Practice Business November 2012

PracticeBusiness november 2012

Practice INSPIRING BUSINESS SOLUTIONS FOR PRACTICE MANAGERS

NOVEMBER 2012

LTCS | PRACTICE PR | COMPETITION

The road to long-term health Are you doing enough to tackle chronic conditions?

DON’T SELL YOURSELF SHORT Promoting your services to the CCG

COMPETITION CLAUSE How to stand a chance against corporate primary providers

Practice Business is an approved partner with...

editor’s letter EXECUTIVE EDITOR roy lilley EDITOR julia.dennison@intelligentmedia.co.uk ASSISTANT EDITOR carrie.service@intelligentmedia.co.uk CLINICAL EDITOR dr paul lamden ACCOUNT MANAGER george.petrou@intelligentmedia.co.uk PUBLISHER vicki.baloch@intelligentmedia.co.uk DESIGNER sarah.chivers@intelligentmedia.co.uk PRODUCTION/DESIGN peter.hope-parry@intelligentmedia.co.uk CIRCULATION MANAGER natalia.johnston@intelligentmedia.co.uk

CONTACT US Intelligent Media Solutions Suite 223, Business Design Centre 52 Upper Street, London, N1 0QH t: 020 7288 6833 f: 020 7288 6834 info@intelligentmedia.co.uk www.practicebusiness.co.uk www.intelligentmedia.co.uk twitter.com/practice_biz

Public relations in practice

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elcome to the newly designed Practice Business. Our designer, Sarah Chivers, has set to work on making the monthly title even easier on the eyes. We’ve rebranded our logo and updated the look and feel to all our sections to make your reading experience that much more pleasant.

In our ‘Primary Provider’ section this month, we have taken the ‘Any Qualified Provider’ mantra and worked to make sure we support NHScontracted GP practices compete for the commissioners’ attention when it comes to additional services and add-ons. We look at what practices are doing to help long-term conditions, a chronic and painful drain on NHS resources. Then on p17 we look at what you can do to promote your practice to commissioners and the community, while on p20 we look at what competition will look like from the big multi-national primary providers.

We know that ‘promote’ is often seen as a bad word in primary care, but practices are promoting themselves in more ways than many people realise.

Just the other day I got a leaflet in my letterbox from a nearby practice – I say ‘nearby’, it’s still a good half-hour walk away – encouraging me to leave my current practice and switch to them. They explained how they would help you do the legwork and quoted some very happy patients, while listing their unique selling points. While it was a tempting offer, I’ve had a more-or-less good experience with my GP practice and the idea of sweating to reach the other practice before it closes to pick up a repeat prescription does not really appeal. However, I was impressed by their effort.

In the past there has been talk of ‘gentleman’s agreements’ between practices, coming to the mutual decision not to poach each other’s patients, while other GP surgeries make not poaching patients a priority promoted on their website. However, with the changing NHS, and increased competition, the future may look very different.

EDITOR

contents sector 06 Practice news

Top news for practice managers this month 08 Executive editor comment The latest from controversial columnist Roy Lilley

primary provider

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10 Provider news A practice manager’s update on providing for a commissioning landscape 13 LTCs Better in the long-term Are you doing enough to tackle chronic conditions?

17 Marketing Sell yourself Promoting your services to the CCG 20 Contracts Competition clause Do you stand a chance against corporate providers?

people

37

24 Case study Military precision A Colchester practice gets even bigger in its britches 28 Case study Changing the system One of the first Scottish practices to introduce the Patient Access system

management 32 Premises A buyer’s market? The pros and cons of renting or buying your surgery’s premises 37 Patients Handling complaints What do you do about it?

40 Clinical QOF This month: hypertension 42 Legal Is your ‘green sock’ clause in place? Partnerships are sometimes closer than marriage. Cover everything

work/life

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44 CPD Becoming partner Is it still such a good idea in this changing climate?

48 HR Face the facts When to get off the phone and email and explain things in person 50 Diary

Grant Burford, IT manager of Imperial College Health Centre, on being ‘paper-light’

your monthly lowdown on practice management

More work, less pay for practice managers

Basic pay for practice managers has dropped since last year, despite bigger work loads. The average income is now £38,758 compared to £39,059 in 2011.

There are also substantial differences based on location and practice size. Greater London remains the top-paying region of the UK, with average total earnings of £42,263. However, this demonstrates a decline of three per cent since last year.

Scotland and Northern Ireland have traditionally been the lowest paying regions, however this year it’s Wales, with an average PM salary of £33,906.

For smaller practices (less than 5,000 patients) the average manager’s income is now £31,589, a two per cent reduction on last year, and for the very largest practices (more than 14,000 patients) the average is £47,491, a 1.5% increase over 2011.

Bonuses have been in a steady decline for the last few years, however, more practice managers have partner status – increasing from three to 3.75 per cent in two years. Partner PMs are more prevalent in medium to larger-sized practices. The average practice list size for managers with partner status is 12,865 compared to an average patient list of 8,685 of all respondents. The total average earnings by those managers with partner status is £55,510 – over 40% higher than for non-partner responders.

For the largest practices, the average manager/partner income is circa £60,000 and remains unchanged from the previous year.

Steve Morris, of First Practice Management, which surveyed 1,300 PMs, said: “At a time when activity levels in practices are stepping up as commissioning gathers fast facts pace, and CQC requirements impose greater demands on managers and staff, n 0.87% - the amount basic there is a view that both practice and pay has dropped for practice personal rewards are inadequate.” managers over the last year n £38,758 – average practice Mark Dowden, sales and marketing manager’s income director at Towergate MIA, which also ran n Greater London is the UK’s the survey, says PMs are essential for the top-paying region “successful running of a practice”, and it is n Wales is the lowest paying region. important they are rewarded accordingly.

06 november 2012

Practices must treat ‘health tourists’ or risk discrimination charges GP practices must register foreign-born patients or risk breaking human rights, new rules from NHS London stipulate.

Foreign-born patients include anyone from overseas students to tourists on holiday as “there is no set length of time that a patient must reside in the UK in order to become eligible to receive NHS primary care services” and they are entitled to the same NHS primary care as British citizens.

NHS London says “nationality is not relevant” to whether or not you can be treated in primary care and practices should not insist on seeing passports as it could be “discriminatory”. Critics worry it is not the best use of taxpayer’s money.

diary

sector

practice news

6-7 November EHI Live NEC Birmingham EHI.co.uk

28 November

Managing change: Transforming the public sector The Barbican, London PublicServiceEvents.co.uk

& 5,218 STATS

FACTS

The amount of staff hours per year it is claimed practices could save using online booking (Source: Patient Partner)

A report on the progress of NHS 111 has highlighted concerns, including its impact on out-of-hours GP services.

The report by the NHS Alliance, entitled ‘Getting to grips with integrated 24/7 emergency and urgent care’, raises concerns about the impact of working towards an integrated emergency and urgent care system while at the same time introducing NHS 111. It poses a number of key questions for commissioning groups, including how well engaged GPs are in urgent care and development of a local urgent care strategy; Are they ready to innovate, especially around access? and How well engaged is the CCG in the local implementation of NHS 111?

The report warns that the nonemergency number could cause a steep rise in demand in general practice and also have a negative impact on out-ofhours GP services.

Despite these concerns, the Department of Health argues that the overall programme for national implementation is on course and a survey of 1,700 users carried out by the University of Sheffield NHS 111 evaluation team has showed high levels of satisfaction with the service, according to the report.

clinical news

Report raises 111 concerns

More than 700,000 people immunised against typhoid recently may not have full protection after a dud vaccine has been recalled by its manufacturer. Sanofi Pasteur MSD has called back 16 batches of its Typhim Vi vaccine after test batches were found not to be strong enough. This could affect anyone immunised since January last year.

While the faulty vaccine is said to be safe and pose no threat, the Medicines and Healthcare products Regulatory Agency (MHRA) worries it could be too weak and as many as 729,606 people who had the jab may not be fully immunised against typhoid. The MHRA is urging people who may be affected to contact their GP if they feel unwell after going on holiday. While a working vaccine is still available, the Department of Health says it is working with manufacturers to ensure any supply problems are resolved as soon as possible. “Anyone who has been to a typhoid region of the world and has a fever, abdominal pain and vomiting should contact a healthcare professional,” said MHRA’s head of Defective Medicines Report Centre, Ian Holloway.

THEY

SAID

Lone GPs left to cover 500,000 patients out of surgery hours

“We must ensure that any fee we charge is fair and proportionate. We have set out six principles to guide how we will charge fees, while we move towards the Government’s policy of full cost recovery from providers. In this consultation we are asking for views about our longer term fees strategy as well as seeking feedback on our proposals for revisions to our current fees scheme and extending it to primary medical services. The changes set out in this consultation demonstrate that we have listened to and acted on the views of service providers.”

David Behan, CQC’s chief executive, on the announcement of a consultation on fees

what we learned

NHS chiefs are routinely assigning just one family doctor to districts that stretch over hundreds of square miles, in an effort to cut costs as a third of PCTs slash night and weekend spending over the past year.

The standard of out-of-hours care had been under scrutiny since 2004, when a new contract enabled GPs to opt out of evening and weekend duties. Now only one in four works out of hours.

Many trusts have since outsourced the cover to private firms that hire locum doctors to fill the shifts.

Using the Freedom of Information Act, the Daily Mail asked every PCT in England a series of questions about out-of-hours cover. Of the 90 that responded, 35 had cut their out-of-hours budgets by an average of 10% since last year. And 11 trusts employed only one doctor at night to cover between 180,000 and 535,000 patients.

