  provides bespoke, specialist IT and training;
• provides buildings and premises if required; and
•  provides the necessary organisational and clinical governance to ensure that commissioning authorities quickly recognise the benefits that the partnership is established to provide.

Why is Assura and its financial backer Assura Group so interested in doing this?

Assura was formed in response to the opportunities provided by the introduction of PBC. By already owning a significant number of large premises throughout the country, Assura Property identified that if clinicians could organise themselves efficiently to develop new clinical pathways and services and operate from modern, flexible premises, the commissioning authorities would be provided with the ideal health care organisations to deliver the new style of community based primary care services envisaged in the White Paper Our health, our care, our say. This would both improve the patient experience and offer the NHS financial savings through more effective care pathways and efficient delivery of services.

As Assura GPCos become nationally recognised local provider companies, they will develop their own critical mass and reputation for quality and efficiency. This will bring more contracts and the opportunity to grow each company to provide a wider range of services creating the organisation of choice for patients and local commissioners.

Whats in it for me as a GP?

GPs already have positive relationships with their patients and commissioners for delivering good quality, locally provided, patient centred services. The PBC agenda offers an exciting opportunity for GPs to build on this reputation and into new areas of service delivery as services move out of hospital and into the community.

However, these opportunities are also attractive to others and a number of private companies are beginning to tender for these new service opportunities.

By forming cluster wide partnerships, GPs in an area can work together to provide new services on a scale that will enable them to compete against other providers to protect their existing services and develop new ones. Assura supports the development of GPCos and shares the profits equally with the GPs.

What does Assura provide for its 50% interest in a good GPCo?

Assura, as part of a national organisation, maintains relationships at all levels of the NHS to help develop services and build on the opportunities presented by PBC.  It shares its experience and learning across its network of GPCos to support each of them in delivering high quality clinical services.

The development of these new services has presented a major challenge for PCTs who have often struggled to implement PBC and develop the new services that the initiative hoped to inspire.

By sharing our national expertise and learning, we are able to support each Assura GPCo to develop community based pathways and services and drive their implementation within the wider NHS.

This approach also helps to exploit the economies of scale that a national organisation brings by reducing the costs of service design, bid management and service implementation benefiting each GPCo.

Due to the fact that Assura operates nationally, all of its members are able to benefit from its bulk purchasing power of equipment and utilities, as well as understand how other localities provide services more efficiently. Where a GPCo is inexperienced or where a management board has challenges, Assura can provide specialist resources to swiftly deal with any issues arising.

If the GPCo requires property infrastructure, Assura as a wholly owned subsidiary of Assura Group has direct access (if required) to specialist surveyors, developers and capital funding as well as dedicated facilities management professionals to ensure the smooth running of its premises.

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2. What do the Assura GP Provider Companies do?

What do the GPCos do?

The transfer of services out of hospital and into the community presents a number of opportunities to re-provide services in a better, more efficient way and improve the patient experience.  Clinical specialties can be improved from the introduction of community based services and pathway redesign. A few examples of such services are:

• musculoskeletal services 
  
• ENT 
  
• gynaecology
  
• chronic disease management
  
• minor surgery
  
• private services
  
• urology 
  
• ophthalmology
  
• dermatology
  
• public health
  
• endoscopy/community diagnostics

This should result in reduced referrals, lower follow up rates or more cost effective staffing structures. In addition to looking to develop services around these existing specialties as the GPCos grow, other opportunities should develop around the delivery of Out of Hours Services, Emergency Admission Avoidance and the management of prescribing budgets.  Assura will support each GPCo to develop the services the GPs and their commissioners want to develop and that reflect local priorities.

We already provide some of these extra services to a proportion of patients in the area. Would we have to do these through the Assura GP Provider Company?

No, unless there was agreement and clear benefits of moving it into the GPCo. There are three ways we can integrate already established services into the GPCo:

• deliver the services through the GPCo more efficiently, to a larger population than the current service.
  
