GP federations organise medicines work by agreeing one approach across their member practices, then delivering it through practices, PCNs and integrated neighbourhood teams. The Neighbourhood Health Framework, published by DHSC and NHS England in March 2026, asks ICBs to set up INTs with an initial focus on specific patient groups, and many of those patients take several medicines. This article sets out how the pieces connect and where clinical pharmacy capacity fits.
What is a GP federation?
A GP federation is a group of general practices that work together, usually through a shared organisation, to deliver services across a larger population than any one practice covers. Federations commonly run shared services, back-office functions and clinical programmes on behalf of their members. Each member practice keeps its own GP contract and its own registered list.
The 10 Year Health Plan, published in July 2025, describes larger providers working across all the GP practices in a footprint, offering a shared back office, data analytics and quality improvement. It notes that in some places GP federations already play this role. That puts federations close to the centre of the neighbourhood changes now being planned.
What is an integrated neighbourhood team?
An integrated neighbourhood team brings different professions and partners together to support people with similar needs in a local area. The Neighbourhood Health Framework says NHS England will ask ICBs to set up INTs with an initial focus on four groups: people with frailty and those who need end of life care, people with multiple long-term conditions, children and young people, and people with cancer.
INTs provide assessment, care planning, co-ordination and follow-on support. The framework leaves the make-up of each INT to local areas, so membership varies from place to place. For the frailty and multiple long-term conditions groups, medicines are a large part of every care plan, which makes medication review an early piece of INT work in most areas.
Where does medicines work sit between practices, neighbourhoods and federations?
Medicines work sits at three levels, and each level suits different tasks.
- Practice level: repeat prescribing, medication queries, discharge letters and clinical letters. This work depends on each practice’s own ways of working.
- Neighbourhood level: structured medication reviews for an INT cohort, polypharmacy reviews ahead of multidisciplinary meetings, and high-risk drug monitoring across a PCN.
- Federation level: one protocol, one set of searches and one reporting format for a workstream, applied across every member practice. Prescribing incentive schemes and ICB medicines priorities often fit here.
The clinical record stays with the practice at every level. Each review, change and follow-up is coded in the practice’s own system, so the GP, the INT and the practice team all read the same history.
What medicines work can a federation organise across its member practices?
A federation can organise any medicines workstream that gains from one standard across many practices. Common examples include:
- Structured medication reviews for a defined cohort, such as people living with frailty
- Problematic polypharmacy reviews, which the NHS England Medium Term Planning Framework names among ICB prevention goals
- Best-value medicines programmes, such as the DOAC work the same framework lists as a 2026/27 efficiency priority, applied only where clinically right for each patient
- High-risk drug monitoring sweeps across all member practices
- Discharge medicines reconciliation to one standard
Our medicines optimisation service sets out the workstreams we deliver in GP practices and PCNs, and each one can be run to a single protocol across several practices.
How does a federation keep one standard across many practices?
A federation keeps one standard by agreeing the protocol once and applying it everywhere. One clinical protocol, one set of searches and one coding convention let the federation compare results across practices and neighbourhoods, and see where each workstream has reached.
Governance carries equal weight. The federation, PCN or practice sets the priorities and signs off the protocol. The clinicians delivering the work do so under one clinical governance framework, with a clear route to the patient’s GP for decisions that belong with the GP.
Reporting completes the picture. A federation board usually wants results per practice, per neighbourhood and for the whole federation, in the same format each time, so it can decide where to widen the work next.
How does a managed clinical pharmacy service fit alongside federation and INT work?
A managed service can add defined clinical pharmacy capacity to a federation or INT programme, without the federation recruiting or managing clinicians itself. The federation sets the scope and priorities, the service delivers the agreed work remotely in each practice’s clinical system, and results come back in the agreed format.
Remote delivery suits medicines work that happens in the record: reviews prepared before a multidisciplinary meeting, searches, monitoring and reconciliation. Findings reach the INT or the patient’s GP through the agreed route, and patient conversations can take place by phone or video. We work in EMIS, SystmOne, Vision and Medicus, so one programme can run across practices on different systems. Our clinical pharmacist service explains how the service is delivered and governed.
What we see in practice
Networks that want one standard across many practices tend to start with one workstream and widen it once the results are clear. In a nine-practice Lincolnshire PCN, we delivered 315 hours of medication reviews to one pathway across all nine practices, and the PCN then moved to a full-year contract. A Norfolk and Waveney PCN received 1,000 structured medication reviews between October and March.
Both are PCN examples. They use the same mechanics a federation programme relies on: one protocol, one clinical governance framework and reporting that covers every practice. We have supported 375+ GP practices and 88+ PCNs, with practices and PCNs in 23 ICB areas across all seven NHS regions. Our case studies set out the detail.
Related reading
- Multi-neighbourhood providers: what they mean for medicines work
- Pharmacists working at scale across PCNs and federations
- Neighbourhood health and medicines: how clinical pharmacy gets organised at scale
Planning medicines work across a group of practices? Send us an enquiry and we will reply within one working day.
Frequently asked questions
Does a federation replace the PCN for medicines work?
Federations and PCNs usually work side by side. The PCN remains the network for its member practices, and a federation can co-ordinate a workstream across several PCNs where one standard helps.
Can INT medicines work be delivered remotely?
Much of it can. Medication reviews prepared before a multidisciplinary meeting, polypharmacy searches, monitoring and reconciliation all happen in the clinical record, and findings pass to the INT through the agreed route.
Who decides the medicines priorities for a neighbourhood?
Local commissioners and providers agree them. The Neighbourhood Health Framework asks ICBs to set clear expectations and contract accordingly, and the INT and its practices shape the detail.
Which clinical systems can one programme cover?
We work in EMIS, SystmOne, Vision and Medicus, and one programme can span practices on different systems.
Can a federation start with one neighbourhood?
Yes. Starting with one neighbourhood or one cohort lets the federation test the protocol and the reporting before widening the work to other member practices.
