Recomendados
Recomendados
Mais conteúdo relacionado
Destaque
Destaque (16)
Semelhante a Optimising your Practice - a toolkit to survive a changing NHS environment
Semelhante a Optimising your Practice - a toolkit to survive a changing NHS environment (20)
Último
Último (20)
Optimising your Practice - a toolkit to survive a changing NHS environment
- 1. Optimising your Practice - tools to survive a changing NHS environment Thursday 9 October The Kings Fund, London
- 2. Welcome and chair’s comments • Programme overview • Housekeeping announcements
- 3. Keynote Speech: What next for general Practice? - now and in the future Michelle Drage Chief Executive Officer Londonwide LMCs
- 4. Optimising your Practice - tools to survive a changing NHS environment Session 1
- 5. New ways of working in primary care Greg Cairns Director of Primary Care Strategy Londonwide LMCs Shanee Baker Director LMC Law Limited
- 6. New ways of working for www.lmc.org.uk General Practice Greg Cairns Director of Primary Care Strategy, Londonwide LMCs Shanee Baker Director, LMC Law
- 7. 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 www.lmc.org.uk care • GP Access and availability • Avoiding unplanned admissions, A&E admissions
- 8. 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
- 9. www.lmc.org.uk Challenges for GPs • Falling income • Contractual changes • Capacity • Primary Care development/infrastructure • Expectations; assumptions • Competition, procurement • Independent contractor, smaller practices?
- 10. 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
- 11. 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.
- 12. Network Provider Organisations • Different models: e.g. Company Limited, Community Interest Company, Super-partnerships, www.lmc.org.uk 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.
- 13. 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
- 14. 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.
- 15. What? why? and how? - the future of General Practice Dr Tim Ballard Vice Chair Royal College of GPs
- 16. Why, what and how? The future for English General Practice Dr Tim Ballard Vice-Chair Royal College of General Practitioners 9th October 2014
- 17. Why? Why - are we where we are? Shipman The 2004 Contract Sustainability & Austerity Changing Demography The personalised Society The Health & Social Care Act 2012
- 18. 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
- 19. 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
- 20. 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)
- 21. How? How - do we know we are making progress? The Labour Party Conference The Conservative Party Conference The RCGP Conference
- 22. How? How – should the profession respond? A salaried service – APMS and private providers? Vertical integration or Integrated Care Organisations? Independent contractor status?
- 23. 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
- 24. 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
- 25. How? How – do we organise ourselves? The Use of Co-Commissioning The Whole systems Integrated Care Toolkit
- 26. Federate - Yes - so why not merge? Andrew Lockhart-Mirams Founding Partner Lockharts Solicitors
- 27. FEDERATE – “Yes” So why not merge? Lockharts (c) 2014 27
- 28. Perhaps a “Good thing” but…… Lockharts (c) 2014 28
- 29. 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
- 30. Liabilities • Compare • Liability as shareholder, and • Joint and several liability as a partner Lockharts (c) 2014 30
- 31. 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
- 32. Reality • Succession – in practice and with patients • Loss of independence • Contract structure • Behind the company façade • Premises • Staff Lockharts (c) 2014 32
- 33. Disposals • Straight succession to new partners • Retirement and dispersal • An “acquisition” Lockharts (c) 2014 33
- 34. 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
- 35. 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
- 36. Contact Details Lockharts Solicitors alm@lockharts.co.uk 020 7383 7111 www.lockharts.co.uk Lockharts (c) 2014 36
- 37. Maximising Practice Income Jane Betts Director of Primary Care Strategy Londonwide LMCs Vicky Ferlia Director of GP Support Londonwide LMCs
- 38. Maximising Practice Income Jane Betts – Director of Primary Care Strategy Vicky Ferlia – Director of GP Support www.lmc.org.uk 9th October 2014
- 39. 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
- 40. What can Practices Do? www.lmc.org.uk Financial health check to: • Establish your current financial position – benchmark yourself against other practices • Minimise expenditure • Maximise income opportunities • Access all possible funding
- 41. 1. Accurate List Size • Essential for calculations • Regular list maintenance (FP69s) • Agree & address anomalies with NHSE • Ensures viability www.lmc.org.uk
- 42. 2. Understand Your Practice’s www.lmc.org.uk 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
- 43. 3. Understand Core Practice www.lmc.org.uk Income • GMS/PMS/APMS Contract Payments – Open Exeter • DES payments – CQRS & manual claims • QoF Payments • Must have robust tracking systems in place
- 44. 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
- 45. 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
- 46. 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
- 47. 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: gpsupport@lmc.org.uk
- 48. www.lmc.org.uk Thank you Any questions?
