optimising your practice - a toolkit to survive a changing nhs environment
DESCRIPTION
Slides presented at the recent education seminar held at the King's Fund, London on 9 October 2014. This event was hosted by OneMedicalGroup, a nationally recognised and award winning provider of bespoke premises solutions and patient focussed care. For more information please see: www.onemedicalgroup.co.ukTRANSCRIPT
Optimising your Practice- tools to survive a changing NHS environment
Thursday 9 OctoberThe Kings Fund, London
Welcome and chair’s comments
• Programme overview• Housekeeping announcements
Keynote Speech: What next for general Practice?- now and in the futureMichelle Drage Chief Executive OfficerLondonwide LMCs
Optimising your Practice- tools to survive a changing NHS environmentSession 1
New ways of working in primary careGreg CairnsDirector of Primary Care StrategyLondonwide LMCs
Shanee BakerDirectorLMC Law Limited
www.lmc.org.uk
New ways of working forGeneral Practice
Greg CairnsDirector of Primary Care Strategy, Londonwide LMCs
Shanee Baker Director, LMC Law
www.lmc.org.uk
The world is changing
• Multi/Co-morbidity; ageing population• Financial pressures (£6.5 billion gap in
London to 2020); cost-cutting• Focus on integrated care, LTCs, co-
ordinated care• GP Access and availability• Avoiding unplanned admissions, A&E
admissions
www.lmc.org.uk
And so is the NHS!
• Systemic changes; commissioning and delivery at wider scale and pace; new organisations
• Reduced specialist care, hospitalisation, pathways/networks of care
• Shifting services; more community-based care• Accountable/Integrated Care• Outcomes-based commissioning• Merged health and social care budgets; Better
Care Fund
www.lmc.org.uk
Challenges for GPs
• Falling income• Contractual changes• Capacity• Primary Care development/infrastructure• Expectations; assumptions• Competition, procurement• Independent contractor, smaller practices?
www.lmc.org.uk
Partnerships
• Before focusing on the new, strengthen the old !
• Protect Partners• Protect Core Contracts• Reinforce your partnership agreements• Old agreements make not be fit for
purpose: take into account CCG membership obligations, provider network organisations, new contract amendments
www.lmc.org.uk
Protecting Core
• Mergers – GMS/PMS• Shared Resource and working
collaboratively: staff/administration• May mean bigger partnerships or
agreements between individual partnerships
• The message is to try not to lose your core to APMS.
www.lmc.org.uk
Network Provider Organisations
• Different models: e.g. Company Limited, Community Interest Company, Super-partnerships, LLPs
• Focus is on having a more robust entity: strength in numbers, more expertise, more resource, more regulated.
• Important for bidding/tendering for contracts• Commissioners want to deal with a single
identifiable entity.
www.lmc.org.uk
So - What does that really mean for GPs?
• Practices can no longer work in isolation• Limitation of risk and liability• More regulated• Need to strengthen partnership
agreements• Need to engage to survive• Contracts (e.g. LES’s) not longer
guaranteed
www.lmc.org.uk
The GOOD NEWS
• GPs have the expertise• GPS have the patients and the relationships• GPs have the premises• Support IS available from your LMC who
have broadened their remit to cater for new requirements and needs – much of the initial advice is available as part of your core membership – make use of it before making decisions about your future.
What? why? and how? - the future of General Practice
Dr Tim BallardVice ChairRoyal College of GPs
Why, what and how?
The future for English General Practice
Dr Tim Ballard Vice-Chair
Royal College of General Practitioners9th October 2014
Why?
Why - are we where we are?
Shipman
The 2004 Contract
Sustainability & Austerity
Changing Demography
The personalised Society
The Health & Social Care Act 2012
What?
What - are the pressures for change?
A Call to Action (NHSE)
The Future Hospital Report (RCP)
The Dalton Review
The Urgent & Emergency Care Review
What?
What - are the pressures for change?
Specialised Services in OOH Settings
The Oldham Report
Chen – Med & Segmentation of Primary Care
General Practice Delivered at Scale (NHSE)
CQC
How?
How can the Profession Respond?
2022 - A Vision for General Practice (RCGP)
The inquiry into Patient Centred Care (RCGP)
Put Patients First Campaign (RCGP)
Your GP Cares (BMA)
How?
How - do we know we are making progress?
The Labour Party Conference
The Conservative Party Conference
The RCGP Conference
How?
How – should the profession respond?
A salaried service – APMS and private providers?