A spokesman from Serco, the private firm which runs out-of-hours cover in Cornwall, where GPs were covering the most patients, told the Mail the company now ensured there were at least two GPs on call.

Almost two-thirds of patients surveyed by the Department of Health in June found the time it took to get care from their GP service outside working hours was “about right”. Two-thirds also described their experience of out-of-hours GP services as “good”.

Typhoid vaccines recalled

Practice managers have been illegally selling NHS access. GP practice managers and ‘fixers’ have been filmed illegally selling access to GP appointments to foreign nationals who would otherwise not be entitled to free hospital treatment. One practice manager was secretly filmed for BBC Panorama selling patient registrations at a health centre to an undercover reporter for up to £800 a time. The reporter went on to have an MRI scan, which should have cost her £800 via private healthcare.

november 2012 07

sector

practice news

sector

comment

There are more briefcases than stethoscopes running the commissioning agenda, ROY LILLEY finds. He asks: How badly do GPs even want it?

ROY LILLEY

Roy Lilley is executive editor of Practice Business. He is an independent health and policy analyst, writer and broadcaster and commentator on health and social issues.

Handing over the controls I

saw a graph. It was in one of the health trade magazines. It was attached to an article about how the ‘liberation of the NHS’ was turning out.

Frankly, I was astonished.

The whole purpose of the upheaval, the palaver and upset was to take commissioning out of the hands of the ‘managers’ and put docs in the driving seat – GPs to be precise. Over time that intent has been eroded. The name gives it away. Originally the commissioning collectives were called ‘GP commissioning groups’. The hospital consultants and the nurses didn’t like the idea of that, so the groups were renamed ‘clinical commissioning groups’ and their membership widened to include consultants, nurses and GPs. Next to go was the idea that commissioning groups could be formed in sizes and configurations that suited the locals – three or four practices getting together in a sort of huddle, based on a wine society or a lodge night. Indeed, the legislation would still permit two practices to form a CCG. The problem with that is they have to be authorised by the NHS Commissioning Board.

The board has made it clear any group covering a population of less than about 200,000 won’t see daylight. Over 300 embryonic CCGs have been bashed and crashed into just over 200. My prediction is they will be made to merge and reconfigure into even bigger groups. Expect anything between 300,000 and 500,000.

GPs were expected to be able to commission all the care for their populations. That wasn’t going to happen either. Over 80 specialties have been taken off the CCGs list of things to do and dropped into the commissioning board’s in-tray.

GPs took it for granted they could involve the private sector as and when they pleased. You can forget that, too. There are getting on for 75 services that will have to be market-tested under the requirements of the Any Qualified Provider provisions.

So, although I was taken aback at the graph, on reflection, I’m not so surprised. It spelled out

08 november 2012

the fact that GPs are walking away from all this, big-time. The graph used pictures. Stethoscopes for GPs, briefcases for managers and a clip board for ‘others’.

The graph was all about accountable officers.

AOs are important people. They are the people who are held to account by the Commissioning Board and (in extremis) the courts. They are important; they are effectively ‘the boss’.

The expectation was that these roles would be filled by GPs. Not so. The graph showed three times as many briefcases as stethoscopes and clip boards combined.

It seems to me the docs don’t really want to be in the driving seat, even if they could drive.

The graph showed three times as many briefcases as stethoscopes and clipboards combined

primary provider

commisioning news

empowering practices in a commissioning landscape

PCTs expand Any Qualified Provider Trusts should have been ready to expand the Any Qualified Provider policy to 39 service areas last month, the Department of Health has said.

The rollout of AQP started last April after the DH identified eight community and mental health services that could be provided under the policy.

AQP providers need to be approved by a PCT to go onto a list of providers from which patients are given a choice.

PCTs are due to have the contracts for the 39 service areas finalised by the end of October. They will then be able to advertise these contracts on the Supply2Health website, allowing providers from the private and voluntary sectors, as well as the NHS, to apply for approval.

The only circumstances in which commissioners can reject providers is if they reject the price offered, refuse to agree to local standards or to comply with pathways and referral thresholds, or if they fail quality standards.

A DH spokesman told GP Online: “The choice of service made available for AQP is by no means ‘top down’. For 2012/13, PCT clusters were asked to offer patients a choice of AQP in at least three services which were identified as local priorities through local engagement.

“Of the 39 services listed, only eight were identified as national priorities. These were proposed after substantial engagement with national patient groups, and had their strong support.”

NHS in distress, says RCGP Dr Clare Gerada, chair of the Royal College of General Practitioners, has spoken out about the “turmoil” caused by reforms to the NHS and the pressure services are under to improve efficiencies while maintaining quality of care.

Speaking at the RCGP’s annual conference in Glasgow, Gerada said: “In England, we were in the midst of the Health and Social Care Bill – and, despite assurances to the contrary, the NHS is

10 november 2012

experiencing the mother of all top-down reorganisations. In fact, the most radical in its 60-year history.”

Gerada said that the whole of the UK’s health services (despite the Health Act only applying to England) are under a great deal of pressure to perform.

She described the bill as “longer than a Tolstoy novel” and as having been “rushed through at breakneck speed”. “As a result, our NHS is in distress,” she said

£1.5m allocated for personal budgets As much as £1.5m has been identified to support the potential roll-out of personal health budgets, according to care and support minister, Norman Lamb.

A personal health budget pilot programme is taking place across 60 PCTs, an evaluation of which is due before the end of hte year. In order to be ready as soon as the findings are known, the Department of Health has identified £1.5m to be made available to support the first stage of a potential roll-out.

Lamb said: “We want to ensure more care is tailored around people’s individual needs and preferences. Giving those with complex health needs the control of how to spend money on their care gives them and their doctors the flexibility to try innovative new approaches to achieve better health outcomes.

“Subject to the results of the current pilot programme, our aim is to introduce a right to a personal health budget for people who would benefit from them most – the scale and pace of this will be informed by the independent evaluation.

“We want to be on the front foot as the results become known – that is why we’ve identified £1.5m to support the NHS in the first stage of the roll out as it starts to implement personal health budgets.”

This is not new money, but NHS money put in the hands of patients to help them decide what treatments work best for them.

People with complex care needs and those with a range of long-term conditions, such as stroke, diabetes, neurological conditions, mental health needs and respiratory problems like chronic obstructive pulmonary disease (COPD), have been involved in the pilots so far.

news

Diabetes cases to rise by 700K The number of people being diagnosed with diabetes is expected to rise by 700,000, warns Diabetes UK The research, based on data collected from the Yorkshire and Humber Public Health Observatory, has revealed that 4.4 million people in England, Scotland and Wales are predicteded to have the disease by 2020.

The majority of these extra cases of diabetes would be Type 2, which is preventable by leading a healthy lifestyle. The charity says that Type 1 diabetes also appears to be on the rise, however it is unclear why this is.

Barbara Young, chief executive of Diabetes UK, said: “The healthcare system is already at breaking point in terms of its ability to provide care for people with diabetes. The result is that many people are developing health complications that could have been avoided, and are dying early as a result.

“Because of this, I have grave fears about the potential impact of an extra 700,000 people with diabetes, which is almost the combined population of Liverpool and Newcastle. We face the very real prospect of the rise in the number of people with the condition combining with NHS budget pressures to create a perfect storm that threatens to bankrupt the NHS.”

Better in the long-term Long-term conditions, by their nature, are a drain on NHS budgets and can only be managed effectively if tackled from every angle. CARRIE SERVICE asks if you are doing enough to make things better in the long-term

A

round 15 million adults in England suffer from at least one long-term condition (LTC) – an incurable condition that can be managed with medication and/or therapy. That’s almost one in three adults. Needless to say, LTCs cost taxpayers a great deal of money and so have been at the forefront of many of the recent changes happening in the NHS. The Government set up a consultation earlier this year looking into how long-term conditions are currently dealt with. It asked people to share their thoughts on what problems they face, either living with an LTC, or in their work affecting people with LTCs, and how they thought these problems could be better tackled. It requested that respondents consider how local services can work together to make life better for people with long-term conditions; how people with longterm conditions can be experts in their own care and how services can be based on their individual needs.

Integration, integration, integration At the Tackling Long-term Conditions conference in May, experts discussed what the future of LTC management in the NHS could look like. David Behan, director general of social care, local government and care partnerships highlighted the lack of joined-up care as the biggest frustration for patients at present. He pointed out that for people with long-term and multiple conditions, their lives are about much more than health and social care and that public transport, leisure and employment are major factors that

need more consideration – a more holistic approach. He also placed an emphasis on older people and their needs – after all, they account for 29% of the population and a massive 50% of all GP appointments. He pointed out that, “a younger sporadic user of health services has very different needs to a frail, elderly person with multiple long-term conditions and chronic care needs”. With this in mind, working with local care homes and community groups to negotiate transport for regular users of specialised primary care services within your practice area or consortium is one way of ensuring that your elderly patients with LTCs get the support they need.

Although the buzz phrase ‘integrated care’ is generally recognised to mean the integration of care between the primary and secondary sectors; distilling this concept and applying it at practice-level could have a significant impact on how long-term conditions are dealt with within your patient population. For example, if you currently share your services with another practice in the locality or another surgery that comes under your practice group, consider whether your own services are truly joined-up. If a patient arrives at your surgery and needs to see someone immediately for a particular service and you can get them an appointment at the practice that provides it, how easy is it for that person to actually get to that appointment? For example, will they need a taxi to get them there? An equally important question is: When the patient arrives, will the person

november 2012 13

primary provider

managing LTCs

primary provider

managing LTCs

carrying out the treatment have access to the patient’s notes, i.e. are you using the same clinical IT system across the practices and if not, what processes do you have in place to counteract this so that care does not become fragmented? Behan also emphasised in his presentation that “you can only improve what you measure”, therefore data analysis and patient feedback is vital to the progression of a strategic and integrated approach to LTC management at your practice. Ramp up your PPG’s activity as much as possible and always give patients the chance to feedback, especially if you are working with another practice where you may not always witness how they manage their services first hand.