- 49. Q & A Panel Optimising your Practice - tools to survive a changing NHS environment
- 50. Refreshment Break Optimising your Practice - tools to survive a changing NHS environment
- 51. Optimising your Practice - tools to survive a changing NHS environment Session 2
- 52. Protecting your Practice from internal threats Jill Coote Specialist Employment Law Advisor Avensure
- 54. Protecting your GP Practice from threats within your Practice
- 55. Presented by: Jill Coote LLB (Hons) Law 25yrs in HR & Employment Law including HR Directorship
- 56. Founded on an innovative philosophy of efficiency and excellence, we are unique, insurance-backed Employment Law specialists
- 57. Credibility and compliance within your business
- 58. Helping you to get it right
- 59. I DON’T KNOW I HAVE GOT A PROBLEM UNTIL I HAVE ONE !
- 60. • Optimising staff performance • Managing staff & dealing with internal complaints within your Practice • Getting the right outcome
- 62. Staff can be: Good Bad Indifferent
- 63. All need to be managed!
- 64. WHO RUNS YOUR PRACTICE?
- 65. DO YOUR STAFF KNOW WHAT THEY SHOULD BE DOING?
- 66. Job Descriptions
- 68. Capability What policies do you have?
- 69. Disciplinary What policies do you have?
- 70. mediate successfully = active management
- 72. Is the solution the right one?
- 73. Managing successfully = Your gateway to success
- 74. Use policies and procedures as a PROACTIVE TOOL FOR YOUR PRACTICE
- 75. STATE YOUR RULES! Protect your Practice
- 76. Protect your GP Practice Ensure processes are adhered to Also reflect current legislation No discrimination
- 77. EMPLOYEES HAVE 78 STATUTORY RIGHTS FROM THE FIRST DAY!
- 79. LET EMPLOYMENT LEGISLATION WORK FOR YOU
- 80. Effective contracts Policies and Procedures reflecting your Practice needs Getting the correct advice
- 81. Ensuring it is up to date !
- 82. EXPENSES MOBILITY SMOKING EQUAL OPPORTUNITY HEALTH & SAFETY HOLIDAYS POLICIES LONE WORKER CAR HARASSMENT LANGUAGE RIGHT TO SEARCH ALCOHOL INTERNET E-MAIL WASTAGE LAY OFF DRUGS MAIL STRESS NOTICE MEDIA BULLYING HYGIENE ABSENCE MOBILE PHONE OTHER EMPLOYMENT LEAVE DRESS CODE
- 83. Application for Employment Return to Work Interview Form Exit Interview Parental Leave Request Holiday Request Holiday Records DOCUMENTATION SSP Withheld Notification of Absence Self Certification Equal Opportunity Monitoring Employee Records Change of Personal Details Proof of Identity Disciplinary Record Staff Appraisals Induction Checklist Interview Rating Other Employment Request
- 84. GRAVITAS WITHIN YOUR BUSINESS it’s not about taking oneself seriously – it’s about taking what one does seriously.
- 85. Enables you to: Manage staff Optimise staff performance Make effective decisions
- 87. WHAT DO I NEED IN PLACE?
- 88. CONTRACTS POLICIES PROCEDURES JOB DESCRIPTIONS INDUCTION
- 89. OUTCOME......
- 90. STANDARDS AND EXPECTIONS PEOPLE WORKING WITHIN YOUR PRACTICE
- 91. HOW CAN WE HELP?
- 92. YOUR HR PARTNER
- 93. COME AND TALK TO US
- 94. A way forward – making something happen Paul Wainwright Founding Director QAD Architects
- 95. A Way Forward - making something happen by Paul Wainwright QAD Architects - Director
- 96. QAD Architects ▪ www.q-ad.co.uk 1 2 3 4 6 1 2 3 4 5 1.0 Site Analysis 5 6
- 97. QAD Architects ▪ www.q-ad.co.uk 1.0 Site Analysis
- 98. QAD Architects ▪ www.q-ad.co.uk 1.0 Site Analysis
- 99. QAD Architects ▪ www.q-ad.co.uk 1.0 Site Analysis
- 100. 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
- 101. QAD Architects ▪ www.q-ad.co.uk 2.0 Design Concept
- 102. QAD Architects ▪ www.q-ad.co.uk 2.0 Design Concept
- 103. QAD Architects ▪ www.q-ad.co.uk 3.0 The Proposal : Ground Floor Plan
- 104. QAD Architects ▪ www.q-ad.co.uk 3.0 The Proposal : First Floor Plan
- 105. QAD Architects ▪ www.q-ad.co.uk 4.0 Artist Impressions
- 106. QAD Architects ▪ www.q-ad.co.uk 4.0 Artist Impressions
- 107. QAD Architects ▪ www.q-ad.co.uk 4.0 Artist Impressions
- 108. QAD Architects ▪ www.q-ad.co.uk 4.0 Artist Impressions
- 109. QAD Architects ▪ www.q-ad.co.uk 5.0 The Completed Project
- 110. QAD Architects ▪ www.q-ad.co.uk 5.0 The Completed Project
- 111. QAD Architects ▪ www.q-ad.co.uk 5.0 The Completed Project
- 112. QAD Architects ▪ www.q-ad.co.uk 5.0 The Completed Project
- 113. QAD Architects ▪ www.q-ad.co.uk Thank you Any questions?