• keep your established services. The first decision of the GPCo and its management board would be to agree not to compete with these services.
  
• agree a gradual migration of the service to the GPCo as the organisation proves its benefits.

We have already got a musculoskeletal service so how can Assura and its GPCo model help?

The existing service may be fine for the current population and the patient numbers it serves, but it may be able to expand to offer a service to all the patients covered by the GPs in the partnership.  To do this, it may require additional capital, premises or other investment that the Assura GPCo can provide.

Furthermore, changes in the Health Care Commissions standards for premises suitable for a range of procedures are likely to mean that existing premises/infrastructure will not be suitable in the future. If this is the case there may need to be substantial investment in new premises and facilities, which again is something the GPCo can help with.

What can Assura do that our local GP group cant?

Assura recognises that groups of GPs may want to form their own partnership to become providers of intermediate and other services and this is one reason why Assura is committed to working with such able and visionary groups.

However, Assura has come across Limited Companies, Social Enterprise Companies (SEC) and Community Interest Companies (CIC) formed by GPs that have failed to achieve success without significant risk to the GPs, and even with the help of significant pump priming to get them established.  We have partnered with these groups in our GPCo model and made a success of the enterprise as we understand the effort involved in obtaining contracts and actually delivering the services on the ground.

Assura removes any risk for any of the GPs as we provide the enablers to get the company going and the ongoing expertise and resources to make it a success.  The central resources and investment by Assura and Assura Group are considerable and could not be justified or afforded by a single cluster of GPs.

Will Assura deliver primary care (GMS) services?

No!  Assura recognises the quality of the exiting GP primary care services and does not look to provide or compete with these services. The only situation in which this might occur is if the Assura GPCo wishes to run a practice within its area which is put out to tender, to prevent another independent organisation from doing so.

What is the difference between PBC and Practice Based Providing?

It is important to differentiate between PBC and the development of GPCos that provide the kind of services that may be commissioned by PCTs as a consequence of PBC recommendations.

The Assura GPCos are developed to provide services by winning NHS/PCT contracts to deliver services for NHS patients. They aim to make an income and profit from providing these services, and offer the PCT potential savings through efficient care pathways and the negotiation of local tariffs. These profits are split 50:50 between the GPs in the partnership and Assura.

This is separate to any arrangements GPs might have through their local PBC groups, and the percentage of savings they may receive from PCTs as a consequence of PBC implemented changes.

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3. Structure, management and ownership of the GP Provider Company

How does a local Assura GPCo work?

If your practice or locality group decides to work with Assura, a new organisation will be set up by Assura in the form of a Limited Liability Partnership (LLP) focused specifically on your locality. It is envisaged that this will cover a defined geographical area and will be known for example as Assura (locality name) LLP or for the purposes of the rest of this paper as Assura Local LLP.

Who will manage the Assura Local LLP?

Each Assura Local LLP will be managed by a locally recruited Clinical Management Board (CMB) which will include elected GP representatives from within the partnership and possible other clinical or non clinical representatives (practice nurses/practice managers, etc). The CMB will have the clinical oversight as well as the day to day responsibility for managing and operating the Assura Local LLP.

In the first instance, the CMB will be responsible for overseeing the development of a business plan which will need to be prepared according to a standard template to be provided by Assura. This will enable every aspect of care provision to be thoroughly researched prior to implementation. Once developed, the CMB will have the responsibility of overseeing the delivery and implementation of the business plan, working in partnership with Assura.

The CMB will appoint a Business Development Manager (BDM) who will manage the Assura Local LLP and develop the operational team who deliver services. The BDM is a critical appointment, made early on in the development of the partnership to drive the business forward and help make it a success.

How is the CMB appointed?

The CMB will usually include four persons nominated by the GP practice members who form the GPCo. Usually, interested members put their names forward for election and all the members of the GPCo vote for the CMB representatives. In addition to the four practice members (one of whom will be the chair for the GPCo) the BDM will also be a member of the CMB and Assura will nominate one member.

