Best Practice newspaper issue 6

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Packed with key stories from primary care and the leading conference for general practice

Giving rural practices a voice

Confessions from the coal face

Collaboration and at-scale general practice have been described as making general practice stronger and more effective.

Best Practice conference chair Dr Rosemary Leonard pens a hasty but candid snapshot of life at the frontline of general practice.

Read full story on page 5

Read full story on page 4

BEST PRACTICE 2014 SPEAKERS AND PRESENTERS INCLUDE:

Rt Hon Andy Burnham, Labour Shadow Secretary of State for Health

Rt Hon Jeremy Hunt, Secretary of State for Health

Simon Stevens, Chief Executive of NHS England

Roy Lilley, Commentator and Blogger, Former Chair NHS Trust

Dr Maureen Baker, Chair of Council, Royal College of General Practitioners

Dr Clare Gerada, Chair of Primary Care Transformational Board

Professor Steve Field CQC, Chief Inspector of General Practice

Dr Ian Walton, GP and IAPT Lead Sandwell

Dr James Kingsland OBE, President NAPC and Chair NPCN

Anne Marie Jones, Director Commercial & Business Healthcare, RBS

Dr Mark Levy, Respiratory Lead for Harrow and Clinical Lead, NRAD

Mark Stone, Pharmacist, Tamar Valley Health, Cornwall

Dr Matthew Fay, Medical Director, Badger Group GP Cooperative

Dr Michael Taylor, GP at York House Surgery and Executive Member, FDA

Dr Michael Smith, GP and Chief Executive Officer, Haverstock Healthcare

Dr Minesh Patel, Chair, Horsham and Mid-Sussex CCG

Ray Guy, Practice Manager, Liverpool

Dr Mark Levy, Respiratory Lead for Harrow and Clinical Lead, NRAD

Helen Lyndon, Nurse Consultant, NHS Cornwall and Isles of Scilly

Dr Nav Chana, Vice Chair, NAPC

Dr Patricia Langley, CEO, Apolline Ltd

Bob Senior, Partner, Head of Medical Services, Baker Tilly

Dr Sara Khan, GP Partner, Vice Chair of Herts LMC, Editor of Medical Woman

Dr Tom Reichhelm, Managing and Medical Director, Malling Health

Dr Yassir Javaid, Clinical Lead for CVD prevention, East Mids SCN

To federate or not to federate...

Paul Larkin, Lead Pharmacist (CCG)

Dr Richard Roope, RCGP and CRUK Clinical Lead for Cancer, GP

Val Hempsey, Practice Manager and NAPC representative

Dr Phil Yates, Chairman & Director of Medical Affairs, GP Care

GP practices will form alliances or federate in droves over the next few years in order to both survive and develop as primary care providers, GP leaders predict.

Read full story on page 3

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Federations: one size doesn’t fit all When it comes to GP federations there are many different shapes and sizes and no offthe shelf solution. Best Practice canvassed three contrasting views about the pros and cons of different models of GP federation.

NHS partnership model The Hurley Group is a large NHS partnership led by practising GPs in about 20 practices providing care to 100,000 patients in some of London’s most deprived communities. It also runs four walk-in centres and six urgent care centres. Community services include x-rays, ultrasound and on-site pharmacies.

The group has grown by acquiring practices and has turned around many failing practices. Its ethos is to integrate primary care strengths with social enterprise, to transform care for vulnerable patients, provide a high standard of care and to invest in its staff.

Dr Arvind Madan, executive director of the group, says: “We are like one GP surgery that just got bigger rather than a bunch of different businesses that decided to work together.

“We are a single business entity. We haven’t adopted a company format because we didn’t want shareholders dictating the direction of the organisation or diluting its clinical integrity. The likelihood that federations will become single legal entities in the longer term are quite remote because GPs are fiercely independent.

The best thing about our model is that it enables us to be big and that gives us an opportunity to achieve economies of scale, to innovate, to influence policy and change the model of general practice. For example we have created an e-consultation and online advice service which signposts symptom checking, enables the patient to consult remotely with a GP and provides information to enable patients to self-care. This is something we would never have been able to do in a small practice.

“Our main NHS contract is fairly straightforward but where it becomes quite complex is with the LES. We have to deal with

a Rubik’s Cube of 10 different commissioners and the particular spin they put on the LES in their area. This makes scaling up difficult outside our geographic territory.

“We are still expanding although we consider the current procurement environment for general practice to be the most challenging we have ever faced.”

The company model Scott McKenzie, NHS management consultant at BW Medical Accountants, believes forming a company is the best model to enable networks of general practices to negotiate with foundation trusts.

service contracts that go out to tender and can guarantee the work will be delivered to certain standards. I have one foundation trust that wants to subcontract all its trauma and orthopaedic outpatients to the federation and work with them in a really close partnership.

worried that a lot of public health contracts were going to the local authority and they would want to deal with one organisation rather than lots of individual practices. But that didn’t actually happen, they are still negotiating with individual practices.

“Another foundation trust is currently looking at a federation doing all its pre-operative assessments in primary care so that it will not waste money cancelling operations because patients are not fit for surgery. We are looking at a system where GPs will track patients for two to three weeks in advance of their operations using a software package to monitor them remotely with a variety of tests.

“The Suffolk Federation are looking to bid for intermediate care services such as district nursing, community ultrasound, Desmond diabetes education, dermatology and endoscopy – none of those services are what you would call general practice. Expanding into other areas may or may not be a good thing – it could bring more risk.

“And what about the competition laws? If your federation owns the community ultrasound service and you send all your patients to your service, not Virgin’s, under any qualified provider are you not creating a monopoly?

“Federating must be done for the right reasons. The vision should be about growing general practice, not just hanging on to what you’ve got, rethinking the delivery model, getting more investment into general practice with viable and interesting clinical work and opportunities to work at scale across a whole population. It is also an opportunity to create some capacity amongst the clinical, managerial and administrative staff by not having everybody duplicating their efforts.”

“Looking at the broader political agenda where does the federation fit in with CCGs and LMCs? In theory all practices are a member of their CCGs and if you are a member of the federation as well how do those two match? LMCs are meant to represent all practices and has a statutory role to do so, so how does that fit in to the federation?

“Federating must be done for the right reasons. The vision should be about growing general practice, not just hanging on to what you’ve got.”

He says: “If you want to be subcontracted by a foundation trust you have to have a legal entity. Nobody is going to give a NHS contract to a loose group of practices.

“The foundation trust wants high quality care, delivered consistently with all the GP providers working to agreed standards and thresholds within a contract and delivering a fantastic outcome for every patient.

“Practices can join a federation, remain independent of each other and still delivering their core NHS contract services but the advantage of being part of a federation is that it can bid for additional services. These could range from vasectomies, anticoagulation, ambulatory blood pressure monitoring, sexual health, gynaecology to migraine and headache pathways – a whole variety of things.

“The federation can compete with big private companies for health

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The sceptic

“All practices have different considerations and needs - no two practices are the same.

Ours is a rural practice and because of the huge distances between practices it can be difficult to get those cost savings and to share things. Some of the stuff you can benefit from you can outsource so why federate rather than outsource?

Dr Richard West, chairman of the Dispensing Doctors’ Association and partner in the Woolpit Health Centre, Suffolk, is not convinced about the benefits of federating and has many questions.

His practice is a member of the Suffolk GP Federation, but he says that does not solve the problem of the lack of funding.

“One of the great strengths of general practice is that people stay in one place for 30 or 40 years and they get to know their local communities and their needs to be a the hub of that community. If you lose some of that essence of general practice you become much more like Tesco.”

“Our practice joined the Suffolk Federation because at the time we were

Scott McKenzie, NHS management consultant at BW Medical Accountants

Hear from Scott McKenzie and Dr Richard West MBE at Best Practice 2014. Register for free via bestpracticeshow.co.uk/newspaper

Alliance Healthcare exhibits at Best Practice 2014 Alliance Healthcare - with our strategic partners Forte Pharma - is committed to providing dispensing practices with the best possible service.

That’s why we are delighted to be supporting the Dispensing Doctors’ Association networking area at this year’s Best Practice event. Not only does the event offer us an opportunity to demonstrate the very real business benefits we can offer dispensing doctors from the different parts of our business, more importantly it gives us the chance to hear directly from you – to improve our understanding of your needs,

to help shape future business plans and develop specific services and offerings to support you and your practice.

Alliance Healthcare recognises the crucial service dispensing doctors provide to patients living in remote and rural areas – but we also recognise how busy that makes you and your practice. Our frequency of delivery, product availability, delivery accuracy, timeliness and reliability at competitive prices – are all aimed at making your practice easier.

Our strength as a national wholesaler

means we can deliver over 12,000 product lines twice-daily to all 16,000+ dispensing points, but through our local dedicated dispensing doctor customer service teams and experienced field account management team, we also deliver a personalised service, direct to you.

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We look forward to seeing you at the DDA networking area, so we can talk more about working in partnership with you, for the benefit of your business.