- 114. Optimising clinician/patient interactions Dr Jim Gardner Group Medical Director OneMedicalGroup
- 115. 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!
- 116. 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
- 117. n=1 commissioning There are over 300 million consultations per year in England. What happens in them is important! Overarching factors: Setting, level of access, time of day, time available, options available to clinician and patient, social and cultural context Clinician Patient Outcome Education & training Policy & guidelines Custom and practice Personality Attitude to risk Level of engagement Available time Decision support systems Shared understanding Age, sex, social class Culture Intelligence Wealth Experience Personality Information Social marketing Product marketing Advice Review Immediate treatment Prescription Further investigations Referral for 2nd opinion Referral for treatment
- 118. Proposed Ground Floor Plan
- 119. Property and Estates Facilities Management Management • 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
- 120. Resilience and Grip
- 122. Significant Event Reporting Q1 - 2014 20 18 16 14 12 10 8 6 4 2 0 Significant Events 2014-Q1
- 123. Integrated management data Monthly Performance Summary Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Centre 6 Centre 7 Green Amber Red Cost, Effectiveness and Efficiency Registered patient list target v actual monthly growth Target: +4 Actual: +3 Target: +28 Actual: -102 Target: +12 Actual: +5 Target: +12 Actual: +28 Target: +35 Actual: +37 Target: +44 Actual: +32 Target: +116 Actual: +135 100% + of target 95 - 99% of target less than 95% Walk in volume targeted monthly walk in volume Target: 6825 Actual: 6018 Target: 840 Actual: 865 Target: 3175 Actual: 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 Patient Care 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% Registered Patient List Cost Centre 7 Centre 6 Centre 5 Centre 4 Centre 3 Centre 2 Patient Care 20 18 16 14 12 10 8 6 4 2 Unscheduled Care Performance For information only To be measured from September 18 10 19 Monthly Group Staff Spend 25 17 £600,000 £500,000 £400,000 £300,000 £200,000 £100,000 30 25 20 15 10 5 0 Number of complaints Total OMC Number of Complaints 80% 85% 90% 95% 100% 105% 110% Centre 1 Monthly Staff Costs Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Centre 6 Centre 7 £120,000 £100,000 £80,000 £60,000 £40,000 £20,000 £0 Monthly Salaried Cost v Locum Cost Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Centre 6 Centre 7 Salaried Spend (£) Locum Spend (£) 800 700 600 500 400 300 200 100 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Walk in's per week Centre 1 Target Actual Last Year 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 1800 1600 1400 1200 1000 800 600 400 200 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Walk in's per week Centre 2 Target Actual Last Year 300 250 200 150 100 50 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Walk In's per week Centre 3 Target Actual Last Year 4600 4550 4500 4450 4400 4350 4300 4250 5050 4950 4850 4750 4650 4550 4450 4350 4250 1 3 5 7 9 11 13 15 17 19 21 List Size Centre 2 FY13/14 Target Actual list size 4200 1 3 5 7 9 11 13 15 17 19 21 List Size Centre 1 FY13/14 Target Actual list size 2700 2650 2600 2550 2500 2450 2400 2350 2300 1 3 5 7 9 11 13 15 17 19 21 List Size Centre 3 FY13/14 Target Actual list size 10000 9950 9900 9850 9800 9750 9700 9650 9600 1 3 5 7 9 11 13 15 17 19 21 List Size Centre 4 FY13/14 Target Actual list size 2100 2050 2000 1950 1900 1850 1800 1750 1700 1 3 5 7 9 11 13 15 17 19 21 List Size Centre 5 FY13/14 Target Actual list size 7200 7150 7100 7050 7000 6950 6900 6850 6800 1 3 5 7 9 11 13 15 17 19 21 List Size Centre 6 FY13/14 Target Actual list size 3400 3350 3300 3250 3200 3150 3100 3050 3000 1 3 5 7 9 11 13 15 17 19 21 List Size Centre 7 FY13/14 Target Actual list size 14 17 2 8 13 5 6 0 4 6 2 2 1 2 17 18 1 11 6 1 1 0 Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Centre 6 Centre 7 Number received SER's, Complaints & Compliments Total SER's Total Complaints Total Compliments 100% 75% 76% 88% 90% 86% 0% Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Centre 6 Centre 7 Percentage of satisfied patients Patient Satisfaction £0 April May June July August
- 124. Contact details Dr Jim Gardner Group Medical Director jimgardner@onemedical.co.uk Telephone: 0113 284 3158 Mobile: 07794 965874
- 125. Q & A Panel Optimising your Practice - tools to survive a changing NHS environment
- 126. What happens next? For more information on any aspect of today’s presentations please contact us: Jane Sadler Head of Business Development & Marketing 07972 231 526 newbusiness@onemedical.co.uk Optimising your Practice - tools to survive a changing NHS environment