Vertical integration or Integrated Care Organisations?
Independent contractor status?
How?
How – should the profession respond?
Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations
Why?
Why – are Federations & Networks the answer?
Enable Professional Control
Keep the traditional patient facing feel of GP
Demonstrate the will to tackle variability
Control Segmentation
Control the way we work with Secondary Care
How?
How – do we organise ourselves?
The Use of Co-Commissioning
The Whole systems Integrated Care Toolkit
Federate - Yes- so why not merge?
Andrew Lockhart-MiramsFounding PartnerLockharts Solicitors
FEDERATE – “Yes”
So why not merge?
Lockharts (c) 2014 27
Perhaps a “Good thing” but……
Lockharts (c) 2014 28
Some caution is needed if you want to go as far as merging–
markedly different characteristics
• Liabilities • Aims• Succession• Disposals• Premises
• Retirement• Staff• Loss of independence• Different contract
structure
Lockharts (c) 2014 29
Liabilities
• Compare• Liability as shareholder, and• Joint and several liability as a partner
Lockharts (c) 2014 30
Aims
• “Partnership is the relation which subsists between persons carrying on a business in common with a view of profit” s.1 Partnership Act 1890
• There are totally different “feels” to a provider company
Lockharts (c) 2014 31
Reality
• Succession – in practice and with patients• Loss of independence• Contract structure• Behind the company façade
• Premises• Staff
Lockharts (c) 2014 32
Disposals
• Straight succession to new partners• Retirement and dispersal• An “acquisition”
Lockharts (c) 2014 33
Some caution is needed- lastly
• Because it could just happen by accident!• It is a matter of fact and not form• BUT• If it “fits” it could be a good thing
Lockharts (c) 2014 34
How Lockharts can help
• Over 30 years experience helping general practitioners
• “Full service” healthcare team for providers covering all aspects of partnership, surgery premises, employment contract work and contentious issues
• Extensive understanding of general practice issues and ambitions and detailed knowledge of regulation, policy, funding and contracts
• Accredited mediators helping with facilitation
• Structural advice and implementation of mergers and acquisitions
• Only acts for providers and never for commissioners
Lockharts (c) 2014 18
Contact Details
Lockharts Solicitors
k
020 7383 7111
www.lockharts.co.u
k
Lockharts (c) 2014 36
Maximising Practice Income
Jane BettsDirector of Primary Care StrategyLondonwide LMCs
Vicky FerliaDirector of GP SupportLondonwide LMCs
www.lmc.org.ukwww.lmc.org.uk
Maximising Practice Income
Jane Betts – Director of Primary Care StrategyVicky Ferlia – Director of GP Support
9th October 2014
www.lmc.org.uk
Background
NHS initiatives impacting on practice income:• Falling Investment• GMS – MPIG reduction• PMS – National Contract Review• GP Provider Unit Contracting• No new premises investment
www.lmc.org.uk
What can Practices Do?
Financial health check to:
• Establish your current financial position – benchmark yourself against other practices
• Minimise expenditure• Maximise income opportunities• Access all possible funding
www.lmc.org.uk
1. Accurate List Size
• Essential for calculations• Regular list maintenance (FP69s) • Agree & address anomalies with
NHSE• Ensures viability
www.lmc.org.uk
2. Understand Your Practice’s Expenditure
• Clinical and non-clinical staff (inc. partners’ drawings & locum costs) - largest cost
• Indemnity and subscriptions• Premises costs – rent reviews & service
charges• Utilities, cleaning & maintenance• Disposables & consumables
www.lmc.org.uk
3. Understand Core Practice Income
• GMS/PMS/APMS Contract Payments – Open Exeter
• DES payments – CQRS & manual claims
• QoF Payments• Must have robust tracking systems in
place
www.lmc.org.uk
4. Understand / generate additional practice income
• LCSs & PH Enhanced Services• Teaching• Travel clinic• Leasing of rooms (notional rent implications)• Offering non-contracted services to
commissioners (e.g. Carpal Tunnel surgery, vasectomies etc)
• Offering private services to non-registered patients (e.g. cosmetic procedures, homeopathy, acupuncture etc)
www.lmc.org.uk
Next Steps (1)• Undertake a full financial assessment of
your practice• Set annual budget & monitor regularly• Monitor locum and other costs• Review all utilities and other contracts• Understand NHSE’s & your CCG’s claim
process • Ensure all ES and other claims are
submitted in time as appropriate
www.lmc.org.uk
Next Steps (2)• Ensure maximum possible achievement
on QOF/ESs etc• Ensure practice evidence and audit trail is
clear• Are there penalties in place practice is
unaware of? Challenge claw backs as necessary
• Review your skill mix in line with practice service requirements
www.lmc.org.uk
Next steps (3)
If you discover financial discrepancies, or are chasing payments, or are being threatened
with claw backs:
Seek advice from the LMC, BEFORE discussing with NHSE or CCG.