Knowledge is power Comments published on the Government’s LTC consultation page suggest that education and support for patients is very much at the forefront of people’s minds when considering how LTC management can be improved. One wrote: “Each individual needs right of access to information about her/his condition and the right to appoint an agent to act as interpreter of such information (with right of access to personal data if such is specified by the individual).”

So educating patients is key – after all, how can they help themselves if they don’t fully understand their own health needs? Another respondent highlighted the importance of patient groups in achieving this goal: “Early diagnosis and referral to appropriate treatment and support can only be fully achieved if health professionals are aware of the value that patient groups can provide in-between appointments. Signposting to appropriate patient groups for the long-term conditions initially diagnosed could prevent a great deal of anxiety for the patient who is experiencing a life-changing event.” They added that cost-effective mechanisms could be put in place if local services developed good relationships with the voluntary sector – making things better for everyone in the long-run: “It could also prevent the patient’s condition deteriorating to the extent that they require expensive and invasive secondary care.”

Telehealth If patients feel that they have the right kind of support around them through support groups and the like, they will have a better chance of making use of self-management

14 november 2012

techniques such as telehealth. But it’s important that they also have support in implementing telehealth and this is another area where patient support groups could play a major role. NHS Yorkshire and Humberside used money from the Regional Innovation Fund to develop a local telehealth hub, offering telecoaching, remote telemonitoring and teleconsultation to patients across the region. In addition, a Health Innovation and Education Cluster was commissioned to deliver an awareness-raising capacity and capability programme demonstrating best practice on new care models using telehealth. It is estimated that in Yorkshire and the Humber there are approximately 11,000 new patients per year suffering from at least one LTC, who could benefit from the use of telehealth at the time of diagnosis on a short-term basis, and about 50,000 patients who could benefit from it on a longer-term basis. In particular, this refers to patients with COPD, chronic heart failure and diabetes. If telehealth is something that your practice is implementing, consider whether or not your patients could benefit from a support network where they could share experiences and have access to information and advice. After all, long-term conditions are here to stay (the clue’s in the name) so the sooner we get to grips with managing them, the better.

A younger, sporadic user of health services has very different needs to a frail, elderly person with multiple long-term conditions and chronic care needs

CQC REGISTRATION

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Special Offer If you take a CPD training session or risk assessment before the 31st December you can purchase dbg membership for a reduced price of £50.00 + VAT (saving £280.00)*

*Annual membership is usually priced at £330 + VAT, offer is first year only

As of July 2012, NHS GP practices across England have been required to begin the process of CQC registration, with inspections expected to commence from April 2013.

With so many regulations for GP practices to consider, and so many different ‘boxes to tick’ it can be hard for practice managers to keep on top of absolutely everything. In many cases when CQC inspectors find a failing, the lack of compliance is normally as a result of lack of understanding on the part of the practice, and not on any grounds of wilful neglect.

This is why it’s so important that as a practice team you fully understand the regulations and how they specifically apply to your practice. Without careful planning and thought, it can be all too easy to miss something out, only to have CQC inspectors pick up on it on inspection day.

Ask yourself, for example: Do you have full records of staff induction training and additional refresher training on all pieces of equipment in your practice? Do you have a suitable infection control policy for your waiting areas? Do you have a full set of up-to-date practice policies and written procedures?

At dbg we can help you address all these questions and more besides, as we work together with you to bring your practice into full CQC compliance. We have over 20 years’ experience working alongside healthcare practices and are ideally placed to meet your practice’s compliance needs. As well as providing membership services to GP practices, we also work closely with dental practices as well. Because dentistry has been under CQC jurisdiction for over three years now, we have built up an incredible amount of experience that we can bring to GP practices, giving you the tools you need to pass your CQC inspection with flying colours.

At dbg, our members’ interests are at the heart of everything we do. Our friendly and experienced team work to provide an excellent level of service and support wherever and whenever you need it, and we will always go out of our way to accommodate your needs. In the world of CQC compliance, we offer a whole wealth of experience, drawn from years of helping practices meet their regulatory requirements. With dbg you can be sure your practice is in good hands.

Following on from your self-assessment, you may wish to work with us further via a full on-site practice assessment to ensure that your responses are accurate and evidence can be validated for a formal inspection. Our expert team can then help you with any areas highlighted and provide a full analysis of any areas where there are gaps in your compliance.

The assessment is designed to demonstrate to your practice team, your patients and the regulatory bodies that you are proactively working towards maintaining your obligations and compliance with the ‘Essential Standards of Quality and Safety’, as well as highlighting any potential issues that you will need to manage.

At dbg, our members’ interests are at the heart of everything we do. Our friendly and experienced team work to provide an excellent level of service and support wherever and whenever you need it, and we will always go out of our way to accommodate your needs. In the world of CQC compliance, we offer a whole wealth of experience, drawn from many years of helping practices meet their regulatory requirements. With dbg you can be sure your practice is in good hands. Together, we can help make your practice perfect.

For more information, call dbg on 01606 861 950 or visit www.thedbg.co.uk

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So whether you’re on a the board of a clinical commissioning group, participating in commissioning, a provider or interested from the side-lines, stay one step ahead of the Government’s plans to give clinicians power over £60bn of the NHS’ budget.

This magazine is aimed at GPs, practice managers, secondary healthcare clinicians and nurses – anyone who has an active role in commissioning. It will provide them with the must-have tips and tools to make a success of clinically-led commissioning.

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PRACTICEBUSINESS

As private business increasingly encroaches on primary care’s remit, it’s time to start marketing your practice effectively or fall by the wayside. GEORGE CAREY finds out how to get the message out there to your patients

Shout it from the rooftops W

ith the likes of Virgin Care and Serco winning the right to fulfil massive NHS contracts and the increased culture of competition in the commissioning age, practices need to become increasingly business-like to survive. This may not have been what Aneurin Bevan had in mind when the NHS started, but it’s where we find ourselves.

The harsh reality is that patients are also

customers and quality treatment on its own isn’t always enough to ensure that they keep coming through the door. Marketing and PR are no longer dirty words in primary care and can make all the difference to patients’ perception of your practice.

Whilst it may seem like a huge culture change, marketing your practice is based on common sense; finding out what patients want, promoting the service, and delivering

november 2012 17

primary provider

marketing

primary provider

marketing

it. You may not have thought of it in these terms before but your practice is a brand, like any other. Once you have a brand, keep it in mind for all of your marketing initiatives. Marketing methods you may want to consider include: direct mail campaigns, brochures and leaflets, organising community events, text reminders or submitting articles to publications (hint).

Newsletters are a great way of keeping in touch with your patients and informing them of changes at the practice, such as additional services, or new staff. Giving the material a personal touch, will allow patients to feel closer to staff and encourage good relationships in the future.

Distinguishing yourselves from other practices is crucial, in order to make you a compelling choice for patients in this more open environment. Whilst it may sound elementary, understanding who your patients are is key to this. Ask yourself, what kinds of people live in the area and make up your existing patient list. Are they families with young children, OAPs or students?

Arming yourself with this knowledge can allow you to tailor services that will stand out and stick in people’s minds, fitting a walk-in clinic or early opening times around commuter schedules for instance, could be a way to differentiate you from other practices, and direct people to you.

Your website is your first point of contact for the new generation of your community, and it is very important to use this valuable

18 november 2012

tool to communicate with existing and potential patients. There may have been a reticence among practices to focus on their digital offering up until now, because it wasn’t seen as an important part of their service offering, but that’s no longer the case. Think about how you would buy services and the importance you attribute to the ease and quality of the website. You automatically relate that to the service on sale. GP practices are no different.

The harsh reality is that patients are also customers Search engine optimisation (SEO) is a very important part of getting recognised on the internet and a competing practice appearing above you on Google’s front page, can make a difference of a significant number of patients. Think about what key search terms your particular demographic might be using to find you and employ that to make your site as visible as possible.

Usability is equally important, and a simple but informative site that is easy to navigate will be a huge plus point in the eyes of patients, especially older people, which

make up a large proportion of your patients, who are not quite as comfortable with digital discourse. With patients now expecting to be able to access repeat prescription forms and make appointments online it is essential to invest in your digital communications in order to stay relevant and competitive.

A section of the site dedicated to health news is a great way to keep your patients informed and show them that you are up to date with all the latest issues affecting healthcare. The time needed to write original news is, of course, more than most practice managers and GPs have, but headlines with links to news agencies is sufficient to get the message across.

In addition to your practices website, social media allows you to engage with patients on a slightly more personal level.

Here you have the opportunity to educate people, and give them useful advice. There are concerns about confidentiality and it’s no replacement for a face-to-face visit but can still be a useful tool. When it comes to confidentiality, bear this in mind: If you wouldn’t say it happily in the middle of the street, don’t say it on social media. It’s very simple really. It can be a great way to gain feedback from patients on your services and start new conversations about healthcare in your area. Armed with a shift in perception and a digital arsenal, it should be possible to expose your practice to more and more patients and ensure that your business stays buoyant and successful.

primary provider

provision

H E A LT H Y COMPETITION With private companies threatening to take a portion of primary care provision, how do existing smaller GP practices contracted to the NHS compete?