The CMB meets regularly and shall have full powers to appoint its members and chairman to serve for such periods as it determines.

In addition to nominating a representative with relevant experience, Assura will provide any additional personnel, business services and development to ensure that each CMB operates and functions effectively.

Who owns an Assura GP Provider Company?

Each Assura Local LLP will comprise a number of GP practices as members, which may range from a single large GP practice to a range of smaller or single handed practices.  The GPCos may also, and are encouraged to, have other health professionals or staff as members.

Individual GPs and clinicians will not be allowed to be members in their own right. All members will belong to actual practices or GPCos recognised as providers of health care services in the locality.

Can a practice be prevented from joining the GPCo?

This is unlikely to occur as the GPCos are encouraged to be inclusive and expand their numbers. The strength of the GPCo is proportional to the number of members it has.

What happens when GP partners retire?

The GPCo is structured such that members are practices so individual GPs can retire without it having an impact on the practice or the GPCo.

What does being a member actually mean for me?

By agreeing to work in partnership with other practices and clinicians, resources and risk will be pooled and best working practices can be shared. The opportunity is for each practice to be much more involved in the development of additional services for patients in primary and secondary care and in the community. However, there is no time commitment except for CMB members, other than asking partners to contribute ideas for service improvements.

We believe that the opportunity for career development for all members of the primary health care team is greatly enhanced by the opportunities created by the Assura Local LLP.  Assura Local LLP members will have much greater understanding and influence on the prioritisation of spending of NHS resources on patient services. There will be an opportunity for GPs to develop special interests and be fairly remunerated with appropriate training if the CMB and GPCo feel that new services and staff should be invested in.

A partnership with Assura Local LLP will enable your practice, neighbouring practices and other clinicians to take on the opportunities offered by PBC which should provide profits and enhanced income for all of its members.

What does it all mean for our practice staff?

Your staff and their terms of employment are unaffected by the development of the GPCo. As the GPCo develops, the range of services and opportunities will grow for others to become involved in, which will increase peoples skills and role within the locality.

If our practice becomes an Assura Local LLP member does this mean that we will have more work to do and longer hours?

No. The services to be provided by each Assura Local LLP will be agreed and developed by members in conjunction with the CMB. Each new service will be properly funded and the staff required to provide it identified in advance. Those staff wishing to do more will be properly paid for their time working in the new service in addition to any of their current responsibilities. In other words, the services to be provided by the Assura Local LLP will not impact upon the normal running of each practice unless it is agreed and paid for. 

Do I have to be involved?

Involvement in the running of the GPCo is totally discretionary. Some members may want a very active role either on the CMB or as a clinician providing services. In either case they will be remunerated accordingly. 

Some members may choose to get involved to help develop a new service opportunity or care pathway. If this is the case the CMB can decide to reward this input on a case by case basis, possibly agreeing a sessional rate for a time limited period.

GPs will be encouraged to understand the service that the GPCo provides and explain that the service is one of the four choices offered to patients. GPs consistently not referring patients to the GPCo services may be reviewed to understand why the service is not appropriate or address any concerns that may exist.

What about my premises?

One of the real benefits of working with an Assura Local LLP is that the premises provision can be from existing sites or new sites and is not dependent upon ownership. In all cases, the Assura Local LLP will fund the rental payments and cost of appropriate facilities management for any space occupied to provide the new services the GPCo will be providing.

Should you have spare space in your practice, which is not currently used for GMS purposes, this could be used by the Assura Local LLP offering you an additional income stream.  Alternatively, should new premises or additional space be needed either by way of extension or improvement or with an entirely new building, this can be provided by practice members themselves or by Assura Property, which is one of the countrys largest primary care property investor and developer.

What services have the current Assura GPCos developed to date?

