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@WardHadHealth
#GPFed
@BWMedical
#GPFed
@ScottMcKenzieCo
#GPFed
National GP Federation Showcase 2015
Thursday 15th October 2015
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Network: LoveMcr
Password: internet
@WardHadHealth
#GPFed
@BWMedical
#GPFed
@ScottMcKenzieCo
#GPFed
Overview of developments in the health service –
opportunities and threats for general practice and
federations
Dr James Kingsland OBE
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Thank you to our supporters
@WardHadHealth
#GPFed
@BWMedical
#GPFed
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#GPFed
All that glitters is not gold
Scott McKenzie
Wifi
Network: LoveMcr
Password: internet
All that glitters is not gold
“the attractive external appearance of something is not a reliable indication of its true nature”
Agenda
• Identifying opportunities
• Understand your motive
• How to cost the work and assess whether it is viable
• Negotiation (not conceding things unnecessarily, knowing when to say no/stand firm)
“The definition of insanity is doing the same thing over and over
again and expecting a different result.”
~ Albert Einstein
Major change failure…….
• Embedded behaviours (culture) from the past prevents the new strategy from delivering.
• You need an agreed strategy that will change the culture – Deliver the outcomes and objectives set within your
business plan.
• Requires you working daily to change behaviours, – Most importantly the deeply embedded behaviours,
learned over many years. – If not addressed likely to prevent the Federation from
flourishing as a ground upwards organisation.
Existing Outcomes
Existing Mindset
Existing Work Practices
Changed Mindset
New Work Practices
Desired Outcomes
Level of COGNITION
Continuum of resistance to change (P.Scholtes)
Where to start - Identifying opportunities?
Small and grow?
• Slower to get to full scale
• Often small income
• Less dramatic
• Engagement more straightforward
• Easier and quicker to implement
• Hub and spoke
• Lead by example
Go large?
• Engagement often challenging
• One giant leap is hard to achieve
• Membership often don’t want
• Immediate scale
• Significant income
• Lead by example
Where to start - understand your motive
• Expanding your existing service
• Expanding or improving capacity
• Reducing waste
• Improving value for money
• Developing a new service
• Generating income for Practices
• Providing staff for Practices
• Shifting care from in to out of hospital
• Service integration
• Etc.
Selecting the right services
• Data and skills analysis
• Local priorities – Public Health
– Local Development Plan
– Local Health Needs
• Look for the procedures – Delivered in hospital
– Could be delivered in Primary Care
• Outside the scope of GMS / PMS – Where scale and pace are
required to implement
• Sustainability – Does the volume tie to the skills
available to you?
– Can you buy in new skills
– Train and develop
• Best plans (at this stage) focused at; – Capacity
– Patient Choice
– Access
– In hospital to out of hospital shift
• Who will commission? – CCG?
– FT?
– Public Health?
– Other?
Costing the service
• Legal • HR • Insurance • Training • IT • Premises • Equipment • Communications • Engagement • Delivery costs • Director costs • Profit
• All have a number of sub sets
• All are required to run a service
• Some standards costs exist within the NHS
• For profit or not for profit; what level do you set – You cannot run at cost
Negotiation
• Adopt four positions 1. Your ideal 2. Where you may start with
agreed steps to reach ideal
3. A start point but no more 4. Breakdown
• Never negotiate on price only ever negotiate on work – If the commissioner wants
to pay less….. – If the money is not right…..
• Demonstrate how you will achieve: – Improved outcomes
– Pathways and minimum standards
– Patient, practice and health economy benefits
– Patient, practice and health economy outcomes
– Efficiencies
– Reduced variation – Etc.
Other key learning
1. Key Performance Indicators (KPI) – Tell you what to do to increase performance
dramatically (day in day out performance)
– A monthly, quarterly or annual measure cannot therefore be a KPI
2. Key Results Indicators (KRI) – Confirm how you have done in relation to the
critical success factors
– Ties to results indicators, which tell you what you have done
"In business, words are words, explanations are explanations, promises are promises, but only
performance is reality."
Harold Geneen
Industrialist
Summary
What’s worked for others?
