Top ten tips for improving access at scale (brief overview)

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GENERAL PRACTICE FORWARD VIEW

Dr Robert VarnamHead of general practice development

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Improving access at scaleTop ten tips …

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Access at-scale: top ten tips









Secure the capacity needed• protect time for leaders to lead• start succession planning early

Choose the right approach• leading people who don’t work for you• lead through commitment to values & vision• coproduce plans (people commit where they

have contributed)• share responsibility widely



Secure the capacity needed• this is not a hobby• few people have ‘spare time’• setup takes more time

Choose the right capabilities• business intelligence• HR and workforce development• IT and information governance• patient and public engagement• financial planning and governance• service redesign• portfolio, programme and project

management



Organisational form• single legal essential for most large-scale

NHS commissions• culture & processes within / under a single

entity are then more important than form

Size• find most natural size for each function• expect a ‘nested’ approach

Location• ensure travel is as easy as possible for

patients• consider premises suitability & costs

Function before form



Access to records• essential• learn from others’ consent models &

information sharing agreements• consider single systems as alternative to

bridges• slower than you think

Tech-enabled care• consider systems to support self care, more

efficient transactions and ‘remote’ consultations

• consider testing demand for video consultations before large scale investment



Engage patients for …

Setting priorities• NHS belongs to us all• people surprise you

Offering new solutions• patients can see different opportunities• patients think beyond medicine

Contributing work• the community can be part of the solution



Potential partners• 111 services, OOH, ambulance trusts, A&E,

community pharmacy, voluntary sector, schools

Benefits• Shaping demand• Clarity for patients• Reducing overlap or duplication of supply• Improved continuity of care

…design deliberately to achieve the benefits



Planning• model scenarios for costs, test assumptions• agree sharing model in advance

Reporting• prepare for comprehensive & detailed

accounting

Procurement• consider specialist input



Clinical governance• accountability structure • processes• protected time

CQC registration• much simpler• allow time

Indemnity cover• include in cost modelling• clarify records access• shop around• consider single provider & group schemes• provide informed choice re exclusions & run-

off cover



Setting priorities• needs analysis• geographical & demographic segments• inequalities

Measurement to motivate• rapid realtime measures of progress

Measurement for accountability• activity• outcomes• safety• costs

Avoid manual data collection wherever possible



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Healthcare

Top ten tips for improving access at scale (brief overview)