Assura has currently eleven GPCos formed across the country representing in excess of 1m patients with a number of new GPCos being developed.  Assura expect to have 1.5m patients registered by April 2008, 2.5m by April 2009 and 5m by 2010.

The range of services that our GPCos are currently providing include: community based urology, dermatology, minor surgery and travel services.  Services currently being implemented include rheumatology, ophthalmology, direct access ultrasound, and ENT.

GPCos have reached the final stages for contracts for Out-of-Hours, physiotherapy and GUM services.

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4. How is a GP Provider Company funded and financed?

Explain how Assura will provide start-up capital and working capital to each local GPCo?

When a GPCo is formed and the legal arrangements have been entered into, Assura will provide the partnership with start-up capital of 2 per patient with the contributions being a minimum of 100k and a maximum of 300k.

This money can then be used by the members of the partnership for all costs associated with the setting up and running of the company and to help it develop a sustainable business plan. This includes paying GPs for their time for attending board meetings, employing the local Business Development Manager (BDM) (who runs the company on a day to day basis) and employing/training other key administrative staff, installing specialist IT and start-up.

Should more capital be required, in accordance with the business plan, Assura will provide this by way of a loan at a rate of 1% over the base rate.

For the avoidance of doubt, GP and clinical members will not be required to contribute capital and any loan made to the Assura GPCo will be risk free to those members.

Do you charge an annual rate for the support we get?

Yes, this is the Management Charge which is 2% of the companys turnover. This management charge will be capped at 50k when turnover exceeds 2.5m per annum.  Assura does not plan to make money from this and the true cost of supporting each partnership is considerably more than the income derived by Assura from this charge.

By partnering with Assura, each company can call on a significant number of core support services and a high level of central expertise that will contribute to and support the ongoing success of the company. From experience, Assura has learnt that through the central provision of key services, we are able to maximise economies of scale, reduce the administrative burden placed upon the company, and provide a level of expertise that would not otherwise be available.  The Management Charge represents a proportion of the overheads required to support the provision of these services to the company.  A full breakdown of the services provided and the levels to which they are provided are laid down in the Service Level Agreement within the written Agreement between Assura and the GPs.

Can we distribute the start-up capital of 2 per patient to our members?

The 2 per patient is for the development of the joint venture and each CMB decides where best to spend the money. To date, all of our GPCo partners have used the money to get the enterprise going, appointing staff and paying individuals for their contribution. Some CMBs have paid individual GPs to develop particular services.  Therefore, only profits over and above the start-up capital can be distributed among members.

Are the GPCos intending to make a profit and if so, how much will this be and how will it be distributed among members?

Each Assura GPCo is run as a separate profit making enterprise.  The profits of the company are then split 50:50 between the members of the GPCO and Assura.

Assura will use its 50% to satisfy its investors and re-invest in new business opportunities.  How the members use their 50% of the profits from the company is entirely up to them.  They may choose to distribute them on a proportional basis across the members or re-invest them in services or facilities for patients.

How are profits shared between the practices and their members within the GPCo?

It is up to the members to decide how they share their profits.  We recommend the share earned by each practice member is determined according to registered patient numbers assuming equal weighting.  For example, suppose that there were three GP practices in a partnership with 15,000 patients, 8,000 patients and 6,000 patients respectively.  Under this pro-rata methodology, the 50% of the partnerships profits would be shared: 26%; 14%; and 10% respectively with actual payment being made directly to each practice.  How the GPs within each practice want to spend or allocate this income is up to them.

In the event that the same Assura GPCo wished to admit other staff e.g. nurse practitioners, pharmacists or practice managers, then it would be up to the CMB to devise what proportion of the 50% these staff should share.

How does Assura make its returns?

The GPCo is a 50:50 split whereby half the profits of the GPCo go to the GPs and half to Assura.

What sort of figures are we talking about?

We encourage our newly formed partnerships to aim for income of 5 per patient after the first 18 months of operation.