• 24 Hour ECG
• 24 Hour ABPM
• 12 Lead ECG
• Front door to A&E
• Extended Access
• Remote Monitoring of INR
• FT subcontract
• FT subcontract
• FT subcontract
• FT subcontract
• CCG direct contract
• Federation choice to replace LES delivery
"Ideas are a dime a dozen. People who implement them are priceless.”
Mary Kay Ash,
Entrepreneur
Summary
• E+R=O
• Identifying the right opportunities
• Understand your motivation
• Cost correctly
• Negotiate firmly
• SYSTEM AND PROCESS ARE THE KEY!
"The only difference between successful
people and unsuccessful people is extraordinary
determination.”
Mary Kay Ash, Entrepreneur
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Subcontracting
Dr. Antony Moore
Director, Newcastle General Practice Services Ltd
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The Background
» Formation of a Federation in Newcastle upon Tyne in late 2013 to facilitate
Practices working together.
» Deliver services that individual members could not provide.
» Powerful, successful and prominent FT in Newcastle, NuTH
» Historical suspicion about the motives of the FT evidenced by takeover of
some Practices in/about Newcastle by another organisation, Freeman
Clinics, with links to the FT
» Sense of lack of engagement with Primary Care from PCT days onwards.
24 Hour ABPM
» Originally existed as a LES in Newcastle.
» Part of NICE guidance on the diagnosis of hypertension.
» Delivered in Practices and well liked by patients and clinicians.
» On expiry of the LES Newcastle CCG opted not to continue it.
» Strong desire to maintain the service in the Community.
» Referral in to the FT, via the Renal Department, posed capacity issues for
the FT.
» NGPS entered in to (reasonably) complicated negotiations with the FT
about subcontracting with a split tariff.
Subcontracting – benefits
» Allowed the continued delivery of a well liked and clinically relevant
service.
» Generated income for Practices and NGPS.
» Flexibility to add new members through contract variation.
» Led to further subcontracts, ECG, GPs in ED.
» Ongoing work on further proposals, these include DVT pathway, 24 hour
ECG.
» FT deals with a single Provider responsible for governance.
Subcontracting – cautions
» Complex agreements not familiar to nascent Federations or to GPs.
» Very familiar to the FT.
» Contain complex commitments around Governance.
» Legally binding with clear implications regarding the responsibilities of
Directors.
Subcontracting – lessons
» Importance of legal advice.
» Certain elements and questions are not easily resolved with “round robin”
emails.
» NGPS seen as a more business like entity for surviving the process.
» Member Practices DO NOT (always) read them.
@WardHadHealth
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Refreshment break
Text your questions for the
speakers and expert panel to:
07872 062 259
Or fill out the slip in your pack
and hand it in at the registration
desk before the end of the
afternoon break
Wifi
Network: LoveMcr
Password: internet
@WardHadHealth
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#GPFed
Contracting and staffing considerations for federations Alison Oliver, Associate, Ward Hadaway
Stuart Craig, Partner, Ward Hadaway
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Outline of session
1. Contracting to provide services
2. Staffing – some common pitfalls and how to avoid them
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Contracting to provide services
Alison Oliver
Associate, Ward Hadaway
Wifi
Network: LoveMcr
Password: internet
Contracting overview – where federations fit in
P3 P1 P2 P3 P4 P5 P6 P7
GP Federation Ltd
Shares CCGs LAs NHSE
GM
S/P
MS
AP
MS
/DE
S
Typical contracting routes
» Competitive tender
» Qualified provider
» Subcontractor
What is a contract?
» Agreement between two or more parties
» Giving rise to enforceable obligations
» May or may not be in writing
» Specific terms
» Express
» Implied
» Valuable consideration
NHS contracting
» GMS
» PMS
» APMS
» NHS Standard Contract
The NHS Standard Contract
» General conditions – national terms
that apply in all contracts
» Service conditions – national terms
that apply where specific services are
being commissioned
» Particulars – set out who the
contracting parties are and schedules
with locally agreed detail
Contracting – some common issues and pitfalls
» Unclear or uncertain terms
» Who holds the contract
» Entire agreement
» Variations & implied terms
» Termination
» Subcontracting
Uncertain terms
» Is it clear exactly what has to be done, by
whom, when, where and to what standard?
» Watch out for:
» Ambiguity
» Conflicting terms
» Vagueness
Who holds the contract?