CARRIE SERVICE speaks to public service expert CRAIG DEARDEN-PHILLIPS

T

he public sector has changed almost beyond recognition in recent years with private sector companies now playing a bigger part in service provision than ever before. The state education sector for example, is now almost indistinguishable from the independent sector, with academy schools sponsored by large private companies, opening up all over the country. And it seems that the health sector is heading steadily in the same direction, with huge multinational corporations, like the recently censured Serco, providing services within the NHS. The issue of private provision in public health is one of great contention, with organisations like the British Medical Association staunchly campaigning against it.

In fact, it has just been announced as I write this that the BMA is considering leading a mass patient opt-out from privately-run health services, which could entail patients being given a ‘patient pledge’ card, allowing them the power to request that they are only referred to state-run services – in effect a boycott of the Any Qualified Provider (AQP) scheme.

20 november 2012

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provision

What about the little guy?

So what does private provision mean for GP practices contracted with the NHS? Well, if you are a small practice, you will be only too aware of what this could mean, and why the BMA is so adamant that private companies should be kept well away. The family-run, one-man-band GP practice is looking increasingly vulnerable as multinationals step in, opening sparkling new health centres and offering every service under the sun.

But there is no denying that there is a lot that can be learned from how private companies use NHS funds, as Craig Dearden-Phillips, public sector business expert and founder of Stepping Out, an organisation that encourages social enterprise in the public sector, pointed out in an article for The Guardian, around the time of the Serco scandal: “Evidence from the world’s most successful health systems – such as Holland, France and Germany – suggests that the most potent way to mitigate the risk of the NHS silting up under its own cost pressures is to open up the whole healthcare market to new entrants.” So how can small providers ensure that they are part of this provision revolution, as opposed to one of the victims of it? When I ask Dearden-Phillips how his vision of the future may affect primary care in particular, he says: “The more enterprising GP practices are saying: ‘Well, ok, we provide primary care, what secondary care can we provide?’” He gives the examples of district nursing, physiotherapy and MSK as some of the services that forward-thinking GP practices should be looking to acquire. “The kind of extra care at home that keeps people out of hospital,” he says. But it’s not only the services you choose to provide at your practice, it’s how you choose to do so that will determine whether or not you’ll survive.

If the most desirable contracts require economies of scale, it might be a case of ‘if you can’t beat ‘em, join ‘em’, he says:“For example, if I was interested in providing healthcare services within my patch as a GP, might I be able to team up with the social enterprise that might be looking for the contract on this… I think for GPs, the scale of the contracting market could well be a challenge because they are locally focused.

22 november 2012

Very little is being commissioned or procured locally by clinical commissioning groups.”

The future Dearden-Phillips believes that the future of small providers doesn’t have to be all doom and gloom – but they will need to take a different approach to provision if they are to keep up with their corporate counterparts.

He maintains that although there will always be a risk of private companies using their “financial muscle” to push out the little guy, the emergence of social enterprises in the health sector could be its saving grace and GP practices should look to getting more involved in these. “The NHS’s problem and challenge is you need a diversity of providers,” he explains. “The challenge is that the way they are doing it, they are going to end up with private players having a ‘big six’ energy company-type scenario if they’re not careful, where you’ve got just a small number of private companies that block everyone else out of the market – and the health consumer is faced with very little choice in reality.” His point is that we are right to have these fears – because nobody wants the future he just described. But if we can make the most of the knowledge and expertise private companies inject into the NHS, it could prove an invaluable resource for primary and secondary care alike: “I think we all know enough about the way health services work to know that having one single unitary that does everything and is run by the state doesn’t produce the kind of results we’re all after. What we need, is a true diversity of provision and the government playing the role of intelligent market makers.”

I think we all know enough about the way health services work to know that having one single unitary that does everything and is run by the state doesn’t produce the kind of results we’re all after

one-to-ones with the people that matter

people case study

Send in the cavalry

24 november 2012

Creffield Medical Centre in Colchester comprises a new-build GP surgery, replacing a former military riding school building with a state-of-the-art primary care facility. As a building it combines complex design features, maintains the listed façade and provides capacity for the practice to develop services such as minor surgery. JULIA DENNISON speaks to senior partner DR VIVIEN ST JOSEPH to find out why the practice is so proud of the scheme

C

olchester is known throughout the world, thanks in part to Blackadder, as a garrison town. So it is no surprise its Garrison Neighbourhood, converted from old barracks outside the centre, has become the latest hot real estate development. Where once the rows of brown brick played home to cavalry horses and the thousands of soldiers stationed therein, they are now abuzz with hammers and cranes as they prepare for families and young couples to move in. This is only one part of a Colchester-wide project to build new homes and facilities to accommodate the wave of commuters attracted to the town’s proximity to London. It is little surprise, then, that Creffield Medical Centre, a family doctors’ surgery that traces its roots back to the start of the NHS, would be attracted to the site when it needed to expand.

Started in 1949 – within months after the National Health Service was started – The practice has a loyal following of patients, three of whom have been on the list since it started 63 years ago. Before Creffield moved to its new premises last year, the practice occupied a converted Victorian house, which was the original home of one of the founding partners.

This Creffield Road surgery was situated near the town centre. “The place was very higgledy piggledy,” senior partner Dr Vivien St Joseph remembers of the previous location. “There were lots of twists and turns in the corridors – couple of steps here, couple of steps there, so very poor disabled access, amongst other things.” Because it was so central, there were no dedicated parking spaces for patients either. “The old surgery was certainly timeexpired,” she adds. “I joined in 1987 and on the practice minutes from that time, one of the top agenda items was to move.”

Planning to expand With expansion in mind, the staff at Creffield Medical Centre went to work finding and acquiring a suitable site while developing a design that would reflect the practice’s traditional ethos. The reason it took so long is that most of the time was spent appealing to the PCT to get permission, since they paid cost rent. The practice went to a PFI and interviewed three different companies, eventually selecting GPG to buy the building and oversee what would be a £2.5m capital investment.

The end result is a new medical facility, which opened in 2011 after four years in the works. It is hoped this new surgery will serve the community for years to come. Complex design features let the building maintain its listed façade, while providing the capacity for the practice to develop further services, like minor surgery. It sets a brilliant example of primary care provision, warranting a visit from the Duke of Kent earlier this autumn.

The history and tradition that exists within the rafters of the Grade II listed building can now be put to use once again as something the local community can feel proud of. Indeed, when I speak to patients in the waiting room, they are very happy with their new surgery. Not least the open reception desk, which, as opposed to the last practice’s glass-enclosed desk, allows them to feel a closer bond with the practice staff from their first point of contact.

The new practice is set over two floors.

This allows for more than one waiting area to triage the patients. The site also houses a pharmacy, providing even more services for patients, while a number of the building’s original features have been kept intact, including the original roof trusses, window openings and external fabric of the building.

The open roof structure provides the practice with natural light and an automatic ventilation system that opens when it gets too warm, while under-floor heating keeps the space comfortable in the winter. From an environmental perspective, the new building received a BREEAM rating of “very good”, thanks, in part, to a carbon reduction of nearly 20%.

Inside the building, the practice operates from 15 GP consulting rooms, which include training facilities for three GPs, three nurse consulting rooms and two dedicated treatment rooms with utilities. In

november 2012 25

people

case study

people

case study

addition, there is also a counsellor’s room and examination rooms alongside the central waiting area. The practice staff also benefit from meeting rooms and office space, while a new car parking area for both staff and patients as well as covered cycle parking and good pedestrian links to the town make the facilities as accessible as possible for patients.

A local yoga instructor even rents the space in the evening for classes and there are exercise sessions available for the over-80s. “We’re in a new development area, and it would be nice to make it a community facility,” says Dr St Joseph. She also appreciates the space the staff now have to gather and exchange ideas. “Our conference room is the secret of the success of our practice, I think, because we have a bank of eight computers and we all go down there for coffee and to do our post, results and prescriptions,” she says.

“Obviously, people’s timings differ slightly but there’s an opportunity to see everybody there and there’s a huge amount of offloading and exchanging of [ideas].”

Moving to the new site, it was imperative for the practice that they kept their identity as a practice. “One of my drivers was to move to a site that still had some character, I actively did not want to move to a brand new, purpose-built surgery,” says Dr St Joseph.

“We’re just so lucky because what we’ve got is a building with enormous character that is basically a shell into which you can put a purpose-built surgery. So all the advantages of a modern, new, infection-controlled, CQC-ready building are all here, but within a framework that has some historical relevance.” She’s very happy with the space too, which she calls “uplifting”. “You come in on a Monday morning, and it’s not so bad coming to work.” In short, the new project benefits the community, the environment and the practice’s patients and staff who now have a bigger and better place to work.

Practicalities of design When it came to funding the project, the practice couldn’t do it as a LIFT project, because it’s a listed building. “Although we looked initially at funding this ourselves, firstly it looked really expensive, and secondly, we’d have to do all the day-to-day running of the move and the building and the planning ourselves and we weren’t sure we had the time or the expertise to do that. And thirdly, we felt we would end up with a building that was so valuable that it would be very difficult to release one’s capital from it,” Dr St Joseph

26 november 2012

explains. The cost rent is manageable and the partners believe the value of the building is worth every penny.

There was relatively little fallout from patients who found the previous town centre location more convenient – only a couple of hundred out of 11,600 patients. This was partly down to the stellar job the team did in informing patients of the big move. “I was very keen to keep the patients informed, but also to get their input into what they wanted from the new building,” says Dr St Joseph.

“Before it became fashionable, we actually set up a patient participation group four years ago.” When it came to the new building, they were very involved – from helping to gather information to lugging boxes when they moved. “They like to be hands-on,” says the partner. “We’ve got our flu day coming up and they will be on hand with assistance.”