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General Practice: big changes, great opportunities

To federate or not to federate... - continued The potential is huge for GP federations to provide more services in primary care and in particular to help move services out of hospitals, prevent emergency re-admissions and allow patients to come home, by providing packages of care, potentially involving specialist input from geriatricians, occupational therapists or pharmacists.

Nigel Edwards Chief Executive, Nuffield Trust As general practice responds to pressure on its funding and concerns about workload and the availability of staff we see early signs of some big changes.

Many of the five year plans developed

by CCGs are premised on a major redesign of primary care and associated community services. These seem to share a number of common features.

evidence about the quality of care for children with serious conditions in primary care. In some areas there may be sufficient work to justify having sessions of consultant input. This is not simply relocating the outpatient clinic into a local surgery. What is more likely to produce results are models where consultants support specialist teams, hold teaching clinics, provide rapid telephone or e-consultation support and are a part of the wider primary care network. Many of the common medical specialties lend themselves to this approach and there are opportunities for GPs with additional qualifications in areas such as dermatology to be part of an extended network offering a high quality service for the more difficult cases across their extended group.

Many envisage creating a larger group of practices working together which share a standardised approach to the management of patients. This is often associated with a change in how community services are organised to bring these much more into alignment with practices. Creating these larger groups offers some great opportunities. This may start with simply sharing back office functions such as IT but some groups are using their greater scale to bring in more professional management. This not only improves efficiency but places the group in an advantageous position to bid for other services. There are even greater opportunities to improve care for patients.

Policy makers have tended to overemphasise access over continuity.

Both are important and greater scale might allow both goals to be met using approaches such as telephone and web responses to patient requests or sharing resources to create a rapid access service in a hub similar to the Dutch model of GP stations. These could offer an expanded set of services including some diagnosis and ambulatory treatment of some medical emergencies. An ambitious model at Abingdon does this and can provide a wide range of responses to problems, particularly in older patients.

This could create more time for those patients that require continuity.

Working together across an area means that there will be scope to develop shared diagnostics – often using existing community hospitals as hubs. There will also be enough activity to allow the use of risk stratification and make it worth considering subspecialisation within the group. Frailty, nursing and residential homes are one area where there is scope for developing new more targeted services. Some CCGs have been looking at specialist primary care models from the USA which target these patients with much proactive multidisciplinary care than conventional services can manage.

This many include the ability to follow patients into hospital and mobilise intensive home care support.

These changes need to evolve rather than be imposed. In many cases we are not sure what the best mix of services, skill mix and approach might be and more experimentation is required to determine the answer for this in particular localities. Creating incentives to support this and some space and relief from the everyday pressure will also be important.

Children’s services might be another area to consider given the worrying

It is estimated that around one in five practices are currently part of a network or federation and more than a third are considering joining one.

GP leaders due to speak at Best Practice, where new models of care and the challenges facing general practice will be discussed, say there has been increasing interest in collaborative working as practices look for new ways of coping with the changing political and financial environment.

The National Association of Primary Care has recognised the trend and has launched a Network for Primary Care Provider Federations. This will share knowledge and provide support for primary care contractors wanting to explore these new models of provision.

NAPC chairman Dr Charles Alessi says: “This important network will assist colleagues with the current challenges faced by primary care providers. Our hosting will enable a collective powerful voice for practice federations and drive forward the agenda to improvement of patient centred care.”

GPC chair Dr Chaand Nagpaul says that federating should be considered by GP practices for a variety of reasons, not just for those facing closure. “Federations cover a range of models from GPs working together in informal alliances to working collaboratively to provide both GP and out of hospital services. It’s a very wide ranging term so what is important is that federations should be there to deliver purpose and benefits for practices working together under proper governance arrangements.

“In some cases the rationale for practices working together is to ease financial pressure where they can pool resources and there are economies of scale. However it’s also important that in these cases

federating should never be a substitute for the appropriate funding for the provision of GP services and that they are not always the solution for every practice in difficulty.

Federating is not the answer for all practices particularly for example for those in sparsely populated rural areas.”

Many practices are still sceptical about the benefits of federating. More than half of GPs who responded to a recent GPC survey said they were not convinced of the benefits of joining forces with other practices, one in four did not believe that large groups would be effective and over a third feared that federating could pose a threat to their independence.

RCGP chair Dr Maureen Baker says: “In order to meet the challenges facing them I believe that many practices will benefit from working more collaboratively either in a formal or a loose arrangement. However for those practices who do not feel the need to federate then there may well not be a need. I very much take the view that this model is a way of working that will suit some practices, it may suit most practices, however some practices may genuinely have not yet scoped out the possibility or the potential of what is best for the practice or their patients.

“There is no point in federating for the sake of it. There needs to be a purpose behind getting together such as to increase quality, improve access or improve the range of services that practices provide.”

NHS England has said it would like to see practices working “at greater scale” through networks, federations or practice mergers.

In a recent speech to the NHS Confederation NHS England chief executive Simon Stevens, who will be delivering a keynote speech to Best Practice, said: “In many parts of the country there’s now real momentum building in favour of testing some new models of general practice and extended primary care.”

Whether you are currently working within a federation or a network or are in the camp that is currently unsure about the future, there will be plenty of expert practical advice and inspiration on offer at Best Practice.

Hear from Dr Maureen Baker, Dr Charles Alessi and Simon Stevens at Best Practice, Register online at bestpracticeshow.co.uk/newspaper

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A medicines optimisation approach to improving quality and productivity in primary care Medicines optimisation can help support the NHS to deliver against the NHS Outcomes Framework and the Quality, Innovation, Productivity, and Prevention (QIPP) transformational programme.

According to the NHS England Medicines Optimisation Clinical Reference Group, “medicines play a crucial role in maintaining health, preventing illness, managing chronic conditions and curing disease. In an era of significant economic, demographic and technological challenge it is crucial that patients get the best quality outcomes from medicines”.

Medicines optimisation is an evolution from medicines management focusing more on getting the most out of medicines, and making best use of medicines.

The focus should be on improving the return on the NHS’s investment in medicines rather than managing prescribing budgets - with a greater focus on:

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Improving medicines adherence Reducing prescribing errors Avoiding medicines wastage Removing unwarranted variations

Medicines optimisation requires front line prescribing advisors and managers to have a fresh perspective on medicines. The medicines optimisation work aims to shift the focus from looking solely at the spend on medicines in isolation toward a more balanced view of the value of medicines and a better understanding of the outcomes derived from using them.

A Prototype Medicines Optimisation Dashboard was recently developed by NHS England and aims to help CCGs explore how well placed they are to optimise the use of medicines across their locality. Over time the dashboard is expected to help CCGs understand how well patients in their locality are being supported to get the most from their medicines and thereby use them as intended, suffer no harm and ultimately derive the most benefit that medicines have to offer.

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Do you believe medicines optimisation is just another term for medicines management?

Who do you think should take responsibility for medicines optimisation in primary care?

Does medicines optimisation make any difference to patient outcomes and patient experience?

Can medicines optimisation make a real impact on NHS spend and resources?

Hear from Paul Larkin and Heidi Wright at Best Practice on the 23rd October, 11:20 in the Transforming Primary Care Theatre.

Register for your free pass at bestpracticeshow.co.uk The session is being sponsored and organised by Ipsen Limited. Editorial content belongs to the speakers.

Join us at this informative session to hear from Heidi Wright, English Practice and Policy Lead at the Royal Pharmaceutical Society (RPS) as she explains the approach and rationale behind medicines optimisation and the crucial role primary care can play in its implementation. She will also share the latest developments and outputs from the national medicines optimisation work. Heidi is the co-author of the RPS Good Practice Guide for Health Care Professionals on medicines optimisation.

Best Practice Speakers Our second speaker is Paul Larkin, Lead Pharmacist for Hertfordshire, Bedfordshire and Luton Commissioning Support who will share how they have optimised medicines use in prostate cancer patients requiring long-term luteinising hormone releasing hormone agonists (LHRHa) treatment and how this change in prescribing approach has led to improved patient experience, cost and resource savings, and capacity improvements.

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Time 08:30

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Opening welcome by stream chair Dr Rosemary Leonard, Media Medic and GP Opening keynote address: What’s coming next for general practice?

Dr Richard Vautrey, Deputy Chair of the BMA GPC and elected member of the RCGP Exhibition & networking

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How to win local service contracts Dr Phil Yates, Chairman & Director of Medical Affairs, GP Care The future of general practice - why developing a federation is the right thing to do!

Scott McKenzie, NHS Consultant, BW Medical Accountants Session sponsored by BW Medical Accountants Exhibition & networking

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Panel Debate: How can practice managers better cope with spiralling workload?