• Alliance
• Network
• Partnership
• LLP
• Company limited by
shares or guarantee
Entire agreement
» This contract constitutes the entire
agreement between the parties and
supersedes any previous agreement
relating to the subject matter of this
contract.
» Check that all the main points negotiated
prior to contract are included.
Variations v implied terms
» All variations to this contract must be agreed in
writing by all the parties.
» But NB in NHS Standard Contract, variations
mandated by NHS England to give effect to
changes in the standard contract can be
imposed.
» Terms might be implied by conduct.
» The Coordinating Commissioner may terminate this contract
by giving the Provider written notice of not less than the
Commissioner Notice Period, expiring no earlier than the
Commissioner Earliest Termination Date
» Various other circumstances in which the commissioner can
terminate
» Provider default vs no fault
» The Provider may terminate this contract by giving the
Commissioner written notice of not less than the Provider
Notice Period, expiring no earlier than the Provider Earliest
Termination Date
» Various other circumstances in which the commissioner can
terminate
» Commissioner default vs no fault
Termination
Consequences of termination
» If as a result of termination the Commissioner procures any service from
an alternative provider the Commissioner (acting reasonably) can recover
excess costs from the Provider for six months after termination.
» Various other provisions including succession plan.
Subcontracting
P3 P1 P2 P3 P4 P5 P6 P7
GP Federation Ltd
Commissioner(s)
Foundation Trust
Subcontracting
» Subcontracting must be permitted under the head contract
» As head contractor:
» Obtain consent or ensure that permitted subcontractors are named in
the head contract
» Ensure that your obligations are passed on in the subcontract
» Ensure that if subcontractors fail to deliver, you can:
»Step in/re-allocate the work
»Recover your costs/losses
» As subcontractor:
» Check that your obligations are limited to those applicable to the
particular services that you are providing
» Check that your obligations are no more onerous than those of the
head contractor in relation to the services that you are providing
Contracting overview – alliance contracting
Commissioner(s)
GP Federation Ltd Foundation Trust Other Providers
Alliance Contract
Contracting overview – joint venture organisations
GP Federation Ltd Foundation Trust Other Providers
Joint Venture Co
Commissioner(s)
In summary
» Read the contract!
» Take advice if required
» Are the provider's and the commissioner's
obligations clear and unambiguous?
» Is anything missing?
» Can you fulfil your obligations?
» What are the consequences of breach?
» Do you have a "get out" clause?
@WardHadHealth
#GPFed
@BWMedical
#GPFed
@ScottMcKenzieCo
#GPFed
Staffing – considerations for federations and how to avoid
risks
Stuart Craig
Partner, Ward Hadaway
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Network: LoveMcr
Password: internet
Staffing – How will a federation take on staff?
» TUPE – if a federation wins a contract or is awarded a sub-contract
» Directly takes on new employees
» "Employs"/engages staff from the practices that form the federation
Staffing – TUPE issues
» Often staff could be coming across on public sector terms and conditions
of employment – either transferring directly from the public sector or having
had the benefit of those terms for a number of years despite them
transferring out of the public sector a while ago.
» Pensions – fair deal
» Agenda for change
» Two tier workforce
» Does TUPE always apply?
Staffing – recruiting new staff
» Who is going to be the employer?
» Which contract of employment should you use?
» Are they going to be offered the same terms as the employees of the
practices?
» Who is going to manage the employees on a day-to-day basis?
» Payroll
» Dealing with disciplinary and grievance issues
Staffing – sourcing staff from the practices
» At the moment most common way of sourcing staff to undertake the work
of the federations is through existing staff at the practices.
» If they are employees of the practice what should they be?
» on secondment?
»pension considerations
» self-employed consultants?
»genuinely self employed?
» employees of the federation
» issues with duel employment?
Staffing – deciding status
» At the moment no current consensus as to what status people should have
and therefore it has to be assessed on what is right for each federation
» Importance of documenting relationship correctly
» However, just because an individual and an organisation enters into a
relationship that is defined in a document does not mean that an
Employment Tribunal and/or HMRC are going to agree that is an accurate
description of the relationship
» What happens on a day-to-day basis is key
Any questions?