Plans for the future By and large, the practice and its staff are very happy with the new building, with no current plans to expand the surgery any further – not that they can within the confines of its listed shell. Dr St Joseph would like to see more nursing staff in future, along with the extra services they would provide.

Of course, there are more side interests she would like to pursue, but she believes “it’s enough of a challenge to continue to provide cracking good clinical care”. When asked to summarise her practice’s ethos, Dr St Joseph felt it was the best of both worlds: “We like to describe ourselves as providing a modern, forward-thinking clinical practice within a traditional family base.” The listed building with a modern core symbolises this philosophy perfectly.

fast facts

Practice Creffield Medical Centre Partners 6 Clinicians One salaried GP, up to three registrars, one nurse practitioner, two treatment room nurses, one healthcare assistant Patients 11,600

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than 35% on telephone calls and line rentals when switching to Atech.

Hassle free: Atech would be responsible for all your line rental and call tariffs. Billing is carried out monthly, directly

by Atech giving you complete peace of mind. Atech’s support and billing departments are manned by fully trained engineers and can be contacted directly by you.

Keep all existing numbers and lines: You do not need to worry about numbers changing, engineering visits or loss of service when switching to Atech as being direct Openreach WLR3 partners, Atech will work with Openreach to provide a smooth transfer for you.

Easy to switch: Transferring across to Atech is cost free and simple. The transfer process can be as fast as 14 days from date of order placement.

LMC Patient Connect One of the latest applications to hit the market, especially

designed for GP practices, and allowing you to integrate your existing CRM system, such as EMIS, Vision or SystemOne is called LMC Patient Connect.

Available from Atech, LMC Patient Connect will greatly increase practice efficiency in a number of ways.

Primarily, by reducing the amount of time spent finding patient records on incoming calls and ‘trapping’ the callers number to be tagged against patient records thus ensuring up to date contact information is maintained.

If you also decide to purchase the fully encrypted call recording and call reporting applications that are available from Atech as a bundle pack with LMC Patient Connect software, then you would also be able, amongst many things, to store call recordings against individual patient records - and add notes against each recording.

The call reporting will enable you to monitor line and extension usage over time and produce bespoke reports that can be automatically generated based on many variables, such as time of day, extension number, call duration etc, etc.

Contact Atech

For further information, contact the LMC Buying Group sales team at Atech

0844 854 0054 lmcsales@atechns.com

people

case study

28 november 2012

Changing the System Just over a month ago, Harbours Medical Practice in Cockenzie, East Lothian became one of the first practices in Scotland to introduce a new system to improve patient experience.

JULIE PENFOLD speaks to practice manager JANE JOHNSTON to find out more

P

atient Access was formed as a social enterprise in 2011 from a community of over 40 GP practices around the UK. The movement now serves over 350,000 patients and continues to grow. The enterprise discovered a way to improve patient access to GPs and reduce waiting times, making clinicians, practice staff and patients much happier in turn.

Practices using the system use a simple process of direct communication between the GP and patient. When a patient wants to make an appointment, they simply call the practice as usual; the receptionist takes their details and the GP then calls them back at a convenient time. Via this system, the GP is able to determine whether they need to see the patient or can diagnose and advise them over the phone. Participating practices have found, on average, only one in three patients actually needs to be seen. Jane Johnston, practice manager at Harbours Medical Practice in Cockenzie, East Lothian is the latest surgery to use the system.

Could you describe how the previous appointments system worked?

We offered appointments in advance and kept a number aside every day to be booked one or two days before. Patients could also call on the morning for appointments that day. We also introduced steps, such as having GPs offer

phone consultations in between appointments and having a duty doctor every day for emergencies. However, the problem of never having quite enough appointments available to meet patient demand always remained.

The lines were really busy and it was very difficult for patients to get appointments as a result. Patients were furious with the situation.

We also had patients who would queue at the surgery to try and secure an appointment. By the end of summer, we had over 40 patients queuing at the surgery. The demand for appointments was higher than what the practice was able to offer. Our receptionists had to say no to patients and would have no alternative other than to ask them to call back the next day. Some of our patients were also able to work out that they could play the system and gain access to a GP by being added to the duty doctor’s list for that particular day.

What impact did this have on the practice?

We were concerned for our patients and were looking for a solution that would prevent them having to call at 8.30am each morning to try and secure an appointment for that day or later that week. We had instances of older patients who were feeling ill that were calling for appointments and been told there were none left for that day, they would not push the situation at all. Instead they would just keep trying to book appointments day after day;

november 2012 29

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people

case study

this would sometimes go on for a week until they could book one. We really felt we had to do something to combat the demand for appointments and the frustration experienced by our patients. We needed a solution where an ill patient who needed to be seen that day could have contact with the GP. The daily duty list was just getting longer and longer. It was getting out of hand the amount of names on the list for the duty doctor to triage on top of their normal surgery.

What interested the practice about moving to the Patient Access system?

One of the doctors had seen previous articles about Patient Access and we had tried various other appointments system methods in the past, such as introducing two-days-inadvance appointments and the day in advance appointments too. These changes did not work out as we hoped. By moving to the Patient Access system, we knew we would be able to deal with the demand for that day on that day. We had seen the Patient Access system in action and witnessed how it works in a practice setting. Harry Longman, the social enterprise’s chief executive, also came to visit us to provide an overview of how the system works. As we had seen how it had worked in other practices, we found it was easier to explain to patients that we were moving to a completely different appointments system that had benefitted patients elsewhere.

What were the aims of the changeover to the new system?

Our main aim was to provide a better service to our patients; this would enable patients to be advised or seen on the day and remove the wait for appointments, which could stretch to up to ten days in particularly busy periods.

We also hoped the new system would help with patient and GP continuity, as patients can request to be called back by their GP. With the old appointments system, appointments were in such demand that patients would take an appointment with any doctor that was available. We’re hoping the new system enables our patients to always deal with the same GP wherever possible.

How did patients react to the new system?

There was actually a very short timescale to enable us to let patients know we were moving to the new appointments system.

We only decided to make the switch three weeks before the Patient Access system went live. Patients were advised of the change

30 november 2012

via the local press, leaflets in pharmacies and messages printed on prescriptions. In addition, reception staff were also handing out leaflets to patients coming into the practice. Word of mouth also helped to spread the news. We decided just at the beginning of September that we would go live with the new system three weeks later. Our Patient Access system went live on Monday, 24 September.

Our main aim was to provide a better service to our patients Although the practice only introduced the system very recently, how are staff and patients finding the changes?

Most of our patients appear to like the new system and really appreciate receiving a call back from the GP on the same day; this is usually within one-and-a-half to two hours from the patient calling. We’re still currently experiencing a surge in calls at 8.30am each morning and are letting patients know when they contact us and also via our website that they can now call at anytime during the day.

Most patients are happy to give details of the reason for their call to the reception staff as this helps us to assess urgency. For patients who find it difficult to make and receive calls while at work, we are trying to resolve this by asking the patient to let us know a suitable time where they can take a call and asking the GP to call at that convenient time. The new system is certainly better for patients.

We also feel it is better for staff as although they are still busy taking calls and requesting details, they no longer have to say no to a patient. That in itself is making it easier.

Instead of our receptionists having to look up how long it will be for an appointment, they can now take details and have a GP contact the patient the same day. In our first week, it was a little quieter than usual and we feel this was as a result of patients perhaps waiting a little while longer to call as the system had just launched. The second week was busier and more like usual.

We have found many patients can be advised and dealt with over the phone which lessens the need for patients to come into the practice to be seen. If a patient is required to see the GP, they can now be seen at a time that is convenient for them.

fast facts

Practice Harbours Medical Practice Patients 9,870 Clinical staff Seven GP partners, four practice nurses and a healthcare assistant. Health visitors and district nurses are also attached to the practice.

Non-clinical staff 9.5 PCT Lothian

Making plans for locum cover Those who work in the medical profession know that anyone can be struck down with illness or injury out of the blue. In GP surgeries hiring a locum is often the only solution if one of the doctors falls ill.

Here are some of the most frequently asked questions about locum protection.

Q: What are typical rates for a locum?

A: Locum prices can vary dramatically across the country. A Medeconomics UK Survey of locum rates for 2011 showed the daily rate can range between £770 in London and £150 in South and East Wales.

Over long periods it will become an expensive resource and it becomes clear that taking out locum insurance is essential.

Q: Who is liable for locum costs?

A: All GP practices are required to provide cover for absent doctors for up to 12 months and the responsibility of who meets these costs is usually determined by the practice’s partnership agreement.

Typically, this agreement creates a mix of shared business liabilities for partners, including salaried GP and other staff costs, and personal liabilities. Many agreements make paying for locum cover the personal responsibility of the partner and it will be their individual decision whether or not to take out locum insurance.

Worried about rising locum costs?

Talk to a specialist…

We’re the experts in locum insurance With daily locum costs of up to £700*, unexpected staff absence can have a serious financial impact on any GP practice. Our permanent locum insurance, Practice Protector Plus can protect you against the cost and disruption with cover that’s tailored to your budget and staffing needs: • Up to £3,000 per week for locum cover • Up to £2,000 per week for sick pay insurance

Q: What should be included in a policy?

A: Whoever takes out the locum policy needs to ensure it suits their needs and circumstances.

• Ideal for both temporary and long term sickness cover • Valuable options to cover many contingencies.

We can provide the full package of cover, and adapt your policy to suit you. Why not see the in-depth guide to locum insurance on our website or speak to your local Financial Consultant?