Contact:
www.lmc.org.uk
Thank you
Any questions?
Q & A Panel
Optimising your Practice- tools to survive a changing NHS environment
Refreshment Break
Optimising your Practice- tools to survive a changing NHS environment
Optimising your Practice- tools to survive a changing NHS environmentSession 2
Protecting your Practice from internal threats
Jill CooteSpecialist Employment Law AdvisorAvensure
Protecting your GP Practice from threats within your
Practice
Presented by:
Jill Coote LLB (Hons) Law
25yrs in HR & Employment Law including HR Directorship
Founded on an innovative philosophy of efficiency and excellence,
we are unique, insurance-backed
Employment Law specialists
Credibility and compliance within your business
Helping you to get it right
I DON’T KNOW I HAVE GOT A PROBLEM UNTIL I HAVE ONE !
• Optimising staff performance
• Managing staff & dealing with internal complaints within your Practice
• Getting the right outcome
Staff can be:
GoodBad
Indifferent
All need to be managed!
WHO RUNS YOUR PRACTICE?
DO YOUR STAFF KNOW WHAT THEY SHOULD BE DOING?
Job Descriptions
CAPABILITY –V- DISCIPLINARY
Capability
What policies do you have?
Disciplinary
What policies do you have?
mediate successfully=
active management
IdentifyManageResolve
Is the solution the right one?
Managing successfully=
Your gateway to success
Use policies and procedures as a
PROACTIVE TOOL FOR YOUR PRACTICE
STATE YOUR RULES!
Protect your Practice
Protect your GP Practice
Ensure processes are adhered to
Also reflect current legislation
No discrimination
EMPLOYEES HAVE
STATUTORY RIGHTS FROM THE FIRST DAY!
78
PROTECTION
COMPLIANCE
LET EMPLOYMENT LEGISLATION
WORK FOR YOU
Effective contracts
Policies and Procedures reflecting your Practice needs
Getting the correct advice
POLICIES
EXPENSES
MOBILITY
CAR
HEALTH & SAFETY
LANGUAGE
RIGHT TO SEARCH
HOLIDAYS
ALCOHOL
INTERNET
LONE WORKER
WASTAGE
LAY OFF
DRUGS
STRESS
NOTICE
MEDIA
BULLYING
HYGIENE
ABSENCE
MOBILE PHONE
SMOKING
EQUAL OPPORTUNITY
OTHER EMPLOYMENT
LEAVE
DRESS CODE
HARASSMENT
DOCUMENTATION
Self Certification
Equal Opportunity Monitoring
Employee Records
Proof of IdentityChange of Personal Details
Parental Leave Request
Disciplinary Record
SSP Withheld Notification of Absence
Exit Interview
Application for Employment Return to Work Interview Form
Induction Checklist
Holiday Request
Interview Rating
Holiday Records
Other Employment Request
Staff Appraisals
GRAVITAS WITHIN YOUR BUSINESS
it’s not about taking oneself seriously – it’s about taking what one does seriously.
Enables you to:
Manage staffOptimise staff performance
Make effective decisions
Credibility
Respect
Trust
WHAT DO I NEED IN PLACE?
CONTRACTS
POLICIES
PROCEDURES
JOB DESCRIPTIONS
INDUCTION
OUTCOME......
STANDARDS AND EXPECTIONS
PEOPLE WORKING WITHIN YOUR PRACTICE
HOW CAN WE HELP?
YOUR HR PARTNER
COME AND TALK TO US
A way forward – making something happen
Paul WainwrightFounding DirectorQAD Architects
A Way Forward -
making something happen
by Paul Wainwright
QAD Architects - Director
QAD Architects ▪ www.q-ad.co.uk
1 2
3 4
6
1
2
3
4
5
1.0 Site Analysis
5
6
QAD Architects ▪ www.q-ad.co.uk
1.0 Site Analysis
QAD Architects ▪ www.q-ad.co.uk
1.0 Site Analysis
QAD Architects ▪ www.q-ad.co.uk
1.0 Site Analysis
QAD Architects ▪ www.q-ad.co.uk
2.0 Design Concept
PRIORY MEDICAL GROUP
• Consider Priory Medical Centre as hub.