Should I buy shares in Assura?

If you like the Assura model you are able to invest in the Assura Group and can buy shares in the company. However, we are not financial advisors and cannot advise you on investments. You should seek independent financial advice from a professional advisor.

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5. Working with the wider NHS

How do the GPCos work with the wider NHS?

One of the main advantages of developing partnerships with GPs is to ensure that the local health economy is not destabilised by the development of inappropriate, duplicated services that are not needed in a given area.

Assura, working with the GPs in the GPCo, aims to work closely with PCTs, acute providers and PCOs to ensure that new services and pathways complement existing local circumstances and provide better, more cost-effective and streamlined services for patients.

One of the first tasks for any new GPCo is to meet with commissioners and relevant provider companies to understand their priorities and pressures and to see what mutual opportunities might exist across the companies. This may include helping the PCT to meet its commissioning priorities, or helping the acute provider with 18 week targets by developing intermediate community based services.

It is this vision of Assura, working in partnership with local GPs that enables truly integrated pathways for patients and the provision of high quality cost effective services across primary, intermediate and secondary care.

Explain what the Assura Local LLP will do in relation to what is already being provided by existing GPs and health professionals?

The Assura Local LLP will work alongside existing practice partnerships and existing health professionals.  It will not be involved in the provision of GMS core services although it may enable core services to be delivered by practices by providing the premises for these.

Assura Local LLPs will look to use local staff to provide the services it develops and have separate contracts with these staff and their companies for the work they do for the GPCo.

It is envisaged that each Assura Local LLP will lease its space from practices, local acute providers or properties developed by Assura Property where these are required. 

In summary, it is intended that the Assura Local LLP will enable the provision of high quality services to happen efficiently and effectively within the local health care community.  It will be constantly informed by the views, experiences and feedback from GPs and other clinicians, professionals, patients, carers and from local communities who might choose to work together for this purpose.  In this regard the Assura Local LLP will look to become the principle provider in the locality and the commissioners first choice for the delivery of local, community based services.

Does each Assura Local LLP employ clinicians?

It is envisaged that the staff delivering the GPCo services will be contracted from their existing employer on a sessional basis.  Many of the pathways for new community based services will require a range of clinicians from a number of different organisations (GP practices, community trusts and the acute sector) and rather than employing these staff directly for possibly short periods per week, it will be easier to purchase the input from their employing organisation.

Our experience shows that these staff and their employers want to work with the GPCo to develop new services and pathways. The development of one stop shop services in MSK and urology are good examples where a range of clinicians working together as an integrated team provide a better service for patients and reduces the number of referrals, follow ups and handoffs. This saves everybodys time and provides a more cost effective pathway for commissioners.

Are consultants involved in Assura?

The development of most new services and care pathways will require extensive secondary care and consultant input. Many of the integrated services will see primary care and secondary care colleagues working alongside one another, or passing patients seamlessly between them.  Given this, the Assura Local LLPs need to work closely with consultants and involve them in the planning and delivery of services.

Assura currently does not see consultants becoming members of the GPCo. Assura has sought advice from senior Department of Health and government officials, as well as commissioning representatives who are keen to ensure that there is an appropriate separation between those responsible for referring patients to secondary care services and those providing them to ensure choice for patients.

We believe that we can work closely with secondary care to redesign community based services, and where patients need onward referral to secondary care, they will choose to go to the most appropriate local provider who has a reputation for delivering high quality care.

Our PCT has overspent so how can we develop new services?

Overspend does not mean no new services. PCTs with financial pressure will be under more pressure to look at services that are more efficient and cost effective. By developing community based services, savings can be made through reduced referrals and more cost effective processes and staffing structures.

Often it is the PCTs who have overspent that will entertain innovation as they have to change and cannot carry on overspending with their existing services.

Do the service models include GPSIs?