Val Hempsey, Practice Manager and Sole Partner of Bridges Medical Practice, Gateshead, Tyne and Wear and NAPC representative on the Practice Managers Network Steering Group Sue Farrant, Managing Partner, Croydon and The Family Doctor Association representative on the Practice Managers Network Ray Guy, Practice Manager, Liverpool and member of the NAPC Practice Innovation Network Neil Turton, Chief Executive, Salford Health Matters CIC Session sponsored by KM&T

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Keynote address by Simon Stevens, Chief Executive, NHS England Integrating primary and community care services to live long and live well Dr James Kingsland, OBE - President NAPC and Chair NPCN Karen Middleton, CBE – CEO Chartered Society of Physiotherapists and immediate past Chief Health Professions Officer at DH Update on the new CQC inspection regime and practice ratings Professor Steve Field, Chief Inspector of General Practice, CQC Exhibition & networking Getting your practice ready - ten top tips Dr Michael Taylor, GP at York House Surgery and Executive Member, The Family Doctor Association Big Debate: How do we solve the primary care premises crisis?

Dr Peter Holden, Lead on Premises for the BMA GPC Michael Bell, Chairman, Croydon Health Services NHS Trust Graham Roberts, Chief Executive, Assura Group Exhibition & networking

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Hot topics in musculoskeletal medicine Dr Ian Bernstein, GP Trainer and Musculoskeletal Physician, London Endorsed by: Primary Care Neurology Society

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Ten top tips for GPs on managing obesity Dr Rachel Pryke, GP Partner, RCGP Clinical Lead for Nutrition

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Healthier Together and primary care in Manchester Rob Bellingham, Director of Commissioning, NHS England Greater Manchester Area Team Dr Raj Patel, Medical Director, NHS England Greater Manchester Area Team Leila Williams, Director of Service Transformation, NHS Commissioners, Greater Manchester

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“It’s all about me” - how to personalise primary care Dr Charles Alessi, Chair, NAPC, NHS Confederation and Lead for Preventable Dementia, Public Health England

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Modern stroke prevention management of atrial fibrillation and the potential role of the novel oral anticoagulant agents Dr Yassir Javaid, Clinical Lead for CVD prevention, East Midlands, Strategic Clinical Network Session sponsored by Bayer

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National Review of Asthma Deaths (NRAD) and asthma and COPD overlap Dr Mark L Levy, Respiratory Lead for Harrow and Clinical Lead for the National Review of Asthma Deaths (NRAD)

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COPD: Optimisation Dr Sunny Kaul, Consultant in Intensive Care and Respiratory Medicine, The Royal Brompton and Harefield Hospital Session sponsored by Teva Respiratory

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What’s new in dermatology Dr Stephen Kownacki, Executive Chair, Primary Care Dermatology Society Endorsed by: Primary Care Dermatology Society

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Session topic TBC Session sponsored by Optum

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Time to get personal – managing longterm conditions in the 21st century Dr Martin McShane, Director (Domain 2) Improving the quality of life for people with Long Term Conditions, NHS England

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Opening welcome to the DDA Annual Conference Matthew Isom, Chief Executive, Dispensing Doctors’ Association

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Chairman’s report Dr Richard West, MBE, Chairman, Dispensing Doctors’ Association

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Dispensing Doctors’ Association Annual General Meeting Open to DDA Members only

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Dementia materclass Periodontitis and dementia Francesco d’Aiuto, HEFCE Clinical Senior Lecturer and Hon Consultant UCL Eastman Dental Institute Endorsed by: Primary Care Neurology Society The challenges of behaviour that challenges Dr Sophie Edwards, Clinical Lead for Dementia and Consultant Physician, North Middlesex University Hospital NHS Trust Endorsed by: Primary Care Dermatology Society

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Ten reasons to work in a GP locum chambers Dr Richard Fieldhouse, CEO, National Association of Sessional GPs (NASGP)

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Growing your primary care business in a federated world Amanda Maskery, Partner, Sintons Greg Moorhouse, Managing Director, IntraHealth Session sponsored by Sintons

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Operational priorities for practice managers in 2015 Neil Turton, Chief Executive, Salford Health Matters CIC

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Focussing on quality outcomes – the case for service improvements in Lower Urinary Tract Symptoms (LUTS) Richard Metcalfe, Head of Strategy & Delivery, NHS Doncaster CCG Dr Tayo Kufeji, Clinical Lead GP, Milton Keynes CCG Session sponsored by Astellas Partnership Working

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The practicalities and pitfalls of using social media in your practice Professor Azeem Majeed, GP Principal and Professor of Primary Care, Imperial College London

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Session topic TBC Session sponsored by Optum

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Cancer challenges Dr Richard Roope, RCGP and CRUK Clinical Lead for Cancer, GP in Whiteley, Fareham, Hampshire Session sponsored by Cancer Research UK

Overcoming barriers to collaborative working at scale Andrew Lockhart-Mirams, Senior Partner, Lockharts Solicitors

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Dispensing practices in the wider primary care landscape Session topic TBC

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Transforming musculoskeletal services Dr Ian Bernstein, GP Trainer and Musculoskeletal physician, London

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Question Time DDA Board including: Dr Richard West, DDA Chairman, Dr Allan Tennant, DDA Vice Chairman Dr Philip Koopowitz, DDA Board Member

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Unravelling VAT John H Barnes, VAT Director, Baker Tilly

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Transforming the primary care workforce through community education provider networks Dr Sanjiv Ahluwia, Head of Primary Care Education and Development, Health Education North, Central and East London Ariadne Siotis, CEPN Programme Manager, Health Education South London Jim Fenwick, Project Manager, Wandsworth Community Education Provider Network Professor Abdol Tavabie, Interim Dean Director Postgraduate Medical and Dental Education, Health Education Kent, Surrey, Sussex Patrick Mitchell, Director of National Programmes, Health Education England

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CQC update and challenges for dispensing practices Professor Steve Field, Chief Inspector of General Practice, CQC

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The changing face of general practice Anne-Marie Jones, Director Commercial & Business Healthcare, North West, The Royal Bank of Scotland Session sponsored by RBS

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Assessing asthma control and reducing admissions Dr Mark L Levy, Respiratory Lead for Harrow and Clinical Lead for the National Review of Asthma Deaths (NRAD)

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Managing frailty in primary care Carol Williams, Director of Nursing, NHS England, Devon, Cornwall & Isles of Scilly Area Team Helen Lyndon, Nurse Consultant Older People, Clinical Lead Frailty, Devon, Cornwall and Isles of Scilly Area Team, NHS England

Exhibition & networking

Exhibition & networking

Exhibition & networking

Exhibition & networking

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Opening welcome by stream chair Dr Rosemary Leonard, Media Medic and GP

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08:30

Exhibition & networking

Lunch, exhibition & networking 14:10 14:40 14:45 15:15

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Opening welcome by stream chair Dr Sara Khan, GP Partner, Vice Chair of Hertfordshire LMC and Editor of Medical Woman

1 HOUR6 CLINICS OF A CPD L

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Opening welcome to the DDA Annual Conference Matthew Isom, Chief Executive, Dispensing Doctors’ Association

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Managing mild anaemia in the elderly

D

guarantee? (but other needs) to protect and improve 10:20 Dr Andy Hughes, Consultant Community C Haematologist, really North Eastdo London NHS Foundation 09:55 D Maximise through smarter • Whether Federations both businesses. Federation hasprofit also been A Federate or Fail? Lessons on how to Trust 10:25 purchasing transform the fortune of your practice allow practices to maintain their described by rural practices as giving 09:30 B Patient-centred diabetes care - how do Anup Sodha, Director, Lexon UK Ltd 10:25 CQC - How to comply with the regulations and Dr Michael Smith, GP and Chief 10.00 we actually make it happen? independence? rural practices a voice, a channel 10:55 planning for inspections 10:30 -and D Monitored dosage systems: a waste of Executive Officer Haverstock Healthcare Dr Waqar Malik, Community Consultant Dr Patricia Langley, CEO Apolline 11:00 time, or a formula to enhance patient (Camden GP Consortium) • Would another business model –Ltd for through whichC to communicate with other Diabetologist, Birmingham Community 09:40 Session topic TBC Session sponsored by Appoline - CQC Compliance outcomes?

10:15 A Keynote address Healthcare Trust, Hon. Consultant, 10:10 Session sponsored by NHS Improving GP practices in areas where distance and example, setting up an umbrella Mark Stone, Pharmacist, Tamar Valley 11:00 Update on new therapies for diabetes 10:45 The Rt Hon Andy Burnham MP, Labour Heartland Hospital Birmingham, Quality Health, Cornwallto make 11:30 Dr–Waqar Community Consultant organisation be aMalik, better business remoteness could otherwise serve Shadow Secretary of State for Health Hon Senior Lecturer, University of Diabetologist, Birmingham Community Healthcare Exhibition & networking 10:50 A How to make the government agenda Birmingham model? it very difficult for the rural practice to have Trust, Hon. Consultant, Heartland Hospital 11:20 work for your practice 10.05 B New NICE guidelines for CKD - impact say of service Birmingham, Hon Senior Lecturer, University of 10:30 12:00 models A Community well being any practices - a at all. CAt scale NICE guidelines for GPs - unlocking Dr Nigel Watson, Chief Executive, 10.35 on primary care Birmingham 11:00 12:35 population wide transformation their Wessex LMCs Specifically for dispensing practices provision are also thought of full aspotential serving as a Dr Kathryn Griffith, Clinical Champion Dave Sweeney, Director of Professor David Haslam, CBE, Chair, Exhibition & networking Exhibition & networking for Kidney Care, RCGP and a GP in York - where dispensing rights are practiceofHalton protecting community Transformation, Halton way CCG and NICE services from Exhibition & networking Borough Council 12:40 A Session topic TBC and and location-specific and where moving cherry picking by external providers 11:45 D Meeting the demands and mitigating the Simon Banks, Chief Officer, Halton CCG 13:10 Session sponsored by Janssen location can risk the total loss of the privatisation ’by stealth’.