Arrange a no-obligation appointment with an expert

www.wesleyan.co.uk/ppplus

@

Q: Who should pay the premiums for any cover?

A: This again is usually dictated by the partnership agreement and what liability is being covered. Insurance premiums for shared business liabilities are usually met by the practice, but premiums for personal liabilities are generally met by the individual Partners.

A single plan can cover all of your practice’s shared business liabilities for locum cover, role replacement cover and sick pay, as well as the Partner’s individual personal liabilities.

The kind of insurance taken out, either an individual or group policy, shouldn’t be decided by any of the practice staff as it is a key part of the family income protection planning for most GP partners.

practicereview@wesleyan.co.uk

0800 009 3675 Quote reference 45664

• Check the policy includes an ‘own occupation’ definition. This ensures there will still be a payout even if they can still do other types of work based on their knowledge and experience.

• Confirm the terms and conditions are permanent throughout the entire term of the policy, no matter how many claims are made or if their condition deteriorates.

• Ensure the plan comes with guaranteed options so they can increase the cover without having to provide further medical evidence.

• Check the length of the ‘deferred’ period. It may be cheaper to have a longer period between the date they’re taken ill and the date that payments are made, but it may not always be the best option. Ideally, the deferred period ties in with their circumstances and how long they can cover payments.

Conclusion

As a practice manager you will want to ensure the surgery runs smoothly and remains in good financial health. If you’re not clear, check the practice agreement to see who is responsible for providing cover and ensure cover is in place, up-to-date and meets the needs of your surgery.

Talk to a financial adviser who has experience of working with GP practices to make sure the right cover is in place to protect both the business and your Partners. *UK survey of GP locum earnings, May 2011.

Wesleyan Medical Sickness is a trading name of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Limited is wholly owned by Wesleyan Assurance Society. Registered No. 1651212. Head Office: Colmore Circus, Birmingham, B4 6AR. Telephone calls may be recorded for monitoring and training purposes.

GP-AD-33-11/12

22386 Practice Business HPV 277x92.indd 1

18/10/2012 15:13

The above does not constitute financial advice and is for general information only.

management

property

Property woes

business intelligence and management sense for practice managers

To rent or to own? With PCTs being abolished in April and properties being handed over to a new property services company, is it time to bite the bullet and buy your practice? And if you’re renting, what can you expect when ownership is handed over from the PCT to the new owners? CARRIE SERVICE takes a look at rent and property issues for GP practices

32 november 2012

D

eciding when is the right time to buy your GP practice can be tough, but in less than five months’ time you could be forced to make a decision whether you like it or not. Come April 2013, PCTs will be no more and any GP practice buildings that are currently owned by the PCT will be taken over by the NHS Property Services company. Recent reports in the press have suggested practices could be at risk of massive rent increases when the it takes over from the PCT. GP magazine recently put in a freedom of information request, to which 132 PCTs responded and 104 admitted to not having signed lease agreements for all the GP practices they currently lease to. The GPC raised concerns that there is insufficient information available about the NHS Property Services company, leaving many practices in fear of extortionate rental increases. However, PCTs have now been tasked with producing the correct documentation before April and ensuring that a signed lease is in place for all practices renting their property. As straightforward as this may sound, there are a still number of issues that practices should think about before they sign their lease. Issues such as the rent level you will be expected to pay and whether this will be reimbursed; how and when your rent can be reviewed; the length of the lease; restrictions around what the property can be used for and whether the building is compliant with health and safety regulations, should all be clarified before you sign.

To buy or, not to buy?

With all the ongoing issues to consider around rent, is it worth practices just taking the plunge and buying their premises?

“Unlike the wider commercial property market, i.e. office, retail and industrial, we have seen healthcare rents continue to rise since the economic downturn,” says Ben Willis, partner at law firm Veale Wasbrough Vizards. Demand for clinical buildings currently exceeds supply due to a number of factors, including an ageing population and an increase in secondary care treatments being moved over to primary care. Therefore, rental prices are continuously on the increase. “The rental value of a property is key to determining the market value of a property,” says Willis. “So if rents continue to rise, then the price of healthcare property will also continue to rise – so now may be the time for GPs to buy their surgeries.”

november 2012 33

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management

property

Timing is everything

Of course, buying your practice may also require securing a loan, resulting in greater liability and capital outlay in the short-term – but it could be worth it in the long-run, says Andrew O’Dowd, director at GP Surveyors: “Owning gives greater flexibility to alter, change use and redevelop, and the freedom to make building management decisions without reference to a landlord. There are also the benefits of possible appreciation in value to the benefit of the partners – together, of course, with a risk that values may fall.”

He also points out that by leasing to third parties, such as pharmacies, there is the potential to produce an additional income.

Willis agrees with this in principle: “You have complete control over the building and can therefore develop the building to continue to meet the needs of the practice, and adhere to current regulations and standards, without having to go through a landlord.” However, he advises that despite the fact that GP surgeries are seen as good solid investments, there are now very few lenders prepared to put forward 100% of the transaction costs and can also restrict partnership changes where there is a requirement to buy in. It’s worth remembering, too, that ultimately you will have full responsibility for the building, so its current state of repair is definitely something to take into consideration, says O’Dowd: “Most PCTs have not operated full planned preventative maintenance schedules for their properties and many are in disrepair, not compliant with statute or CQC requirements and may well contain asbestos.” A full survey, as well as a valuation and identification of liabilities, is vital.

34 november 2012

If you are going to buy, time it well, taking into consideration your current situation, says Willis: “Tactics and timings are very important when considering purchasing your surgery. Of particular importance is how long you have left to run on your current lease.”

If you only have a couple of years left, you are much more likely to be able to purchase the building from your landlord without any issues than if you still have, say, 15 years left.

Another area to consider is which ownership structure you will be choosing.

“Most buy through the operating partnership and own the property as partnership property,” explains O’Dowd. “Separate investment vehicles – company or limited liability partnership – to own the property with a lease back to the operating partnership are also often considered and very often the drivers on structure will be tax lead.

These schemes can be complex and proper advice should be taken to ensure they are tax efficient and ‘fundable’, i.e. acceptable to the lending bank.”

The changing shape of general practice

Unlike the wider commercial property market, we have seen healthcare rents continue to rise since the economic downturn

With more practices now taking on services that would normally only be available in secondary care, general practice now needs to equip itself for a whole other calibre of patient. A small converted town house might have sufficed when the practice consisted of one or two GPs and a couple of thousand patients. But if you are hoping to provide a bigger range of services, perhaps including district nursing or minor surgery for instance, then you will need more than a couple of consultation rooms and a small waiting area.

As property management changes come into play, think about how fit for purpose your building is and whether it’s worth moving into a more suitable property before you decide to buy or renew your lease. If you think that the building is just in need of a few repairs and improvements, grants are available from some PCTs to help with refurbishment, however it will depend on your locality whether or not these are available to you. If you would like to continue renting for the time being but are coming to the end of your lease and are looking for something else, have you considered joining forces with a larger practice or health centre? This could provide you with the facilities you require to provide additional services and also give you the economies of scale you need to procure the best contracts.

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Let the games begin

How the Olympic Games could impact your practice

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Keeping schtum

Quick ways to improve patien t confidentiality

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Fighting Fire with Fire

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As more care moves into the community, general practice faces a time of great opportunity and much challenge: increased competition, greater accountability and a need for strategic, top-quality business management. Practice Business supports practice managers with information-packed articles, the latest news analysis, best practice interviews and easy to read guides to all aspects of your role. All this can be yours free for six months - how’s that for best value?

020 7288 6833 subscriptions@intelligentmedia.co.uk @ www.practicebusiness.co.uk/subscribe/

*TERMS & CONDITIONS In order to qualify for a free subscription, the recipient must be a first time subscriber and be a finance, practice and/or business manager with purchasing authority at surgeries and practices in the UK or Ireland. For those who do not qualify log on to our website to subscibe for half price.

For details or to subscribe contact Natalia Johnston on subscriptions@intelligentmedia.co.uk, +44 (0)20 7288 6833 or visit www.practicebusiness.co.uk/subscribe/

M ET L A H C I OD N MO LLIFICATIO

Whilst receiving complaints can be a demoralising experience, they are inevitable and can improve your practice in the long-run.

GEORGE CAREY looks at the best way to deal with them

C

omplaints have hit the headlines in recent months, in particular, a report published in September by the General Medical Council showed that one in 64 doctors now face the possibility of being investigated by the regulator, as complaints rose by 24%. This also has to be viewed in the context of a study carried out by the Medical Defence Union last year, which shows that doctors believe patients are more likely to go to the media with a complaint about their treatment compared to five years ago. So is it the case that the standard of treatment in primary care is falling, or are patients simply becoming more vocal about

smaller issues? As usual where the headlines are concerned, the suspicion is that the truth lies somewhere in the middle. And when one of your patients has a complaint, what’s the best way to deal with it in a timely and painfree manner for all concerned?

Positive outcomes As all but the most despotic of us would agree, complaint is generally a necessary part of any service and is an essential part of establishing where improvements need to be made. It is, in the end, a force for improvement and, when done correctly, should result in positive outcomes. As

Mike Farrar, chief executive of the NHS Confederation, says: “Patient feedback is an invaluable part of improving care. It is essential doctors listen to their patients’ experiences – good and bad – to improve professionally. And it is crucial that the right systems are in place to learn from occasions where things go wrong.” He opines that the rise in complaints may simply be down to more vocal and assertive patients, although does not rule out the possibility that it could be down to more serious issues, concluding: “Every patient should be given the necessary time to discuss healthcare concerns which can often be complex and upsetting.”

november 2012 37

management

complaints

management

complaints

We are all prone to procrastination to some degree and when it comes to complaints, it is the worst possible course of (in)action. Sir Donald Irvine is former president of the General Medical Council and urges practices to deal with problems sooner rather than later, as he advised the Medical Protection Society: “For both the patient and the doctor, complaints are best resolved early on and at a local level. We know from experience that things go wrong when they are not. The underlying reality is this – that complaints, when resolved quickly and sincerely, help all of us to provide better quality service. The more that we as doctors become accustomed to dealing with and responding positively to comments and criticisms from members of the public and our peers, the better.”