If there are accredited GPSIs who wish to work locally as providers, they are encouraged where appropriate, and providing it fits with best practice guidelines. The services the GPCo would look to develop are not predicated on GPSIs and many use local consultants. Local acute trusts are often keen to provide their local consultants to support the development of better pathways and create stronger links with primary care.

While all providers need to ensure appropriate governance and ensure patients are offered the choice of the most appropriate providers, it is recognised that the vast majority of patients will choose to go to their local hospital for secondary care procedures. Consultants supporting good community services will see more appropriate referrals, thus freeing up time to concentrate specialist elective procedures as opposed to inappropriate new referrals and follow ups.

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6. Competitors and other partnership models

Who else is providing this type of activity or service?

Assura is not aware of any company providing the same business model offered by Assura. There are a number of different locality groups and Foundation Trusts who are actively seeking to develop their sphere of activities but these tend to be at a local level and in a defined geographical area.

The additional benefits of this structure are that your existing practice partnership remains untouched and that the funding costs to set up each Assura Local LLP are provided at no cost to the practice or its clinical members.

Who are Assuras competitors?

Probably our greatest competitors are GPs looking to provide services themselves.  There is considerable talent in primary care but it takes a lot of effort to develop new innovative services and win contracts from PCTs. GPs are generally busy enough with their own GMS concerns and the increasing demands being made.

Assura has worked with a number of GP clusters who have tried to become scale providers of new services, but recognise they need a partner who can manage the risk and provide the enabling infrastructure and funding to establish these companies as credible providers.

What about the conflict with a GP referring to services they have a financial interest in?

Assura recognises the perception of conflict arising from GPs referring to a local company that they have a financial interest in. However, much of this conflict is an outcome of PBC itself, and not the Assura GPCo model.

It is essential that GPs are able to refer their patients to the most suitable and appropriate service for their needs, subject to the patients own choice of provider. The development and provision of locally based, high quality services by GPs should not be discouraged because of this potential conflict.

Assura ensures that each GPCo puts in place appropriate governance arrangements to ensure that patients fully understand any potential conflict with GPs declaring to them that they have a financial stake in the company.

What about the conflict between GPs as commissioners and GPs as providers?

Assura has developed its GPCos by keeping a clear division between the GPs running the GPCo and those GPs making PBC recommendations to local PCTs.

By separating these roles, PCTs can be advised on the best design of community based services and still have local primary care clinicians offering to provide them without a conflict of interest.

GPs who sit on established PBC groups should not also sit on the CMB of the GPCo and similarly GPs on the CMB should not be on PBC management groups.  They can be members of each organisation.

To ensure transparency and best value, PCTs should ultimately award contracts based on the recommendations being made by PBC groups to providers delivering the best quality services cost effectively.

So what about Choice?

Assura supports the NHS Patient Choice Agenda and any GP within the GPCo is entitled to refer where they feel appropriate.  GPs referring to a service that they have a financial stake in will be required to declare that interest to the patient.

What is the Any Willing Provider guidance?

Any Willing Provider is the term given to the guidance that enables providers to deliver services to patients and encourage plurality and competition in the NHS.  By meeting a set level of clinical and governance standards, providers can offer their services to patients (via GP referrals) through patients choice without any formal contracts for activity with local PCTs.

Assura GPCos can and will provide services on this basis where PCTs are unwilling or unprepared to award contracts, but ideally would respond to more formal PCT tendering processes where possible.

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7. Developing the Assura GP Provider Company

How is the GPCo set up and how long does it take?

Assura is committed to developing long term partnerships with groups of GPs and there are a number of critical steps in the process of developing a GPCo to ensure the process is managed smoothly, and at all stages both parties are happy with the direction the company is taking and the mutual commitment they need to make.

Usually before the decision to form a partnership with Assura is made, the GPs in a locality would have received a presentation from Assura explaining what the model is about and how it works.