12:15 impact of the 2014/15 contract and PMS Exhibition & networking 12:45 Maximising the benefits of online access for your Lunch, exhibition & networking review practice’s dispensing rights - he will 13:15 practice and patients 11:45 C Streamlined and community-delivered Bob Senior, Partner, Head of Medical Dr Masood Nazir, Clinical Informatics Advisor, NHS 13:50Lockhart-Mirams D platform of Essential facts on controlled drug use the 12:15 DVT care: our model and experience the DDA Annual In his presentation, Mr Services, Baker Tilly England 14:20 regulations Dr Phil Yates, Chairman & Director of 12:20 D Conference13:20 2014 to explain the options whose law firm, LockhartsAlison Solicitors, The post QoF era; what does quality Digital health: Improving access, outcomes and Shelton, DDA Board Medical Affairs, GP Care 12:50 care look like for general practice?

13:50 satisfaction Session sponsored by Bayer open to dispensing practices. For such specialises in GP business models in 11:20 B A medicines optimisation approach to Dr Minesh Patel, Chair, Horsham and Dr Jim Gardner Group Medical Director D Refresher on controlled drugs registers 12:20 C Current challenges in paediatrics 12:00 improving quality and productivity practices, even a practice merger can be generalinpractice, will14:25 set- out the potential for Mid-Sussex CCG OneMedical Group 14:55 Alison Shelton, DDA Board 12:50 Dr Andy Winrow, Consultant primary care Session sponsored by MSD Dr Nicholas Robinson Consultant Digital Health problematic – causing new administrative federation and other new business models.

Paediatrician, Kingston Hospital NHS Heidi Wright, Practice and Policy Lead Lunch, exhibition & networking Consulting Foundation Trust Exhibition & gains, networking for England, Royal Pharmaceutical problems for the dispensary manager, and He will discuss potential efficiency such 13:55 Avoiding antibiotics through self-care: a practical Lunch, exhibition & networking Society bringing into sharp focus thetheoften punitive as higher quality management (collective 14:25 guide to averting apocalypse 15:45 D Paul Larkin, Lead Pharmacist (CCG), Practical dispensing issues - Q&A 14:00 A Keynote Debate: Does general practice Dr Peter Smith OBE, Senior 16:30 office Hertfordshire, Bedfordshire and Luton session reimbursement arrangements thatPartner, can Churchill delivery of certain back functions), 14:35 need 10,000 more GPs? Medical Centre, Kingston and Vice President, NAPC Commissioning Support Alison Shelton , DDA Board Dr Maureen Baker, Chair, RCGP apply to dispensing practices. internal referrals between clinicians within 13:35 B Using cereal dietary fibre and wheat Exhibition & networking Session sponsored by Ipsen Ash Soni, OBE, President, Royal Exhibition & networking 14:05 bran fibrepractice, to improve digestive health which will have a 12:05 tightly Federation, Pharmaceutical Society B the employment of specialists Helping primary care tothe do better at the Dr Jan de Vries Janet Davies, Director of Nursing 12:35list cliff edge controlled dispensing patient and no Lockharts Solicitors has over 30 years’ (who otherwise would be unaffordable by a Kathryn O’Sullivan & Service Delivery, Royal College of Paul Stringer, Project Lead nearby practices Session sponsored

by Kellogg’s All Bran with which to merge? experience helping general practices and small practice) and finally, the achievement Nursing Katherine Andrews, Project Manager 14:10 B to be considered Sponsored Session Sheinaz Stansfield, Practice Manager mass on the political stage – but This isTBC just the question 14:40 A Keynote Address in negotiating of GMS and PMS contracts of critical 14:40 and participant 15:10 The Rt Hon Jeremy Hunt, Secretary of by the DDA 2014 Annual Conference, and it can offer extensive specialist advice without losing the Unique Selling Point of Collaboration and at-scale general practice State for Health Lunch, exhibition & networking in a presentation by Andrew Lockharton regulation, policy, funding and contacts general practice – independence. been described as making 15:15 - have A general Closing Debate: What will primary care Exhibition & networking 15:45 practice look like instronger the future? and more effective. They Mirams entitled: “Overcoming barriers to in general practice.

Roy Lilley, Commentator and Blogger, collaborative working at scale”.

He will pose questions such as: areFormer seen as the way to achieve the health Chair NHS Trust 15:35 C Hot topics in atrial fibrillation Dr Tom Reichhelm, Managingfor and general practice service’s new vision 14:05 C The Prime Minister’s £50 million 16:05 Update on new NICE guidelines Medical Director, Malling Health Ltd and 14:35 challenge a case Mergers, federations or networks, or thefor general practice Hear from Andrew Lockhart• -Is Federation really a mechanism to that achieves aims such as demonstrating Dr Matthew Fay, GPwSI in Cardiology, GP Partner, West Malling Group Practice study from West Wakefield establishment of ‘provider entities’ have Yorkshire Miriams, one of the specialist save money? theDrvalue ofGPgeneral practice to the health Shipley, West Ian Walton, and IAPT Lead, Dr Chris Jones, GP and Chair West Endorsed by: CVGP Sandwell been mooted as potential options Wakefield for Commissioning presenters speaking at the DDA • Network, Can patients access other GPs in the service and also supporting the development Anticoagulation Dr Fay Wilson, Medical Director, Badger NHS 111 Clinical Governance Lead for general practices 2014 Annual Conference taking Federation? of Group community-based practices, teams and Dr Andy Hughes, Consultant Communitywanting to achieve ‘scale’ GP Cooperative, West Midlands Wakefield CCG Haematologist, North East London NHS are reports of practices 15.45 - networks A Keynote address in practice.

There place at Best Practice. Register • Do Federations offer scope to use to support flexible models of care.

Exhibition & networking Foundation Trust 15.55 Dr James Kingsland, OBE, President, which are struggling with excess demand for your free pass online via different structural options, such as Exhibition & networking NAPC for services, which have successfully bestpracticeshow.co.uk/newspaper charity, social enterprises, consortia But how &does this new vision for general Exhibition networking merged with practices with excess capacity and companies limited by shares of practice apply to the rural dispensing 09:35 09:40

Opening welcome by stream chair Dr Nikki Kanani, Vice Chair, NHS Bexley CCG, Quality Lead, FMLM

Giving rural practices a voice - continued

Endorsed by: CVGP

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17:10 17:40

Doctor Association Big Debate: How do we solve the primary care premises crisis?

Dr Peter Holden, Lead on Premises for the BMA GPC Michael Bell, Chairman, Croydon Health Services NHS Trust Graham Roberts, Chief Executive, Assura Group Exhibition & networking

A

www.bestpracticeshow.co.uk Join the conversation

#bestpracticeshow

Session Exhibition & networking

09:00 09:05

PPRRAACCTTIICCEEMM AA

Opening welcome by stream chair Dr Rosemary Leonard, Media Medic and GP

R AACCCCRREEDDIITTEEDD SSPPAAR

Time 08:30

CONTENT GEERR CONTENT IISSAAMM NNAAG

Theatre

A

Federate or Fail? Lessons on how to transform the fortune of your practice Dr Michael Smith, GP and Chief Executive Officer Haverstock Healthcare (Camden GP Consortium)

A

10:15 10:45

Keynote address The Rt Hon Andy Burnham MP, Labour Shadow Secretary of State for Health

A

10:50 11:20

How to make the government agenda work for your practice Dr Nigel Watson, Chief Executive, Wessex LMCs

A

CLINICAL UPDATES Time

Session

08:30

Exhibition & networking

09:25 09:30

09:30 10.00

10.05 10.35

Exhibition & networking

12:20 12:50

Meeting the demands and mitigating the impact of the 2014/15 contract and PMS review Bob Senior, Partner, Head of Medical Services, Baker Tilly

D

The post QoF era; what does quality care look like for general practice?

Dr Minesh Patel, Chair, Horsham and Mid-Sussex CCG Session sponsored by MSD

D 12:20 12:50

Lunch, exhibition & networking

1 HOUR6 CLINICS OF A CPD L Theatre

Opening welcome by stream chair Dr Sara Khan, GP Partner, Vice Chair of Hertfordshire LMC and Editor of Medical Woman

B

Patient-centred diabetes care - how do we actually make it happen?

