Building Healthcare Collaboration from the Ground Up: Insights from a Federation CEO

As always, we write our blog for primary care leaders, and this blog is specifically for those of you who:

Are managing collaborative working between GP practices
Want to understand how federations and PCNs can work together effectively
Are looking for practical insights on navigating financial challenges in primary care

I recently sat down with Darren, CEO of K2 Healthcare, where he shared:

How K2 Healthcare structured their neighbourhood approach before PCNs.
Practical solutions for financial challenges facing GP practices.
Building trust and effective governance in healthcare collaborations.
Advice for new healthcare leaders.

Let's Jump In!

Teal square with text: "Building healthcare collaboration from the ground up. Insights from a federation CEO Darren Altus." Includes video.

Watch the interview or keep scrolling to read the blog.

Understanding the Structure

K2 Healthcare has been pioneering collaborative healthcare for years. Darren explained:

"I'm the CEO of K2 Healthcare, which is a federation of 16 GP practices, and within that, we have two neighbourhoods / two PCNs, so our Grantham area and our Sleaford area. In my spare time as well, I'm the director of transformation for our PCN Alliance, which sees all of the 14 PCNs working together across Lincolnshire."

What's fascinating is that they were ahead of the curve on neighborhood-based care:

"We had neighbourhoods before the mandate and the support that came with PCNs."

This proactive approach demonstrates how grassroots innovation often precedes formal policy structures in healthcare.

Financial Realities and Solutions

When I asked about financial challenges, Darren made an important distinction:

"It's more from the viewpoint of an individual GP practice than from a federation's standpoint. From a federation's perspective, it's challenging, as we're navigating very different territory."

"We base our financial planning on a worst-case scenario. This year, our model accounted for increased pay without raising the overall cap. Similarly, for the next year's additional roles scheme, we have planned for no inflationary wage increase within that cap and have also considered a national insurance rise."

This cautious planning has served them well in navigating uncertainty.

Solution-Focused Collaboration

Despite challenges, Darren emphasised their commitment to finding solutions:

"We as a federated group of practices have been solution-focused, our voices around designing, innovating, creating solutions."

Examples of successful collaborative initiatives include:

Coordinated Care for Complex Patients: "Much of our effort is focused in that area. We are organising care for our frailest and most complex individuals by forming a neighbourhood team. This is achieved through the additional roles reimbursement scheme to introduce new services and establish a new team in the community."

Research at Scale: "Collaborating as a network of 16 practices to conduct a research program is significantly more feasible at this scale, allowing us to support, manage, and simplify participation for the practices. Additionally, it generates some income."

Service Provision: "We offer services to our treatment centre and community diagnostic centre, as well as asylum services... We are seeking more opportunities to excel in the community, which is where we also aim to generate additional income."

What Good Governance Looks Like

When questioned about the qualities of an effective board, Darren highlighted the importance of trust.

"The key to creating an effective board is trust, which is built through proven achievements and delivering results. An effective board operates with governance that functions smoothly without the need to consult the rule book at every meeting."

"This trust-based approach has created remarkable consensus".

Workforce Models and Flexibility

K2 Healthcare takes a pragmatic approach to staffing:

"We have carefully designed our service model to find the best fit for delivery. By incorporating a remote pharmacy into our model, we have created more flexibility and options for our team"

This flexibility extends to how they structure their decision-making and collective working... but it's not perfect.

"Our clinical directors and PCN managers meet frequently. We address different and the same topics, sometimes through a different lens, and come us together as we need to."

Essential Advice for Healthcare Leaders

After nearly eight years as CEO, Darren offers valuable advice for those new to healthcare leadership:

Build Relationships:Invest in getting to know people and seek support from the right sources. You cannot do it all by yourself.
Listen More Than You Speak and spend the time to get to know the environment.
Choose Your Battles: Not everything needs to be addressed immediately. It’s crucial to decide which issues to focus on and contest.
Maintain Resilience: Brush yourself off and keep going. Your friends will help you get over a bad week.

The Future of Healthcare Collaboration

Looking ahead, Darren sees stronger collaboration as key:

"Strengthening the collaboration across our PCNs... Now we're looking at a view of doing things across a county, and to do that, we need to do that in partnership with our neighbouring PCNs."

He envisions a future where federations can:

Strengthen collaborative models across larger geographic areas.
Deliver effectively on national requirements.
Develop additional income streams to support member practices.
Create more opportunities for community-based care.

The Bottom Line

Whether you're managing a PCN, leading a federation, or considering new collaborative structures, the key insights from Darren's experience include:

Start with Trust: Build relationships and governance models based on trust.
Plan for the Worst, Hope for the Best: Take a conservative approach to financial planning.
Focus on Solutions: Keep innovation and problem-solving at the centre of your work.
Be Patient-Centered: Keep patient needs at the heart of all decisions.
Choose Flexibility: Let service needs drive your organisational models.

Remember, it's not just about creating structures - it's about building relationships that enable better patient care across your community.

This interview was recorded in March 2025, following the release of new guidelines on neighbourhood health and GP contract changes.

About Us

THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network Management and the creator of the Business of Healthcare Podcast. With over 20 years in the industry, we've supported more than 200 PCNs through interim management, training, and consultancy.

Our expertise spans project management and business development across both private and public sectors. Our work has been published in the London Journal of Primary Care, and we've authored over 250 blogs sharing insights about primary care networks.