Alison Oliver
Associate | Ward Hadaway
T: 0191 204 4240
Stuart Craig
Partner | Ward Hadaway
T: 0191 204 4381
@WardHadHealth
#GPFed
@BWMedical
#GPFed
@ScottMcKenzieCo
#GPFed
Wigan Borough Federated Healthcare – a case study Dr David Humphreys
Wifi
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Ashton, Leigh and Wigan
Ashton, Leigh and Wigan
Population of 320 000 Largest borough by population in Greater Manchester
High deprivation High levels of chronic disease
63 practices 5 Localities
Getting Started
• Long-term discussion of ‘federated working’
• Suggestion from CCG to work collaboratively
• Change in European law regarding bids
Two Existing Groups
• CIC
• Set up by new CCG lead
• Breathlessness Service
• 12 member practices
• Private company
• Large buy-in to individuals
• Links to other organisations
• Cross border work
The Decision
• 17 practices- 1 vote per practice
• 140 000 patients
• Limited company funded by loans
• Mainly north and central Wigan but some outliers
• Board of 5: 3 GPs and 2 PMs
• CQC Registration
Work with the CCG
• Bid for ‘Better Care’ money for over 75s
• Business case for INR monitoring
• Business case for ABPM
• All came to nothing
• Collaboration around PMCF
• LES for INR monitoring
Work with Foundation Trust
• Initially really positive
• Talk around several subcontracts
• Offer of practice on site of hospital
• Number of projects
• Held up with secondary care restructuring
• Now very quiet
Work with Community Provider
• Now an FT
• Initially really positive
• Then quiet
• Then positive
• Struggling to engage beyond their board
Other Projects
• PMCF wave 2
• Local private providers
• Local Authority projects
Hopes for the Future
• Stronger links with community trust
• Links with private hospitals
• Better grouped working
• Push the CCG!
• Collaborative working with other feds
• Work out of the Greater Manchester Devolution Project
Fears
• Continued brick wall working with the CCG
• Local Foundation Trust looking towards primary care
• Lack of engagement
@WardHadHealth
#GPFed
@BWMedical
#GPFed
@ScottMcKenzieCo
#GPFed
A View from a Trust
Helen Byworth, The Newcastle upon Tyne Hospitals NHS Foundation
Trust
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Context of a Trust like NuTH
» One of the largest teaching hospitals in the UK
» Millions of patients through the doors each year
» Substantial contracts with 11 CCGs, Specialised Commissioners, Local
Authorities and other UK Health Boards
» Complex network of outreach, subcontracting, shared care etc. Possible
up to 500 such service arrangements
» Restricted capacity (like all NHS) up against increasing demand plus
£££s and expectation
» Less corporate/administrative staff than a small CCG
What have we Achieved so Far?
» Established relationship with local Federations
» Three formal contracts in place and others in the pipeline
» Engaged law firm to draw up contract
» Basis for future services (with same or other Federations)
» CCG acknowledges role of Federation to ‘make things happen’
Ambulatory Blood Pressure Monitoring
NUTH
Federation
Device
Supplier
GP Practice GP Practice
GP Practice GP Practice
Contractual Relationship
NuTH’s Community
Services Directorate
CCGs
Added Value
» Patients and System as a Whole
» Joint working between primary and secondary care
» Good use of scarce resources
» Saving unnecessary trips to hospital
» Building up clinical dialogue/shared expertise
» Federation
» One body to manage the GP practices, politics etc
» Single negotiation (prices etc)
» Quick turnaround
» Trust
» Existing contractual relationship with commissioners with entitlement to
subcontract
» Clinical oversight/governance/expertise
» Potential to scale-up procurement etc
Challenges
» Cash-restricted CCGs and an increasing reluctance to see Federations
taking a share
» Lines of communication not always clear
» Fluctuating tariffs and changing payment systems
» Trusts are not able to provide services on the basis of whether they are
“profitable”
» Managing Federations’ expectations given current pressures
» Data flows, processes, reconciliation
» Managing multiple Federations with differing cultures
The Way Forward
» Mutual benefit important
» Keep things as simple as possible
» Invest in getting it right the first time
» Keep the right individuals in the Trust involved – contracts will not be
agreed without them
» Working across boundaries
@WardHadHealth
#GPFed
@BWMedical
#GPFed
@ScottMcKenzieCo
#GPFed
Collective purchasing
Peter Masters
Caradoc
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Network: LoveMcr
Password: internet
Caradoc Medical Services
Buying Group
Peter Masters
Business Manager
October 2015
Caradoc
Buying Group
• Not for Profit NHS aligned organisation
• FREE membership
• 100+ approved suppliers
• £25m+ turnover
Represents over 2000 GP surgeries, over 50% of OOH organisations, GP Federations etc.