Dr Waqar Malik, Community Consultant Diabetologist, Birmingham Community Healthcare Trust, Hon. Consultant, Heartland Hospital Birmingham, Hon Senior Lecturer, University of Birmingham

B

New NICE guidelines for CKD - impact on primary care Dr Kathryn Griffith, Clinical Champion for Kidney Care, RCGP and a GP in York

B

TRANSFORMING PRIMARY CARE Time

Session

08:30

Exhibition & networking

09:35 09:40

09:40 10:10

Keynote Debate: Does general practice need 10,000 more GPs? Dr Maureen Baker, Chair, RCGP Ash Soni, OBE, President, Royal Pharmaceutical Society Janet Davies, Director of Nursing & Service Delivery, Royal College of Nursing

A

14:40 15:10

Keynote Address The Rt Hon Jeremy Hunt, Secretary of State for Health

A

15:15 15:45

Closing Debate: What will primary care look like in the future?

Roy Lilley, Commentator and Blogger, Former Chair NHS Trust Dr Tom Reichhelm, Managing and Medical Director, Malling Health Ltd and GP Partner, West Malling Group Practice Dr Ian Walton, GP and IAPT Lead, Sandwell Dr Fay Wilson, Medical Director, Badger Group GP Cooperative, West Midlands

A

Keynote address Dr James Kingsland, OBE, President, NAPC

A

15.45 15.55

13:35 14:05

14:10 14:40

Opening welcome by stream chair Dr Nikki Kanani, Vice Chair, NHS Bexley CCG, Quality Lead, FMLM

Session topic TBC Session sponsored by NHS Improving Quality

EDUCAT IO SUPPOR NAL T:

Theatre

C

C

10:30 11:00

Community well being practices - a population wide transformation Dave Sweeney, Director of Transformation, Halton CCG and Halton Borough Council Simon Banks, Chief Officer, Halton CCG

C

Streamlined and community-delivered DVT care: our model and experience Dr Phil Yates, Chairman & Director of Medical Affairs, GP Care Session sponsored by Bayer

C

Managing frailty in primary care Carol Williams, Director of Nursing, NHS England, Devon, Cornwall & Isles of Scilly Area Team Helen Lyndon, Nurse Consultant Older People, Clinical Lead Frailty, Devon, Cornwall and Isles of Scilly Area Team, NHS England Exhibition & networking

DDA ANNUAL CONFERENCE

Current challenges in paediatrics Dr Andy Winrow, Consultant Paediatrician, Kingston Hospital NHS Foundation Trust

C

11:20 12:00

Time

Session Exhibition & networking

Using cereal dietary fibre and wheat bran fibre to improve digestive health Dr Jan de Vries Kathryn O’Sullivan Session sponsored by Kellogg’s All Bran

B

Sponsored Session TBC

B

12:05 12:35

B

09.40 09:50

Opening welcome to the DDA Annual Conference Matthew Isom, Chief Executive, Dispensing Doctors’ Association

D

09:55 10:25

Maximise profit through smarter purchasing Anup Sodha, Director, Lexon UK Ltd

D

10:30 11:00

Monitored dosage systems: a waste of time, or a formula to enhance patient outcomes?

Mark Stone, Pharmacist, Tamar Valley Health, Cornwall

D

12:00 12:35

NICE guidelines for GPs - unlocking their full potential Professor David Haslam, CBE, Chair, NICE

A

12:40 13:10

Session topic TBC Session sponsored by Janssen

A

Helping primary care to do better at the cliff edge Paul Stringer, Project Lead Katherine Andrews, Project Manager Sheinaz Stansfield, Practice Manager and participant

B

C Endorsed by: CVGP

Exhibition & networking

Exhibition & networking

14:05 14:35

The Prime Minister’s £50 million challenge for general practice - a case study from West Wakefield Dr Chris Jones, GP and Chair West Wakefield Commissioning Network, NHS 111 Clinical Governance Lead for Wakefield CCG Exhibition & networking

14:25 14:55

15:45 16:30

Essential facts on controlled drug regulations Alison Shelton, DDA Board

D

Refresher on controlled drugs registers Alison Shelton, DDA Board

D

Practical dispensing issues - Q&A session Alison Shelton , DDA Board

CPD CONTENT FOR PRACTICE MANAGERS ACCREDITED BY AMSPAR

Time

Session

08:30

Exhibition & networking

09:50 10:20

Managing mild anaemia in the elderly Dr Andy Hughes, Consultant Community Haematologist, North East London NHS Foundation Trust

10:25 10:55

CQC - How to comply with the regulations and planning for inspections Dr Patricia Langley, CEO Apolline Ltd Session sponsored by Appoline - CQC Compliance

11:00 11:30

Update on new therapies for diabetes Dr Waqar Malik, Community Consultant Diabetologist, Birmingham Community Healthcare Trust, Hon. Consultant, Heartland Hospital Birmingham, Hon Senior Lecturer, University of Birmingham Exhibition & networking

Exhibition & networking D

Exhibition & networking

12:45 13:15

Maximising the benefits of online access for your practice and patients Dr Masood Nazir, Clinical Informatics Advisor, NHS England

13:20 13:50

Digital health: Improving access, outcomes and satisfaction Dr Jim Gardner Group Medical Director OneMedical Group Dr Nicholas Robinson Consultant Digital Health Consulting

13:55 14:25

Avoiding antibiotics through self-care: a practical guide to averting the apocalypse Dr Peter Smith OBE, Senior Partner, Churchill Medical Centre, Kingston and Vice President, NAPC Exhibition & networking

**Programme correct at time of print

Lunch, exhibition & networking

Hot topics in atrial fibrillation Update on new NICE guidelines Dr Matthew Fay, GPwSI in Cardiology, Shipley, West Yorkshire Endorsed by: CVGP Anticoagulation Dr Andy Hughes, Consultant Community Haematologist, North East London NHS Foundation Trust

Theatre

Lunch, exhibition & networking

A medicines optimisation approach to improving quality and productivity in primary care Heidi Wright, Practice and Policy Lead for England, Royal Pharmaceutical Society Paul Larkin, Lead Pharmacist (CCG), Hertfordshire, Bedfordshire and Luton Commissioning Support Session sponsored by Ipsen

5

BEST PRACTICE WORKSHOPS

08:30

13:50 14:20

Exhibition & networking

15:35 16:05

15:50 16:20

Exhibition & networking

Lunch, exhibition & networking 14:00 14:35

D

Exhibition & networking

Exhibition & networking 11:45 12:15

CQC update and challenges for dispensing practices Professor Steve Field, Chief Inspector of General Practice, CQC

QUALIFYING DELEGATES WILL RECEIVE COMPLIMENTARY PASSES TO BEST PRACTICE, REGISTER NOW AT: WWW.BESTPRACTICESHOW.CO.UK OR CONTACT THE DELEGATE RELATIONSHIP TEAM ON: TRAINING@CLOSERSTILLMEDIA.COM T: 0207 348 4906

Exhibition & networking 11:45 12:15

16:05 16:35

Exhibition & networking

Exhibition & networking

CONFERENCE TIMETABLE: THURSDAY 23 OCTOBER PRACTICE BUSINESS & PLENARY SESSIONS

Provider Network Professor Abdol Tavabie, Interim Dean Director Postgraduate Medical and Dental Education, Health Education Kent, Surrey, Sussex Patrick Mitchell, Director of National Programmes, Health Education England

challenges Dr Sophie Edwards, Clinical Lead for Dementia and Consultant Physician, North Middlesex University Hospital NHS Trust Endorsed by: Primary Care Dermatology Society

C

Confessions from the coal face continued First, an admission. I’m writing this in a hurry. It should have been submitted yesterday, and I’m usually pretty conscientious about getting my work in on time.

So what’s my excuse?

downright silly parts of QOF had been removed, though asking 94 year olds how many hours they had spent on a bicycle in the past week did bring many moments of much-needed laughter into my consultations. But instead we now have the ‘admissions avoidance’ template to complete.

To be fair, having a record of next of kin for ‘at risk’ Last month, one of the two YOU REGISTER PLACE IN 4 EASY AT www.bestpracticeshow.co.uk/ti14 FORM AND FAX BACK TO 0207 603 2643 OR þ EMAIL training@closerstillmedia.com NoCAN under 18’s willYOUR be granted access toWAYS: the show and strictly no children. þ ONLINE þ CALL US ON 0207 348 4906 þ COMPLETE THE BOOKING patients seems sensible. other partners at my surgery Asking about resuscitation decided, at the grand old Information was correct at time of press. CloserStill reserve the right to amend content without prior warning. The Best Practice has been an interesting age of 49, that she simply conference has been brought to you by CloserStill Medical in association with our partners and sponsors. The views and opinions academic exercise – and if of the speakers are not necessarily those of CloserStill Medical or of our partners and sponsors. Best Practice sponsors have couldn’t carry on being a only I had the time ( some helped develop the programme. Sponsors have not had any input into the programme except where an individual session states it’s GP. She was burnt out by sponsored. The session topic and speaker have been developed by each sponsoring company. hope…) I’d record the working long hours filling results in a way that could in boxes that were adding be published. For I’ve found, nothing to patient care, with almost universally, that must-knows of the HMRC rules ever-increasing demands those with a good quality of relating to PA items. from patients that they be life are telling me they’ve seen and dealt with straight had a good innings, and no Looking at appliances, appliance away or they would make a way do they want anyone contractor NWOS will be on hand formal complaint. And her trying to break their ribs to to explain how involvement in take-home pay had fallen so keep them going. agency schemes with an appliance much it just wasn’t worth it contractor will ensure that any more – she’d worked out In contrast, those who are dispensing practice patients remain that she was averaging £39 an so ill and frail that they need able to access appliances in a hour, before tax, what with all carers in three times a day convenient and timely way – whether the hours she was spending are horrified at the thought they collect these items from the doing paperwork in the of ‘do not resuscitate’. “After practice dispensary, or have them evenings and at weekends. all, doc, life’s worth living delivered directly to their own home.