• Radiate links to Group Surgeries
• Establish brand / association identity
QAD Architects ▪ www.q-ad.co.uk
2.0 Design Concept
QAD Architects ▪ www.q-ad.co.uk
2.0 Design Concept
QAD Architects ▪ www.q-ad.co.uk
3.0 The Proposal : Ground Floor Plan
QAD Architects ▪ www.q-ad.co.uk
3.0 The Proposal : First Floor Plan
QAD Architects ▪ www.q-ad.co.uk
4.0 Artist Impressions
QAD Architects ▪ www.q-ad.co.uk
4.0 Artist Impressions
QAD Architects ▪ www.q-ad.co.uk
4.0 Artist Impressions
QAD Architects ▪ www.q-ad.co.uk
4.0 Artist Impressions
QAD Architects ▪ www.q-ad.co.uk
5.0 The Completed Project
QAD Architects ▪ www.q-ad.co.uk
5.0 The Completed Project
QAD Architects ▪ www.q-ad.co.uk
5.0 The Completed Project
QAD Architects ▪ www.q-ad.co.uk
5.0 The Completed Project
QAD Architects ▪ www.q-ad.co.uk
Thank you
Any questions?
Optimising clinician/patient interactions
Dr Jim GardnerGroup Medical DirectorOneMedicalGroup
Why is this important?
• Bedrock of the medical model• Improves outcomes for patients• Improves efficiency• Improves cost-effectiveness• Improves patient satisfaction• Improves clinician satisfaction• Improves organisational satisfaction!
What are we trying to do?
Improve outcome
Improve experience
Optimise per capita
cost
Improve outcome
Improve patient
experience
Be a great place to work
Optimise per
capita cost
IHI Triple Aim
With thanks to David Fillingham
n=1 commissioningThere are over 300 million consultations per year in England.
What happens in them is important!
Clinician Patient Outcome
Overarching factors: Setting, level of access, time of day, time available, options available to clinician and patient, social and cultural context
Education & trainingPolicy & guidelinesCustom and practicePersonalityAttitude to riskLevel of engagementAvailable timeDecision support systems
Shared understanding
Age, sex, social classCultureIntelligenceWealth ExperiencePersonalityInformationSocial marketingProduct marketing
AdviceReviewImmediate treatmentPrescriptionFurther investigationsReferral for 2nd opinionReferral for treatment
Proposed Ground Floor Plan
Property and Estates FacilitiesManagementManagement• Consolidation of estates
resources• Estates management• Maximising the estate resource• Space utilisation• Re-modelling premises• Aligned to standardisation and
group purchasing• Property enabling strategy
• Outsourced group wide FM• An ‘average’ practice manager will
spend half a day a week or 24 days a year on FM
• On a PM salary of 30Kpa the average practice is spending £3000 per year
• And whilst they are doing this they can’t be doing anything more useful or value adding
• Over a group/federation outsourcing FM the savings are considerable
Resilience and Grip
Significant Event Reporting
Significant Event Reporting Q1 - 2014
Clinica
l care
Prescribing
Infection P&C
Communication
Information G
overnance
Patient conduct
Staff conduct
Appt/waiting time
building/F
M
Health &
Safety
Other servi
ce provid
erOther
0
2
4
6
8
10
12
14
16
18
20
Significant Events 2014-Q1
Integrated management data Monthly Performance Summary
Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Centre 6 Centre 7 Green Amber Red
Registered patient list target v actual monthly growthTarget: +4Actual: +3
Target: +28Actual: -102
Target: +12Actual: +5
Target: +12Actual: +28
Target: +35Actual: +37
Target: +44Actual: +32
Target: +116Actual: +135
100% + of target 95 - 99% of target less than 95%
Walk in volume targeted monthly walk in volumeTarget: 6825Actual: 6018
Target: 840Actual: 865
Target: 3175Actual: 2694
100% 95-99% 0 - 94%
Staff Costs % of monthly budget, inc. locum costs 143% 102% 125% 102% 102% 95% 108% 0 - 100% 101 - 105% 106% +
Locum Usage Locum spend as % of total staff costs 6% 3% 20% 14% 28% 51% 27%