Finances
• Not for Profit
• On average 1% commission paid
• Surplus re-invested into NHS
Supporting GP Federation
launches around the country
GP Federations
• Telephony
• Insurance
– Surgery / Locum
– Indemnity
• Printers
Telephony
– Created Network (VOIP)
• Rental cheaper than traditional ISDN lines
• Free calls to other networked practices/NHS organisations
• Disaster recovery / business continuity
• In hours central appointment answering
aracalls
Vision
• Telephony / IT
– One telephony network
– One IT system
• Advantages
– Savings
– Future work streams/tenders
Caradoc Insurance
• Insurance - Federated approach
• Surgery / Locum
– Extra discount if federated practices join together
• Indemnity
– GP Indemnity Scheme for federations
• PMCF
• Federation contracts etc…
● Great deals on printers
● Full range of consumables
● Contract options on supplies/hardware/service
● Warranty extended to cover you printer
● Next day delivery
● 100% satisfaction guarantee
CALL 08450 500620
www.practicesupplies.co.uk
Product code: TN3330 Product code: RBTN3380
Cost: £56.95 Cost: £54.95
Supplied by: Brother Supplied by: PSL
Prices correct at time of going to press and are exclusive of VAT
Contact Us
Visit: www.caradocmedicalservices.co.uk
Email: [email protected]
Call: 01743 454 900 /
Peter Masters 07817 556 883
Thank you to our supporters
@WardHadHealth
#GPFed
@BWMedical
#GPFed
@ScottMcKenzieCo
#GPFed
Lunch, exhibition and
networking
Text your questions for the
speakers and expert panel
to:
07872 062 259
Or fill out the slip in your
pack and hand it in at the
registration desk before the
end of the afternoon break
Wifi
Network: LoveMcr
Password: internet
Keith Taylor FCA Head of Medical Services / MD www.bw-medical.co.uk
• Partnership Vs Limited Company
Financial Management & Record Keeping
• Partnership
– Minimal accounting regulation
– Best accounting practice still applies
– Partnership Agreement compliance
– No accounts filing requirements
– Not in the public domain
Financial Management & Record Keeping
• Limited Company
– Onerous accounting regulation
– Statements of Standard Accounting Practice – SSAPs
– Financial Reporting Standards – FRSs
– Companies Act 2006
– HMRC requirements
Financial Management & Record Keeping
• Partnership
– Partners are the business owners
– Partners make all financial and business decisions
• Limited Company
– Distinction between shareholders and directors
– Shareholders own the company
– Directors are appointed by the shareholders to manage the business
– Memorandum and Articles of Association
– Shareholders’ Agreement
Financial Management & Record Keeping
• Directors’ Responsibilities
– Filing documents at Companies House • Annual accounts
• Annual Return
• Appointment/resignation of directors
• Allotment of share capital
– Keeping adequate accounting records
– Ensuring financial viability
– Safeguarding the assets of the company
– Prevention and detection of fraud
Financial Management & Record Keeping
• Adequate Accounting Records – Section 386 CA 2006
a. To show and explain the company’s transactions
b. To disclose with reasonable accuracy, at any time, the financial position of the company at that time
c. To enable directors to ensure that any accounts required to be prepared comply with the requirements of the Act
Financial Management & Record Keeping
• Accounting records must, in particular, contain
a. Entries from day to day of all money received and expended by the company and the matters in respect of which the receipt and expenditure takes place, and
b. A record of the assets and liabilities of the company.
Financial Management & Record Keeping
• Accounting transactions
a. Allotment of share capital
b. Receipt of loan funding
c. Receipt of contractual income
d. Expenditure 1. Company formation costs
2. Employment costs
3. Overheads
4. Taxation – Corporation Tax/VAT
SUPPORTING DOCUMENTATION!!!