The GPs then need to indicate where practices are likely to join the partnership, and who are the GPs leading the process locally.  Although GPs are not required to commit to joining at this stage, it is critical that there is a level of GP engagement and leadership locally to develop the partnership. Assura does not want to partner with groups of GPs who do not see the benefits of forming a GPCo or working with Assura to do so.

Assura will then begin a parallel process of developing the GPCos Provisional Business Plan by undertaking a feasibility study of the area while the GPs examine the legal agreement (the Limited Liability Partnership Agreement) which details the basis for the partnership.

The GPs should form an interim working group to help support the development of the Provisional Business Plan and Assura will support discussions to look at the service opportunities in the area and the infrastructure requirements needed for the GPCo.

The GPs will usually appoint solicitors to review the legal framework who will work with Assuras solicitors to address any questions and develop the document into a draft that both parties are happy with.

Once the GPs are happy with the legal framework, they will normally hold a meeting with all the GP practices thinking of joining the partnership where the Provisional Business Plan is presented and any final legal issues clarified. The GPs are then given usually two weeks to decide if they want to join the GPCo or not.

This process will be driven by the speed of the GPs and Assura but ideally it will be completed within three to four months.

It is essential that this process is a joint process between Assura and the GPs in the locality.  Assura fully recognises that each practice will need to move at its own pace and will have its own questions and issues to discuss, but unless there is a level of commitment from a sufficient number of GPs who can see the benefits of forming a partnership with Assura, the company will not succeed and realise the opportunities available.

You have mentioned the Provisional Business Plan.  Who decides how this is written and who prepares it?

The Provisional Business Plan for each Assura Local LLP will be different and will be entirely dependent on commissioning objectives and needs in each geographical area.  To enable the Provisional Business Plan to be prepared in a timely and relevant way, Assura will provide a template and advice so that all of the key issues can be addressed.  By being part of a larger company, lessons learned from other Assura Local LLPs can be shared amongst members so that the plan is realistic and deliverable.

The Provisional Business Plan will be the responsibility of the interim working group leading the development of the GPCo locally, supported by a range of Assura staff and looking at all aspects of the GPCos development. This will then be ratified and developed by the main CMB once formally elected.

What happens if we decide at a later date that Assura or an Assura Local LLP is no longer in the best interests of our staff or patients?

Your practice or clinical group can leave the Assura Local LLP at any time with three months notice.

If a practice leaves what happens?

If a practice leaves there are no consequences. In particular there are no liabilities on behalf of the leaving partners.  If a practice leaves and sets up a service in direct competition to the GPCo then they are required to pay back their proportion of any outstanding losses the GPCo may have.

Can a practice sell or transfer its interest in an Assura Local LLP?

There is nothing to sell onwards.  When a practice leaves it just ceases being a member of the GPCo.
Do we have to sign up for a specific period?

No.  There are no time scales for membership in the Agreement.

We are interested in Assura but does that mean we have to sell our premises and integrate your pharmacies?

No. Assura can stand alone. In one of our GPCos in Bath and North East Somerset, covering 190,000 patients, there is no Assura Property or Assura Pharmacy presence.  The GPCo can provide services either from the GP estate or the community hospital.

Assura Pharmacy and Assura are complementary to Assura Property and can enable the affordability of new building projects especially in the light of cash strapped PCTs, but the development of GPCos are not dependent on property or pharmacy developments.

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8. Next steps and actions

What do I do next if Im interested in developing an Assura GP Provider Company?

If you have not had a presentation by Assura we can arrange this for interested practices and other health care professionals. If you would like to arrange this please contact Claudine Cash in the first instance via the contact details below.

We are quite interested but we would prefer to wait until we have seen some specific service examples delivering intermediate care in the community.

This is fine. We can invite you to visit any of our Assura Local LLPs at any stage and discuss the Assura model with GPs from other provider partners.

To initiate formal discussions with Assura, please contact Claudine Cash
who will arrange for a further meeting to take matters forward.

Claudine can be contacted on:
Tel: 0845 123 5464

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