Alliance arrangements
What you need to know before you enter into an alliance arrangement.
Alliance agreements allow practices to benefit from the economies of scale that mergers or super partnerships offer, without compromising their practice’s autonomy.
As with any similar arrangement, you should prepare carefully and enter into a contractual agreement. This ensures that each party knows what is expected of them, and expectations are clear from the outset.
With the increasingly high demand for GP services and tough NHS budgetary constraints, the pressure faced by general practice is growing. Partnerships are finding their numbers dwindling as partners retire and replacements are harder to recruit. To combat this, practices are following the trend for ‘working at scale’ and turning to mergers, GP networks/federations and super partnerships.
However, these models are not for everyone, and we have found many practices opting to establish less formal ‘alliances’. Allowing them to alleviate their workloads, without compromising their autonomy and control over their business.
The form that such arrangements take depends largely on the practice’s objectives, and the requirements of the local commissioners. GMS and PMS Regulations restrict practices from sub-contracting their rights or duties under the contract unless certain conditions are satisfied – including that they have notified the commissioner of their intention.
Alliance agreements can be appealing, but you must properly prepare. It is important to define the rights and obligations of each party in a contractual document so everyone knows what to expect.
Here are the top things we suggest that you cover in an alliance agreement:
- Services
What are the details of the services being ‘shared’? Think about the practical process of how they will be supplied (from booking appointments through to follow up ones)
- Resources
What will each party need to commit to the arrangements?
- Obligations
Under the arrangements, what are each party’s obligations? For example, where clinical services are being provided, you might expressly outline:
i. That the supplier must ensure that any GPs satisfy the qualification requirements under the GMS/PMS Regulations (and that it has received all relevant references), and
ii. The quality expected of each party in delivering the services (this would essentially mirror the requirements under the core contract)
- Patient records
If applicable, how are patient records to be updated?
- Insurance
What insurance obligations apply, and where does the responsibility sit?
- Price and payment
What are the payment terms (if any)?
- Liability
Who is primarily liable if there is an issue with the services provided (whether care, advice or other support)?
- Staff
Who will be responsible for the staff employed to deliver the service? You would expect there to be an agreement that each party is responsible for their own employees. You may need to consider whether the Transfer of Undertakings (Protection of Employment) Regulations 2006 (TUPE) will apply in the event that the service is terminated.
- Term
What is the length of the agreement (for example, a fixed term or rolling contract which continues indefinitely unless terminated)?
- Termination
In what circumstances and how can the agreement be terminated?
- Review provisions
You would usually wish to identify i) the key contacts for each practice, and ii) the provisions for emergency and periodic reviews
- Confidentiality and data protection
What are the parties’ obligations in terms of confidentiality and data protection?
- Dispute resolution
How will disputes be resolved (for example, by some form of alternative dispute resolution such as mediation or arbitration)?
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Contact us for more information if you are considering entering an ‘alliance agreement’, or would like information about working at scale.