Financial Management & Record Keeping
• Accounting records, what is required?
• Federation provider companies are not complex multi-national entities
• Basic accounting software – Sage 50
– Xero
– Quickbooks
– Spreadsheets
Financial Management & Record Keeping
• Financial Management
– Bank mandates • Control
• Signatories
– Board meetings • Regular finance report
• Presentation of management information/KPIs
– Compliance with deadlines
• Accounts
• Taxation
Financial Management & Record Keeping
Purpose of Accounts
COMPANY PARTNERSHIP • To report results/profits to
shareholders • To collate the results for the
Partners
• Shareholders need assurance that directors are meeting their responsibilities
• Basis for determining Income Tax payable
• Basis for determining Corporation Tax payable
• Medical Partnership – determine superannuable profits
Contact us
Keith Taylor FCA Head of Medical Services / Managing Director BW Medical Accountants [email protected] / 0191 500 6930
Keith is a chartered accountant and has worked in the profession for over 32 years, latterly specialising in the delivery of specialist accountancy and taxation services to GP Practices and healthcare professionals. With a proven track record in medical finance and a wealth of experience, Keith is a leading expert in accountancy services for the healthcare sector. His vision was to create a niche firm which raises the bar in terms of medical accountancy service provision. By recruiting a talented team with proven track records, our depth and breadth of knowledge is unrivalled. BW has the largest and most experienced medical finance team and we currently act for over 75 GP Practices and over 700 medical professionals across England
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1st Care Cumbria – a case study
Sarah Cousins
Wifi
Network: LoveMcr
Password: internet
1st Care Cumbria
• Formed December 2014
• 34 Practices
• 211,500 patients
• Broad geography and demographics
• Mission:
– “General Practice at the heart of healthcare in Cumbria”
• Success Regime
Why we formed 1st Care Cumbria Ltd
• To keep General Practice at the heart of healthcare in Cumbria
• GP Practices in Copeland, Allerdale and Eden recognised the need to work at scale due to the challenges of: • the Health & Social Care Act 2012 • Aging population with complex morbidities • Increased demand on General Practice • Reduction of funding in General Practice
• In order to work at scale and in greater collaboration with other local providers • 1 contract instead of 34
• Company limited by shares, but with the ethos of a Community Interest Company
Above all else:
1st Care Cumbria is locally run, by local General Practice, to the benefit of the local population,
remaining sensitive to the different needs of different parts of our population, while
protecting NHS Services and keeping care as close to home as it possibly can be.
Engagement
• Practices
• Community/Mental Health Provider – Engagement from the outset – Now subcontracting
Pulmonary Rehabilitation and Falls
– Exploring a number of ideas
• Out of Area Providers
– Now in discussion with other providers who provide care to Cumbria patients
• LA – Initial positive meetings – Better use of health checks
• CCG – Regular meetings
– No contracts
• Acute Trust – Ongoing discussion around
subcontracting properly resourced work to 1st Care Cumbria
Remote Monitoring of Anticoagulation
• A new innovative approach to anticoagulation – use of remote monitoring, which frees capacity in the
Practices – In line with national and clinical policy – Saves patients having to come in to Practices – Reduction in strokes – Improve patient care for those on anticoagulants
• Evidence from pilot demonstrates more patients in therapeutic range
• AF Project – review of registers and identification of patients with AF through use of Alivecor
• Blocked by the CCG on the basis of increased prescribing cost
The GPC list of unfunded work • 24 hour ambulatory blood
pressure monitoring • Alcohol & drug misuse • Asylum seekers & refugees • Bank holiday working • Cardiovascular health checks • Chlamydia screening
• D-Dimer / DVT management in the community to avoid hospital admissions
• Shared care / specialist drug monitoring
• ECG recording • Extended hours • Flu immunisation • Gonadorelin analogue treatment • HIV in primary care • Homeless patients • Insertion of contraceptive devices • Insulin initiation or conversion
• Minor injuries • Nursing Homes – enhanced services
• Phlebotomy • Post-op suture removal • Pre and post ops • Primary care sexual health scheme
• Prostate cancer follow up • Provision of immediate and first
response care • Referral review scheme
• Ring pessary insertion • Sigmoidoscopy • Smoking cessation programmes
• Spirometry • Student Health • Alcohol and substance misuse • Vasectomy • Violent patients
• And others not on this list
Unfunded Work • 1st Care Cumbria unfunded work audit
– Figures extrapolated indicate £1.4m (approx £7 per patient)
• Majority from Local Acute Trust • Engagement and discussion from February 2015 with both
CCG and Trust • Notice given on 8th May that the following work would be
returned unless appropriate sub-contracted arrangements were in place: – Results for tests/investigations not requested by the practice – Re-referrals within the Trust for the same condition/symptoms – Patient enquiries, including fitnote requests – Pre-op and post-op care
• All parties now around the table to find a solution
Summary
• There needs to be engagement from either the CCG or a main Provider and willingness to contract/sub-contract
• Geography/demographics don’t matter
• Like-mindedness from member practices – Better to start small and grow
• Think broadly about services and service-delivery
• Don’t give up!
