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How to create the right corporate structure for a GP organisation

By: Graeme Cleland | Post date: 20/12/2017 | Time to read article: 2 mins

The information within this article was correct at the time of publishing. Last updated 14/11/2018

Can you please tell us how to identify the corporate structure that best suits the needs and challenges of a group of GPs? This can be complex – please tell us how you reviewed the numerous options and structures. Can you explain the process you adopted and specific learnings?

Graeme Cleland discusses how to identify the best corporate structure to suit the needs of a group of GPs.

Transcript

There’s lots of options available for the establishment of GP organisations. So there is the super practice model, there is the limited liability practice model, there is cooperatives, community interest companies, not-for-profit and limited liability companies. They’ve all got their benefits and they all have their challenges. We as an organisation rationalised our decision making down to two. The two we considered were a community interest company or a limited liability company. We made a decision to form a limited liability company because a community interest company has different regulations that apply to it in its ability to retain cash, retain earnings and actually a limited liability can do that whereas a community interest company can’t. And the other reason was that there is an asset lock associated with a community interest company. In a community interest company the investment that anyone makes in it from inception is effectively gone so they can’t trade out of that, they can’t pass that on. So we chose the limited liability company so that it allowed for that to happen. I won’t say that’s been without its challenges because there are varying positions within the system about what’s good and what’s not. Super practices and super partnerships are an effective way of bringing together partners and practices under a General Medical Association umbrella. As we move into new models of care and the flattening of structures, there will be challenges in the way in which they work, but we strongly believe there is a place for a super practice within a larger GP organisation or body because as we move to more place-based commissioning in the Sustainability and Transformation Plans, Accountable Care System, Accountable Care Organisation environment there is still a place for those models. We went through a process. We took very, very sound legal advice from British Medical Association law and one of the larger London medico-legal organisations and we went through that process in a very considered way. We decided that where we got to was limited liability company and we bound that all up into our articles. It’s an evolutionary thing so as we have gone on and developed we’ve identified that unless we create a structure that effectively mirrors a cooperative federative aspect and a provider aspect actually we will have a very limited future. So, what we’re in the process of doing right now, is establishing a cooperative, federative business, alongside a provider business. The two parts of the business are symbiotically co-dependent on one another. They have different ways of working but they need to work collaboratively together and that’s the same right across. Whether you’re operating in any part of the system and in any one of those models. One of the challenges around establishing new organisations is access to NHS pensions but they’ve changed the regulations, NHS PA has changed the regulations around the pensions and the opportunity is there for those organisations that hold either an NHS standard contract or a GMS contract to have access to the NHS pension fund. Because that’s a really key thing in getting people to come across, particularly people who are 50 years plus of age and have served more than 30 years inside the NHS and actually they want to hold onto those really great benefits they’ve accumulated over time. So it’s really important to create organisational structures that are fit and compliant and work within that structure in a cohesive way. 

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Graeme Cleland Medical Protection Expert

Graeme Cleland

Graeme Cleland is the managing director at Taurus Healthcare Ltd, a business he set up himself. Here, he helps to provide primary care services at scale, provide out of hospital care to the public and negotiate contracts with the NHS, CCG and regional commissioners.

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