A listening ear Openness and accountability are important when dealing with complaints. While resolution of the complaint may not be quick, it’s important to acknowledge receipt of any complaints as soon as possible. Anyone annoyed at the service they have received

already will not have their opinion improved by being made to wait for a response. As part of this, the practices complaints procedure should be made readily available or, better still, be displayed so that those with a complaint know what to expect and have an idea of the time scales involved. It’s also important to record everything that occurs, in case things cannot be resolved quickly and amicably. Emails are particularly helpful in this event, but if that is not the medium of discourse, then the witnessing by a third party of correspondence would be of use.

The best way to ensure that complaints are kept to minor grievances and suggestions, rather than angry diatribes is to encourage feedback at every opportunity.

It’s when patients are left to stew on their opinions that problems become exacerbated.

This is where patient discussion groups can be invaluable as well. Having regular open discussions with patients will show them that you are trying to improve any circumstances they are not happy with and that their opinion is valued. A regular report on agreed objectives and progress against those will

serve to reinforce your status as a practice that listens to and, more importantly, acts on their suggestions for improvement.

The hope would be that complaints can be resolved without taking up even more time from the busy days of GPs and practice managers, but occasionally it is the personal approach that will make all the difference.

While email’s are an efficient and convenient way to answer problems, a five-minute meeting could save your practice a lot of time in the future. Dealing with complaints is a lot like weight loss, we all know the right way to do it in theory but adhering to that best practice at all times is the challenging part. At the end of a long day it’s far easier to have a takeaway than prepare a healthy meal, just as it’s tempting to leave an email of complaint until the next morning rather than deal with it straight away. A speedy and objective response to complaints should usually be enough for an acceptable resolution for both sides. Stick to those principles and you should have the recipe for a more streamlined and happier practice, for patients and professionals alike.

For both the patient and the doctor, complaints are best resolved early on and at a local level

38 november 2012

management

QOF

A generous amount of QOF points are available for GPs who monitor and treat hypertension. For example, six points can be obtained if the practice can produce a register of established hypertensive patients. PAUL LAMBDEN explains what ‘hypertension’ means and how to avoid ‘white coat syndrome’

Hypertension

DR PAUL LAMBDEN

is a practising GP and a qualified dentist. He has been a GP for 35 years, over 20 of which have been in practice. He has previously worked as an NHS trust chief executive, principal of a medical defence organisation, LMC secretary and Parliamentary special adviser. He is a writer and broadcaster.

E

veryone has blood pressure; without it blood would not circulate. It is the force exerted by blood on the walls of the arteries when the heart beats. The blood pressure rises when the heart contracts, forcing blood into the arteries

hormonal abnormalities or drugs, such as the oral contraceptive pill, may be responsible.

It is now recommended that an ambulatory blood pressure monitor is used to establish whether the blood pressure is raised or whether

(systolic pressure), and falls when the heart relaxes and fills with blood again (diastolic pressure). For most people, a blood pressure of 140/85mm of mercury pressure is desirable. Blood pressure varies normally, rising during exercise and falling during sleep. It also increases with age. When blood pressure is persistently raised, it is called hypertension and affects about 16 million Britons.

Raised blood pressure increases the risk of a heart attack, stroke, kidney disease and dementia.

It is usually without symptoms and there is often little warning of the damage it does to vital organs.

For this reason, it is important to have the blood pressure checked on a regular basis so that it can be treated if raised.

No cause is found in over 90% of patients who develop high blood pressure (essential hypertension). In the remaining cases, a variety of factors, such as kidney disease, thyroid disease,

treatment is effective. Using the technique eliminates ‘white coat syndrome’ and often helps identify problems like nocturnal hypertension.

The device consists of a cuff, which is fitted round the upper arm, connected to a small pump and monitoring device usually fitted to a waist belt. The device automatically measures the blood pressure every 15-30 minutes during the day and every 30-60 minutes during the night for 24 hours. The patient should do normal activities (except bathing or showering!). The device is removed after 24 hours and the results analysed by computer. The technique gives reliable BP readings and variances.

A large number of QOF points are available for GPs. Six points can be obtained if the practice can produce a register of established hypertensive patients. The other points available are distributed across a number of clinical areas and demonstrate the importance of good blood pressure monitoring and management (see table).

If the blood pressure is raised, it needs to be reduced to a normal level. This can be done by pursuing a healthy lifestyle and a number of simple actions can be of great value: n Do not smoke n Eat a healthy diet, low in saturated fats n Keep to the ideal weight n Reduce salt intake n Do not exceed recommended levels of alcohol intake n Exercise regularly n Reduce stress.

If simple measures do not reduce blood pressure, the hypertensive patient may need to take medication. There are a range of different types that work in different ways. Patients often need two or three different ones to control blood pressure effectively. All may produce side effects and it may

40 november 2012

QOF

Table

INDICATOR

POINTS

PAYMENT STAGES

BP4

Record of BP in the preceding nine months

8

50-90

BP5

Patients with BP of 150/90 or less in preceding nine months

55

45-80

CHD6

Percentage of patients with CHD with BP of 150/90 or less in preceding 15 months

17

40-75

Stroke6

Patients with history of stroke or TIA with BP of 150/90 or less in preceding 15 months

5

40-75

CKD2

Patients on CKD register with record of BP in preceding 15 months

4

50-90

CKD3

Patients on CKD register with BP of 140/85 or less in preceding 15 months

11

45-70

DM30

Patients with diabetes in whom last BP was 150/90 or less

8

45-71

DM31

Patients with diabetes in whom last BP was 140/80 or less

10

40-65

PAD3

Patients with peripheral arterial disease with BP of 150/90 or less in preceding 15 months

2

40-90

take time to find the right drug or combination for an individual.

There are several different types of medication for hypertension.

Diuretics, e.g. bendroflumethiazide or furosemide, help the body remove water and salt. They make the patient pass more urine and consequently are usually taken in the morning. ACE Inhibitors

It is now recommended that an ambulatory blood pressure monitor is used to establish whether the blood pressure is raised and sometimes whether treatment is effective (ramipril or enalapril) prevent the creation of the hormone angiotensin II and therefore open blood vessels. They may cause a troublesome dry cough in some people. ARBs (losartan or candesartan) block the angiotensin receptors and work in a similar way to ACE inhibitors.

Calcium channel blockers (amlodipine) open blood vessels through a direct action. They may cause swollen ankles. Beta blockers (atenolol) slow the heart by blocking adrenaline and they open blood vessels. Alpha blockers (doxazosin) block blood vessel receptors, lowering blood pressure.

These days, home blood pressure monitors are very reliable and cheap to purchase (a suitable one can be bought for £10 at a supermarket). Checking BP in the comfort of your home, in a relaxed atmosphere, gives an accurate reading of the true pressure and, increasingly, doctors are accepting patients’ readings rather than taking the BP in the surgery. A machine is worth the investment. n

How do you keep up to speed with news and developments that affect your role?

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management

legal

A sockable offense Don’t like the cut of your fellow partner’s jib?

VEALE WASBROUGH VIZARDS says make sure a ‘green sock’ clause is in place

P

Does your partnership deed include a green socks clause? VWV will be happy to carry out a free review of your current arrangements.

Please contact opool@vwv.co.uk or at 0117 314 5429.

42 november 2012

artnership is a relation closer than marriage, and the fallings out can be just as acrimonious.

We recently heard of a falling out involving a couple of feuding partners (not VWV clients) whose dispute led to one of them crashing his car into the other’s car in the car park. It goes without saying that having any involvement in a partnership dispute is an unpleasant experience.

It sometimes comes as a surprise when partners find they do not have an automatic right to expel a partner that they have fallen out with. The rights that they do have will depend on what is in the partnership agreement – so a partnership deed that does not give the partners the necessary protection can be a serious problem.

I usually recommend that a ‘green socks’ clause be inserted in partnership agreements – these allow for partners to be given six months’ notice to retire, without the need to prove fault on either side. The ‘green socks’ clause is so called because it could be served merely because a partner comes in wearing green socks every day, and the others couldn’t bear it.

While no one would ever expel someone for something so trivial, it does illustrate the point: If a partner has become difficult or impossible to work with, but is not in outright breach of the agreement

and is still treating patients properly and so on, then unless there is a green socks clause the others are left with very little recourse, and the only way to achieve a departure is to negotiate it. That is never a pleasant process and inevitably involves a cash settlement.

Even if a green socks clause is present, care should still be taken if the partner has any ‘protected characteristics’. Usually, the power of a green socks clause lies in the fact that nothing actually need be ‘proven’ against the partner for it to be activated – usually notice can be served merely because the business relationship isn’t working out. However, all partners have a right not to be discriminated against, and if a green socks notice were served because a partner were disabled, then the partnership could find itself on the wrong end of a discrimination claim.

Particular difficulties can arise if the ‘problem’ partner goes off work with stress (which can count as a disability). It is then very difficult for the other partners to serve notice without risking being accused of discrimination – liability for which is uncapped.