Private Income % of monthly target achieved 28% 102% 65% 80% 146% 11% 160% 100% 95-99% 0 - 94%
Enhanced Services % of monthly target achieved 100% 95-99% 0 - 94%
Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Centre 6 Centre 7 Green Amber Red
QOF % at month end 63.77% 61.98% 61.98% 61.64% 66.46% 72.31% 65.00%
DNA % % DNA of all appointments 10% 4% 10% 12% 10% 11% 8% 9% - 10 - 11% 12%+
Patient Satisfaction Token board,% of patients satisfied or better 76% 88% 86% 90% 75% 100% 75% + 65 - 74% 0 - 64%
Complaints Number of complaints received 2 2 2 1 4 5 0 0-3 4 - 5 5 +
Compliments Number of compliments received 11 6 1 1 18 6 17 2+ 1 0
SER's Number of SER's submitted 8 13 6 5 17 2 14 2+ 1 0
Audit Compliance Total Audit compliance for the quarter % 86% 91% 95% 94% 98% 92% 97% 90% + 80 - 89% -80%
Patient Care
Cost, Effectiveness and Efficiency
Registered Patient List
Unscheduled Care Performance
Patient Care
Cost
For information only
To be measured from September
18
10
19
25
17
0
5
10
15
20
25
30
Num
ber
of c
ompl
aint
s
Total OMC Number of Complaints
80% 85% 90% 95% 100% 105% 110%
Centre 1
Centre 2
Centre 3
Centre 4
Centre 5
Centre 6
Centre 7
Monthly Staff Costs
Centre 1
Centre 2
Centre 3
Centre 4
Centre 5
Centre 6
Centre 7
£0
£20,000
£40,000
£60,000
£80,000
£100,000
£120,000
Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Centre 6 Centre 7
Monthly Salaried Cost v Locum Cost
Salaried Spend (£)
Locum Spend (£)
0
100
200
300
400
500
600
700
800
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Wal
k in
's p
er w
eek
Centre 1
Target
Actual
Last Year
0
200
400
600
800
1000
1200
1400
1600
1800
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Wal
k in
's p
er w
eek
Centre 2
Target
Actual
Last Year
0
50
100
150
200
250
300
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Wal
k In
's p
er w
eek
Centre 3
Target
Actual
Last Year
4250
4350
4450
4550
4650
4750
4850
4950
5050
1 3 5 7 9 11 13 15 17 19 21
List
Siz
e
Centre 2
FY13/14 Target
Actual list size
4200
4250
4300
4350
4400
4450
4500
4550
4600
1 3 5 7 9 11 13 15 17 19 21
List
Siz
e
Centre 1
FY13/14 Target
Actual list size
2300
2350
2400
2450
2500
2550
2600
2650
2700
1 3 5 7 9 11 13 15 17 19 21
List
Siz
e
Centre 3
FY13/14 Target
Actual list size
9600
9650
9700
9750
9800
9850
9900
9950
10000
1 3 5 7 9 11 13 15 17 19 21
List
Siz
e
Centre 4
FY13/14 Target
Actual list size
1700
1750
1800
1850
1900
1950
2000
2050
2100
1 3 5 7 9 11 13 15 17 19 21
List
Siz
e
Centre 5
FY13/14 Target
Actual list size
6800
6850
6900
6950
7000
7050
7100
7150
7200
1 3 5 7 9 11 13 15 17 19 21
List
Siz
e
Centre 6
FY13/14 Target
Actual list size
3000
3050
3100
3150
3200
3250
3300
3350
3400
1 3 5 7 9 11 13 15 17 19 21
List
Siz
e
Centre 7
FY13/14 Target
Actual list size
14
17
2
8
13
56
0
4
6
2 21
2
1718
1
11
6
1 1
0
2
4
6
8
10
12
14
16
18
20
Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Centre 6 Centre 7
Num
ber
rece
ived
SER's, Complaints & Compliments
Total SER's
Total Complaints
Total Compliments
100%
75% 76%
88% 90%86%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Centre 6 Centre 7
Perc
enta
ge o
f sa
tisfi
ed p
atien
ts
Patient Satisfaction
£0
£100,000
£200,000
£300,000
£400,000
£500,000
£600,000
April May June July August
Monthly Group Staff Spend
Contact details
Dr Jim GardnerGroup Medical Director
[email protected]: 0113 284 3158 Mobile: 07794 965874
Q & A Panel
Optimising your Practice- tools to survive a changing NHS environment
What happens next?
For more information on any aspect of today’s presentations please contact us:
Jane SadlerHead of Business Development & Marketing07972 231 [email protected]
Optimising your Practice- tools to survive a changing NHS environment