Of course, she’s not alone. isn’t it?”. Not quite what those She’s merely one of the many Whether your practice is medicines and appliance supply who designed the question Pharmacist Mark Stone will kind, caring, family doctors dispensing or non-dispensing, services achieve the best possible had in mind, I suspect. And also look at the impact of using who just don’t want to do all GP practices have a need to result for the patient, the NHS and if they thought filling in the Monitored Dosage Systems on the job any more, and have maximise income where they can: the practice. questionnaire was going patients’ treatment outcomes, walked away.

GP practices everywhere are under to make any difference to as well as the practice budget. unprecedented financial pressure.

At this year’s DDA Annual hospital admissions rates, Delegates will come away able Our practice finances are Conference, speakers will be on they are sadly mistaken. I to recognise and diagnose poor so tight we’re trying to limit Personally Administered Items (PA) hand to guide practices through the already know which of my adherence, as well as offering an locum costs, so I’ve been are one source of income that is arrangements and considerations patients are likely to fall adherence-boosting treatment plan. working 14 hour days trying often neglected by prescribing GPs. in these areas of practice. over, or have a stroke, and to ensure the patients are Misconceptions about the amount I’ve already done everything The Dispensing Doctors’ dealt with, the results get of work or bureaucracy required In his presentation on ‘Unravelling I can to try and prevent it Association is the expert in seen, the letters get read – to source, store, administer and VAT’ VAT expert John Barnes happening. Spending 15 dispensing and rural practice, and and their contents actioned claim for payment for PA medicines will examine the VAT liability minutes writing it down on it specialises in giving all members and coded. Then there is are often cited as the reasons for and payments arising from of paper isn’t going to help in of the dispensing practice team the the little matter of the extra ignoring what can be a reliable and Personally Administered Drugs, any way at all. It’s merely practical and realistic advice they stuff that needs to be done to substantial source of income. Yet, the NHS and private fee income, going to make a lot more hard need to improve patient care, while keep the money coming in so arrangements for claiming for PA reclaiming of VAT on purchases working GP’s even more fed maximising dispensing profitability. the staff get paid. I rejoiced payment are very easy and should and overheads, partial exemption, up with their job. when I heard that some of the take no more than a few minutes of property related VAT issues and the the practice’s time to complete.

VAT implications of new business This year’s Dispensing Doctors’ structures and shared resources.

Hear Dr Rosemary Leonard’s welcome as conference Association Annual Conference Similarly, scripts ordering chair in the Practice Business & Plenary Programme is your chance to get the help appliances or requiring the support Conference delegates will come stream at Best Practice. Register for your complimentary and advice you need – attend for of a Monitored Dosage System away better able to understand the pass at www.bestpracticeshow.co.uk/newspaper free at Best Practice, register can faze even the best dispensing VAT liability of different sources online via bestpracticeshow. practices - yet there are handy of income, the entitlement of co.uk/newspaper solutions available to practices that dispensing doctors to reclaim VAT will ensure that the practice’s NHS as well as getting to grips with the

Maximising income in general practice: don’t ignore the opportunities!

6

Join the conversation

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See the latest cost saving innovations and technology at Best Practice 2014 PLENARY THEATRE AND PLENARY THEATRE PRACTICE BUSINESS ANDAND FINANCE PRACTICE BUSINESS AND FINANCE TRACK A THEATRE

CLINICAL UPDATES CLINICAL UPDATES TRACK B THEATRE

B50

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D15 FDA

HAVEN D25HEALTH

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COMMUNITY E49 VENTURES

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GLUCO RX D34

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D47

2 D32 TALKING MMP POINT 2

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To get involved contact Jude Small on 0207 348 5753 or on j.small@ To get involved contact Jude Small on 0207 348 5753 or on j.small@

and a new stream of powerful general content. www.bestpracticeshow.co.uk Join the conversation

CTED N 2013

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#bestpracticeshow

7

THERE ARE ONLY 12 STANDS LEFT! The next couple of weeks represent your last chance to get involved, your last chance to showcase your products, solutions and expertise in front of over 2,200 decision making delegates. Act now to claim your chance to match or beat your competition and most importantly your last chance to use Best Practice to generate new business for your company.

Stand number

Dimensions

m2

Cost (shell scheme)

A4

2x2

4

£1,676

D19

4x3

12

£5,028

D47

3x2

6

£2,514

H18

3x3

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A30

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9

£3,771

G36

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£6,704

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£7,542

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9

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C52

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C54

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9

£3,771

G52

3x3

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IN PARTNERSHIP WITH:

MAIN SPONSOR

MAIN MEDIA PARTNER

In partnership with: In partnership with:

Now featuring NOW the DDA FEATURING THE DDA

Annual Conference: ANNUAL CONFERENCE ticeuk #bestpracticeuk | www.bestpracticeshow.co.uk

SFORMING SFORMING MARY CARE MARY CARE

CK C THEATRE

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SPENSING SPENSING OCTORS’ OCTORS’ SOCIATION SOCIATION CK D THEATRE

CK D THEATRE

Now featuring the DDA Annual Conference:

SPONSORS:

COME AND MEET COME AND MEET 2,200+ PRIMARY CARE ®

2,200+ PRIMARY CARE

DECISION MAKERS DECISION MAKERS

SUPPORTED BY:

SPACE: SPACE: +VAT 2 £409 +VAT/M2 £409 /M SHELL: SHELL: +VAT 2 £419 +VAT/M2 £419 /M

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Exhibitor spotlight Key supplier of medical consumables and equipment for 25 years. We stock thousands of high quality, competitively priced products ideal for surgeries and healthcare establishments.

Our exclusive range of Nutouch Disposable gloves are the UKs leading brand of quality disposable gloves. Stocking a huge range of latex, nitrile and synthetic gloves.

The Cardiomyopathy Association is there to help people and families affected by cardiomyopathy. We provide free patient information resources to help them to understand cardiomyopathy, allay their fears, answer questions and promote independence. We have a Helpline staffed by experienced inherited cardiac disease nurses to respond to the many calls for help we receive.

We also provide free medical education opportunities for doctors through our annual national conference programme and smaller local meetings. We work with healthcare providers to enhance the services provided to patients. All our information resources and services are provided free of charge on request. Email, info@ cardiomyopathy.org

Looking for something new? We help GP’s find positions across Australia.

We have a range of vacancies available with contracts from just six months to more long term positions.

Whatever you are looking for in Australia, contact us for more details.

Email our Head Recruitment Consultant Lee Brooks: leebrooks@ gprecruitmentaustralia.co.uk | www.gprecruitmentaustralia.co.uk

Multi-award winners, PinBellCom Ltd are specialists in Administration and Compliance Management Solutions for primary care organisations of all sizes. Organisational efficiency, cost savings, targeted information and evidence gathering are just a few of the many benefits of their solutions. Go to www.pinbellcom.co.uk or telephone 0333 011 0333 for more information.

High value, the highest quality. Stirling Anglian Pharmaceuticals is a new breed of pharmaceutical company, focused entirely on redefining value and challenging existing clinical practice – to ensure patients gain access to the best medicines at the best prices.

Come and see us at the show

Many GP practices love TalkingPoint Digital Dictation - simple to use and a big step forward from tapes. Many feel that DD is becoming obsolete since TalkingPoint Speech Recognition can remove the transcription process entirely!

Unnecessary “double handling” work disappears, and much more gets done in the available time. Practice staff love it!

8

Join the conversation

#bestpracticeshow www.bestpracticeshow.co.uk

GPs hitting targets but missing point of unplanned admissions DES There is strong evidence that many hospital admissions for dying patients are preventable, estimated by the National Audit Office to be about 40-50% of all admissions (NAO EOLC Report 2009). In addition hospitals are struggling to cope with increasing numbers of elderly frail patients whose admissions could be averted, and recent reports have highlighted the plight of such patients in hospital, most notably in the Francis Report, CQC Thematic Review and Ombudsman’s reports (2013).

more people to live well in the final stage of life and die well in the place of their choice.

Yet the rapid introduction of the DES from April 2014, with little supportive training or resources, has meant that many practices are unprepared and some might be’ hitting the target but missing the point’. There is a concern that they might end up tickboxing to secure payments, rather than ensuring sensitive effective proactive care for the 2% most vulnerable patients, which includes the 1% of people in the final year of life. So, despite good intentions, if poorly implemented, there are real dangers that introduction of the DES might lead to insensitive discussions, patient complaints and sub-optimal effectiveness.