Any Questions?
@WardHadHealth
#GPFed
@BWMedical
#GPFed
@ScottMcKenzieCo
#GPFed
Competition and procurement rules
Optimising success and avoiding pitfalls
Sarah Podesta, Associate, Ward Hadaway
Wifi
Network: LoveMcr
Password: internet
Primary Care Community Care Acute Care
Primary Care Community Care Acute Care
The effect of the competition and procurement rules
Setting up a federation
» Principle: collaboration should not
adversely restrict patient choice and
competition between practices
» Risk: interventions including i) merger
control and ii) competition
investigation: setting aside of unlawful
arrangements
» Solution: planning a structure and
constitution that achieves objectives
and benefits in the least restrictive
way
Operating as a federation
» Principle: federations wishing to bid
for contracts will need to follow
procurement processes
» Risk: bids that do not meet the rules of
a procurement (including the
specification) risk being rejected by the
commissioner. Non-compliant contract
awards can be challenged by third
parties.
» Solution: careful reading of the spec
and the rules; training bid team in
tendering processes
Primary Care Community Care Acute Care
The future?
1. Identify
objectives and
benefits 2. Demonstrate value
3. Preserve
choice
@WardHadHealth
#GPFed
@BWMedical
#GPFed
@ScottMcKenzieCo
#GPFed
Thank you!
Wifi
Network: LoveMcr
Password: internet
@WardHadHealth
#GPFed
@BWMedical
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Refreshment break
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Primary Care Cheshire – a vanguard site case study
Dr Jonathan Gregson
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Jonathan Gregson [email protected] @PrimCareChesh
Primary Care Cheshire
•Community interest company •Federation of 34 practices and an associate member practice. •Covers the whole of West Cheshire CCG. •250,000 patients •3 Localities •9 Clusters
If West Cheshire was a village of 100 people….…
People aged over 85
People aged 19-65
Children and young people aged 5-19
Children aged under 5
£1243 Spent on each person’s healthcare
70
2
9
3
14
18
People drink alcohol to levels described as binge drinking
THEIR HEALTH
2 People with three or more long term conditions
25 People with raised blood pressure
People with depression
1
Person with severe mental illness
Person with dementia
2
People with cancer
5 People with diabetes
4 People with heart disease
Live in areas described as “most deprived”
16
People aged 66 - 85
100 peopl
e
12
1
10
People who are carers
What will the West Cheshire Way do?
Five Year Forward View
•Multi-Speciality Community Provider •GP registered list •Primary Care Cheshire will work collaboratively across all 3 localities •Partnership with West Cheshire CCG, Cheshire and Wirral Partnership Trust, Countess of Chester Hospital, Cheshire West and Chester Council, Patients
•Starting Well 54,550 people (21.2%) preventing ill health and releasing savings but over a longer time period
•Living Well 51,349 people (19.8%) preventing deterioration of ill health (and associated savings) in the medium term.
•Ageing Well 23,726 people (9.2%) improving health outcomes and releasing efficiencies.
Care Model
Cornerstone of MCP
•9 GP Practice Clusters •3-4 Practices •Integrated Community Team
•District Nurses •Physio/Occupational Therapist •Pharmacist •Social Worker •Well Being Co-ordinator
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Panel discussion / question and answer session
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Chair's closing remarks
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