Most patients have an average of three hospital admissions in the final year of life, and with discharge delays, this can have considerable cost implications to hospitals and commissioners.

These admissions can be distressing and disruptive for patients, carers and families, particularly for those nearing the end of life, and have a significant impact in bereavement.

So with more proactive anticipatory community care, this is an important issue for patients and their families, commissioners, GPs, care homes and other providers of care.

The introduction of the Avoiding Unplanned Admissions Direct Enhanced Service (DES) might therefore be seen to be very timely. This could be a fantastic opportunity to develop proactive primary care, helping practices develop preventative strategies that prevent the distressing admissions and enable many

The Gold Standards Framework (GSF) Going for Gold programme provides practices with the necessary tools to seriously address this important issue and meet the requirements of the DES, whilst also ensuring that the 2% vulnerable patients receive top quality care. (see DES section on GSF website) GSF Going for Gold is a practice-based six module programme designed to help practices identify vulnerable patients early, record advance care planning discussions, and enable better coordination. All of which helps practices to reduce hospitalisation, enabling more people to live and die at home or their usual residence. In practical terms, it involves an introductory session, four

“Practices can provide excellent care for those in the last year of life concurrently achieving the admission avoidance DES.” one-hour lunchtime sessions as a team and a subsequent follow-up session. In addition The GSF Centre run a ‘Silver ‘Programme with 2 interactive workshops plus homework and evaluation.

Practices that have completed the programme and gone on to gain accreditation with a Quality Hallmark Award have experienced a substantial boost in the number of patients on their register, a major increase in the number of advance /personalised care plans and a significant decrease in the number of hospitalisations. The programme was recently a finalist in the 2014 BMJ awards. With early identification and needs-based coding, the ‘blue’ category includes the wider 2% patients , thereby broadening to care for all people in the final years of life, not just those in the final days, and includes care of frail elderly for whom prognostication is particularly difficult.

Dr Karen Chumbley GP, Essex End of Life Care Lead whose practice has been GSF accredited, said: “It’s a culture change doing Going for Gold, we couldn’t go back to the

way we were... Building on your GSF work will help achieve the targets needed for the DES. Care planning for those at the end of life supports admission avoidance for many of the 2% most at risk of admission. Practices can provide excellent care for those in the last year of life concurrently achieving the admission avoidance DES.” The challenge therefore is to use the opportunity of the DES in the most effective way, and we have yet to see the impact of its rapid implementation, though we hope this might lead to further improvements that lead to better care for these most vulnerable patients.

For more information about the best use of the DES, free tools to support practices, the GSF Going for Gold programme, phone 01743 291895, email primarycare@gsfcentre.co.uk or go to www.goldstandardsframework.org.uk/ avoiding-unplanned-admissions-directenhanced-service.

NOW ONLY 126 FREE PASSES AVAILABLE - REGISTER NOW W: BESTPRACTICESHOW.CO.UK | T: 0207 348 4906 | E: TRAINING@CLOSERSTILLMEDIA.COM

Docman saving time and money for 6,000 GP Practices Electronic Document Transfer – letters are received electronically from hospitals into Docman’s workflow engine and filed into the clinical system. Benefits include, zero scanning, auto-patient matching, pre-populated filing fields and significantly improved document processing time.

Clinical Content Recognition – an advanced system that automatically detects patient and filing details, significantly improving speed and data quality of filing and summarising.

Intuitive Workflow – reported to save each of your GPs up to 15 minutes per day by using Quick Steps to combine actions and workflows into one mouse click.

Complete Practice Management – Docman BackOffice allows you to securely store and retrieve all of your practice documents in one categorised place. BackOffice Apps help you to prepare your CQC evidence with the latest applications to digitally record fridge logs, assets, events, feedback and more…

Audited Collaboration – Docman Collaborator offers a fully audited discussion platform enabling everyone to manage, share and discuss patient or practice matters.

Arrange a Demonstration

Visit stand D15 or call us on 01977 66 44 96 www.docman.com

Take your practice forward General Practices play an important part in Primary Care services in the UK. If you are looking to take the next step in your business and need support, talk to us. We are ready to listen at the best practice show October 22nd & 23rd on stand number C40 Contact details: Anne-Marie Jones, Corporate Banking Director, Northwest Healthcare. Mobile: +44 (0) 7799 868173 or Email: AnneMarie.Jones@rbs.co.uk

The Royal Bank of Scotland plc. Registered in Scotland, No. 90312. Registered Office: 36 St. Andrew Square, Edinburgh EH2 2YB. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

10

Join the conversation

#bestpracticeshow www.bestpracticeshow.co.uk

Getting to grips with the GP-owned pharmacy GP-owned pharmacies have been in the news recently, following evaluation of the pilot pharmacy service, the New Medicines Service (NMS). The evaluation has revealed that GP-owned pharmacies offer the best environment for promoting medicines adherence (the objective of the NMS).

In their evaluation, the researchers, who were commissioned by the Department of Health, found that “co-location enabled closer working between pharmacists and GP to confirm and refer patients, possibly leading to a triangular relationship between patient, pharmacist and GP, rather than two separate bi-lateral relationships”.

The Dispensing Doctors’ Association is a keen proponent of the GP-owned pharmacy, and many DDA Board members have an existing or stated interest in offering integrated medicines supply – a supply that makes the most of the unique and complementary skill sets of the community pharmacist and the general practitioner. In the August 2014 issue of the British Journal of General Practice, a paper by the DDA reiterated this view, outlining the potential for collaborative working by community pharmacists and general practitioners in the management of hypertension.

Via its website, and through the advice of pharmacy-owning DDA Board Members, the DDA is able to offer a range of advice for GP pharmacy owners on setting up and running a pharmacy. This information, which is exclusive to GPs with an interest in running a pharmacy, is available via the DDA’s online Integrated Medicines Provider Forum.

Each year the DDA Annual Conference also hosts a Question Time, where DDA Board Members will be on hand to answer delegates’ questions. This year, the Question Time takes place on Wednesday, October 22 at 1:50-2.20pm in Theatre D at Best Practice. GPs do not need to be a DDA member to ask a question - and attendance is free - so come to the DDA Conference at Best Practice to get some first-hand advice on all your dispensing-related issues.

Last year, questions answered by the DDA Board included the following: •

We run a dispensary side by side a 100 hour pharmacy which has its own pharmacist, dispenser and counter staff. The areas are separately demarcated and labelled. When the dispensary is closed e.g. evenings and weekends, is the surgery allowed to give permission to the Pharmacy to hand out their dispensed bagged up items?

•

What happens if my pharmacist calls in sick? Am I able to continue dispensing via the dispensary?

•

Could the DDA alert members of changes to standard drug prices when they go above the Tariff price?

•

If you have a hybrid pharmacy/dispensary, why should you continue with your dispensary?

•

Are there any ways in which a hybrid pharmacy/dispensary can operate without a Wholesale Dealer’s Licence?

•

Should the Wholesale Dealer’s Licence be owned by the dispensary or the pharmacy?

•

What mechanism must be in place in hybrid operations to ensure that patients’ wishes are complied with at each dispensing?

•

What provision would you advise to have in the pharmacy shareholders agreement regarding the retirement of a GP partner?

•

Do we as dispensers have a responsibility or obligation to inform our non-exempt patients if their prescribed NHS item would be cheaper to buy from a chemist rather than paying the levy fee?

NOW ONLY 126 FREE PASSES AVAILABLE - REGISTER NOW W: BESTPRACTICESHOW.CO.UK | T: 0207 348 4906 | E: TRAINING@CLOSERSTILLMEDIA.COM

About Us

Healthy Solutions For A Healthier Nation ...

A leading healthcare provider. We’re focused on preserving the values of NHS General Practice, the delivery of great patient care and continued relationships with the communities we serve. Embracing new ideas and seeking alternative ways to providing care including the use of new technology or adoption of new initiatives.

Meet our Business Development & Recruitment Team at Stand C35.

01732 525830 info@mallinghealth.co.uk www.mallinghealth. co.uk Or Scan Our QR Code

Stand C35

www.bestpracticeshow.co.uk Join the conversation

#bestpracticeshow

11

Developing a federated model of General Practice - Why now?

Scott McKenzie NHS Consultant – BW Medical Accountants Can you get by on your core GMS/PMS contract?

Assuming the answer is no, please read on.

for another company as a salaried staff member; salaried means pay and conditions, with a lack of control.

General Practice, as providers of Primary Medical Services, are at a crossroads; potentially a defining moment in the history of the NHS. It faces many challenges and standing still to try and address these is not an option. Keep doing what you have always done, and you can expect to keep getting what you have always got (or in the current climate - less!).

Why instead don’t you take control? While this will mean working to implement change, you will be in control of the change and working with people you know and trust.

Nobody can force you to do anything you don’t want to.

This requires a positive choice to become engaged in the process.

There are, though options for practices to explore. This of course means doing something different; simply tinkering around the edges will get you an outcome that goes with that, and it will not be enough! The time has come for something radically different that will allow all practices to re-think their delivery model; develop new ways of working and meet the challenges that are here and now.

There are of course options. You can do nothing. The clear risk with that is a destabilised and unviable General Practice. You could become employed and work for someone else; working

Dr. Richard Roope CRUK and RCGP Clinical Lead for Cancer fragmentation and supports continuity of care. Additionally, local services help avoid unnecessary referrals and admissions to hospital.

Our session will explore all the key benefits and answer the questions everyone’s asking: • • •

Forming a federation allows practices to play to their strongest suit, as it will be locally run, to meet local needs and serve local patients. Size in numbers adds strength.

•

A number of patient benefits are also easily attained.

Patients like the idea of Practices coming together to respond to the challenges the Health & Social Care Act has brought them. Patients also very much like that federations are locally run, by local GPs, for local people.

•

Patients understand with the Practices pulling together and supporting each other this potentially avoids service

From Better to Best Practice

• •

Why have Federations emerged as the big topic for General Practice?

What exactly is a Federation?

What is their place in the delivery of Primary Care?

How does it differ from other deliverers of Primary Care?

What sort of activities should they be doing?

What is the best structure for a Federation?

What pitfalls should you be looking out for?

Now is the time for practices to weigh up the benefits.

Now is the time to make a conscious decision on the best way forward for your practice; if not a federation then what?

Don’t leave it to happen to you, take a positive step, make a decision, and together take control NOW! (Our experts will be on stand H19 to answer further questions)

Not so long ago cancer was seen very much as rooted in Secondary Care. Primary Care’s role was to refer patients with suspected cancer onto the various pathways and its next involvement was end of life care. We were told that the average full time GP would see less than 8 cases of cancer a year and the implication was that as it was rare, we’d expect GPs would “not get it right every time”.

Now in 2014 much has changed and continues to change. As the number of people diagnosed with and surviving cancer rises, more cancer care and support is shifting to Primary Care.

There are now 2 million patients living with and beyond cancer in the UK. This is projected to rise to 3 million by 2020 and 4 million by 2030 . The latter will represent 670 patients in a practice with 10,000 patients (these numbers are similar to those of patients with diabetes). This reflects an ageing population, better treatments and higher cure rates. The projections suggest that the lifetime risk of cancer is fast approaching 1 in 2. These changes have huge implications for our society and for the funding of health care.

Primary Care will be required to step up to help address this situation – we have a part to play at all stages of the patient journey. The World Health Organisation identifies that “Prevention offers the most costeffective long-term strategy for the control of cancer.” Latest data suggest that 42% of all cancers in the

UK are preventable . Primary Care, if appropriately resourced, is ideally placed to engage with this task – tackling issues as wide ranging as breast feeding rate (breast feeding for 6 months reduces the risk of breast and ovarian cancer in the mother and childhood obesity rates) and encouraging more exercise before, during and after cancer.

In regards to early diagnosis, there have been notable improvements over the past few years: colorectal cancer 1 year survival has improved from 71% to 75% between 2000-2004 and 2007-2011 . Improvements are also reported for other cancers including breast, ovarian, prostate and lung.

The NHS is doing better but there is still room for improvement. We can be more approachable, hone our communication and consultation skills, put in place safe systems so that no-one “falls through the net”.

We want to refer the right patient to the right place to see the right person at the right time. We then should seek to provide the right care and support, in the right place for our patients as they live with and beyond cancer. We need to aspire to move from better practice to “Best Practice”.

Hear from Dr Richard Roope at his session at Best Practice: Cancer challenges. Register for your free pass at bestpracticeshow.co.uk/ newspaper

Your patients’ first steps towards understanding and managing their conditions – from depression to chronic pain The Reading Well Books on Prescription scheme recommends books that provide effective self-help treatment for a range of common mental health conditions using cognitive behavioural therapy.

The books are available to borrow in public libraries.

The scheme is delivered by The Reading Agency and the Society of Chief Librarians with funding from Arts Council England.

Recommended and endorsed by health professionals.

Find out more at readingagency.org.uk/readingwell

more in just two packed days than you would do from months at your desk.

12

Join the conversation

News in brief Continue your learning all year-round Build on the skills you learnt from Best Practice 2014 with free webinars available to delegates all year-round. Speaker presentations from 2013 and 2014 can be accessed through a learning portal exclusive to NHS and healthcare professionals who attend Best Practice in October.

The first drink is on us!

#bestpracticeshow www.bestpracticeshow.co.uk

16 hours of FREE CPD Training @bestpracticeuk #bestpr

Best Practice is the national showcase for excellence and innovation in general practice and it returns in October 2014, delivering world-class#bestpracticeu @bestpracticeuk clinical and business training. We understand it’s hard to justify time away from your practice but with content touching on every area of running a modern day practice, you will learn more in just two packed days than you would do from months at your desk. Whatever your role in primary care there will be education, innovation and networking opportunities for even - 23free October 2014 the most experienced professionals.22 Receive CPD training accredited 22 - 2 by the RCPG and AMSPAR by registering via bestpracticeshow.co.uk NEC, Birmingham NEC, or call 0207 348 4906.

22 - 23 October 2014 CPD certificates will be emailed to attendees two weeks after the conference.

NEC, Birmingham

THERE’S SOMETHINGTHERE’S SOMETHIN THERE’S SOMETHING FOR EVERYONE FOR EVERYONE FOR EVERYONE

Relax with colleagues and friends after the first the day of Best Practice at the official show drinks reception. Free drinks will be served from 5:45 on Wednesday 22nd October on the show floor.

It’s a great time to wind down and network with exhibitors, catchup with colleagues and enjoy the buzz of the fantastic exhibition.

NAPC Awards and Gala Dinner The official black tie event in primary care takes place on the first evening of Best Practice 2014. Join official show partners NAPC at their annual Award Ceremony and Gala Dinner for an evening celebration, fun and some surprises! 2014 award categories: • • • • •

Practice Manager of the Year Joint Working Initiative of the Year Clinical excellence award Equality & Inclusion Award Health and Wellbeing Innovation of the Year

Tickets are still on sale for £49.99, email Sally Kitt via napc@napc. co.uk to reserve your ticket. Discounts are available for group bookings.

DRINKS RECEPTION

Join us for a drink from 5:45pm on Wednesday to celebrate the opening day of Best Practice. It’s time to wind down at the end of day one and p Join us for a drink from 5:45pm on Wednesday eveningan ideal opportunity to talk to exhibitors, catch Join us for a drink from 5:45pm on Wednesday evening to celebrate the opening day of Best Practice. It’s a greatcolleagues and enjoy the buzz of this fantastic ex to celebrate the opening day of of day Bestone Practice.

It’s a great time to wind down at the end and provides FREE to all attendees.* time to opportunity wind downtoattalk thetoend of day one provides an ideal exhibitors, catchand up with an ideal opportunity talkoftothis exhibitors, catch up with colleagues and enjoy thetobuzz fantastic exhibition.

FREE to all attendees.* colleagues and enjoy the buzz of this fantastic exhibition.

DRINKS DRINKSRECEPTION RECEPTION

DON’T DELAY BOOK TODAY! NAPC AWARDS AND GALA DINNER

NAPC AWARDS AND GALA DINN

FREE to all attendees.*

Wednesday 22nd October at the Hilton Metropole Birmingham

NAPC AWARDS AND GALA DINNER This black tie event is not to be missed with wha Wednesday 22nd October at the Hilton Metropole Birmingham

be an evening of celebration, fun and some surp

Wednesday 22nd October at the Hilton This black tieBirmingham event is not to be missed with what will With the following awards to be won: Metropole be an evening of celebration, fun and some surprises! •

Practice Manager of the Year

This black tie event is not to be missed with what will • Joint Working Initiative of the Year With the following awards to be won: be an evening of celebration, fun and some surprises!

• Practice Manager of the Year With the following awards to be won: • Joint Working Initiative of the Year Practice Manager of the Year •• Clinical excellence award • Joint Working Initiative • Equality & Inclusion Awardof the Year Clinical excellence •• Health and Wellbeing award Innovation of the Year

• • •

Clinical excellence award

Equality & Inclusion Award

Health and Wellbeing Innovation of the Yea

Tickets can be purchased via napc@napc.co.uk £49.99 per person or discounts for group bookin

•Tickets Equality InclusionviaAward can be & purchased napc@napc.co.uk at £49.99 per person or discounts for group booking POA. • Health and Wellbeing Innovation of the Year

CLAIM YOUR WWW.BESTPRACTICE CLAIM YOUR COMPLIMENTARY PASS BY REGISTER

ONLY 126 FREE PASSES AVAILABLE! WWW.BESTPRACTICESHOW.CO.UK/TI14 AND SAVE THE £699 Tickets can be purchased via napc@napc.co.uk at £49.99 per person or discounts for group booking POA.

*Com

CLAIM YOUR COMPLIMENTARY PASS BY REG WWW.BESTPRACTICESHOW.CO.UK/TI14 AND SAVE TH *Complimentary passes are reserved for NHS employees and qualified healthcare professionals only

*Complimentary passes are reserved for NHS employees and qualified healthcare professio