It is therefore important to deal with any performance issues as they arise, and to ensure that your partnership deed allows you broad rights to expel if necessary.

A couple of feuding partners’ dispute led to one of them crashing his car into the other’s car in the car park

work/life

advice

Partnership: is it for you?

advice for busy lives

Thinking of becoming partner at your practice? CARRIE SERVICE looks at the risks involved for PMs and how to navigate the change of role

44 november 2012

F

or a practice manager, achieving partner status might feel like the icing on the cake and the perfect recognition of your efforts at the practice. The prospect of earning more money – 40% more than non-partner PMs according to a recent survey – and having greater influence over business decisions sounds like a win-win situation, right? But as the old saying goes, with great power comes great responsibility and it is not a decision that should be taken lightly. Practice manager partnerships are a bit of a rarity, with just 3.75% of PMs in the UK having partnership status to date, so if you’ve been approached to become partner at your practice, you must be doing something right.

Steve Morris, general manager of First Practice Management and an ex-practice manager, advises PMs not to get blinded by flattery and keep a level head. “Manager partnerships are not for everyone,” he says. “You need to be clear on your personal motives and do your homework thoroughly – and in advance.”

Losing your rights Becoming a partner will ultimately mean losing many of the basic rights you have as an employee at the practice, as you will effectively become self-employed. You will therefore need to decide whether your relationship with the other partners is strong enough for this to not become an issue.

If you have worked at the practice for a number of years – which is probable if you are looking to become partner – then it is more than likely that any potential conflicts have already arisen and been resolved by this point. But if you are relatively new to your current practice, be sure to think it through before you sign on the dotted line.

You may all be getting on like a house on fire at the moment, but things could look very different when reality sets in and you come to realise that your partner’s actions directly affect your own investment in the practice – and vice versa. It’s also worth bearing in mind that you will no longer be able to bring unfair dismissal claims and may

november 2012 45

work/life

advice

work/life

advice

not be covered for constructive dismissal (when an employee is forced to quit their job against their will because of their employer’s conduct).

Till death do us part If the partners broached the idea of partnership with you rather than the other way around, ask what the motives for their proposal are and what they hope to gain from the partnership. Aside from the fact that they believe you are worthy and capable of the role, they are probably keen to secure your presence at the practice for the foreseeable future. Ask yourself if you are ready for such a commitment and clearly lay out what you hope to get in return. “You will have your own agenda that may include greater autonomy; wider authority; parity of status, equity, risk and reward; and the full agreement of all of the existing partners,” says Morris. “You will also need to commit time, your long term career, and your emotional well-being. Be sure that the move is right for the practice and right for you. Instructing your own specialist solicitor and accountant to act on your behalf is absolutely essential.”

Identity crisis Be aware that your new position will bring a change in dynamics at the practice that not everybody will see as positive and being the only non-clinical member of the partnership could cause issues for some. In a case study on the First Practice management website, practice manager Dr Ann Burntonwood (PhD) writes about her own somewhat fraught personal experiences of becoming a partner at a GP practice in south Wales. Although the final decision to appoint her as partner was unanimous, one partner had wavered on their decision because they had reservations about having a non-clinical member in the partnership; worrying that she might start to manage some of the clinical aspects of the role. Also, as she has the title of Dr Burtonwood like her clinical counterparts, concerns were raised about confusion from patients about her being a GP. These reservations played on Burntonwood’s mind and made her feel as though she perhaps hadn’t earned the full confidence of the other partners.

It’s easy to see how this could affect relationships within the partnership if not fully resolved, as Morris reiterates: “Less than a full agreement from the partners may result in a residual element of resistance and possibly a negative effect on confidence and perceived standing. Consequently there is a danger that the manager is placed in something of a limbo – not part of the staff group

46 november 2012

and not feeling a full partner either.” If you are part of a larger management team, there is a chance they might view your becoming a partner as ‘changing sides’ potentially creating a feeling of segregation within the team. With this in mind, something to get clear from the offset is how your job role is going to evolve with your new status – how will your duties in management change – if at all? What will your new job title be? If you do decide to take partnership, think about how this might affect other members of your team and let them know how you will be divvying up your time from now on. If the practice will be taking on someone new to assist with extra duties, ensure that staff know where this person sits in the practice hierarchy. Keeping people as informed as possible could help avoid the same feelings of isolation that Burntonwood suffered.

Financial risks You are making a huge financial commitment that will affect the rest of your life – be it for better or for worse. So seeking independent legal and financial advice from a professional outside of the practice is essential. Some even suggest appointing a ‘next friend’ to help you stay completely objective. It may even transpire that the other partners are unable to offer you what you want from the partnership, so make your expectations and demands clear from the beginning. “One certainty is that you will be looking for a personal benefit for you and that this must therefore be at the expense of the partnership,” explains Morris. “So the partners will need to be certain that a manager-partner is best for the practice in the long-term, and that the risks, benefits and costs to the practice have been properly assessed as part of a solid and well-researched business case.” Burntonwood opted for a fixedshare partnership with full premises buyin on an equal sharing basis – something that takes time to calculate as there are many influencing factors. “The fixed share was agreed by working back equivalent employment costs – salary, NI and other on-cost amount – agreeing uplift in income plus cost rent etc., then converting this sum into a percentage, based on the last accounts,” explains Morris.

“Over the years other expenses and other sources of income have been added into the equation.”

Considering the complicated issues involved in becoming a partner, it’s easy to see why so few practice managers have chosen to do so.

But with proper research, planning and a good open relationship, becoming a partner could be the secret ingredient your career is missing.

There is a danger that the manager is placed in something of a limbo – not part of the staff group and not feeling a full partner either

DO YOU KNOW ABOUT OUR COMMISSIONING MAGAZINE?

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While we will still cover commissioning-related topics from a primary care provider point of view, practice managers heavily involved in clinical commissioning will want to refer to our bi-monthly commissioning magazine, Commissioning Success. For a free copy, email your details to subscriptions@intelligentmedia. co.uk with the subject line “Commissioning Success”.

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In developing the new range, Meltemi solicited feedback from those working in practice. Now, in addition to the new colours, their Ella blouse range is available in both semi-fitted and loose-fit blouse shapes to help provide a choice of style and shape to meet staff preference.

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How the Olympic Games could impact your practice

Keeping schtum

Quick ways to improve patient confidentiality

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Fighting Fire with Fire

One practice recovers after an arson attack

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As more care moves into the community, general practice faces a time of great opportunity and much challenge: increased competition, greater accountability and a need for strategic, top-quality business management. Practice Business supports practice managers with information-packed articles, the latest news analysis, best practice interviews and easy to read guides to all aspects of your role. All this can be yours free for six months - how’s that for best value?

020 7288 6833 @ subscriptions@intelligentmedia.co.uk

www.practicebusiness.co.uk/subscribe/

*TERMS & CONDITIONS In order to qualify for a free subscription, the recipient must be a first time subscriber and be a finance, practice and/or business manager with purchasing authority at surgeries and practices in the UK or Ireland. For those who do not qualify log on to our website to subscibe for half price. For details or to subscribe contact Natalia Johnston on subscriptions@intelligentmedia.co.uk or visit www.practicebusiness.co.uk/subscribe/

work/life

comment

SAY IT TO MY FACE

With more communication done via technology, the lines are blurring between what is and what isn’t acceptable to discuss via e-mail and phone. We know effective communication is vital to good business practice, so why do we still avoid those face-to-face conversations in the workplace? HR coach JULIE COOPER discusses why you need a good conversation 48 november 2012

T

here are many times in our working lives when we need to talk to each other. Of course, this should be easy, right? We are all capable of holding a conversation. What else is there to it?

If only life were that simple. People are complex beings, with different personalities, opinions, perceptions, values, beliefs and experience.

Add to the mix the many reasons there may be for talking to someone, including both your agenda and theirs, and it becomes apparent that there are many different directions a conversation can take. Much of the time we get the results we want, but other times we come away wishing that the outcome had been different, or with that nagging feeling that we haven’t done as well as we hoped we would.

Let’s not underestimate how important this is. Speaking to someone face-to-face (as opposed to pinging a quick email, for example) is the cornerstone of building effective relationships. Now, you may not feel you need a good relationship with the people you work with. You are there to do a job. But here’s the ‘but’ – and it’s a mighty big ‘but’ – people perform better when they have a good relationship with their line manager. Recent studies have shown a strong correlation between this relationship and the degree to which an employee is actively engaged in their work. Engaged employees not only perform better, but they also have less time off sick, have less accidents and are prepared to go the extra mile for you. In simple terms: Good face-to-face skills = good relationship = engaged staff = productivity + extra mile.

It’s not rocket science, but is so often overlooked as a critical element of staff management, and is instead thought of a luxury we don’t have time for. Let’s get this straight right now. In your brain, file ‘good working relationships’ under ‘essential’ not ‘when/if I have time’.

I’m sure you can see the flaw in the otherwise simple plan – if the one-to-one discussion is not handled well, the opposite applies and you could have disengaged, disinterested ‘jobsworth’ clock-watchers, which will just make your job even harder.

So how do you make sure your one-to-one meetings are effective? Start by being aware of your own personal style, then think about how

If you want to get a point over, doing it the way that suits you may not best fit with the other person

If you have a one to one meeting coming up, you can prepare by considering the following:

n Outcome

Also known as beginning with the end in mind. What specifically is it you want?

n Think ahead

you can adapt it to better match the style of the other person. We all have personality traits and ways of learning that have an impact on how we best absorb information. If you want to get a point over, doing it the way that suits you may not best fit with the other person.

You may also think you know how to listen. Many people hear what they want to hear, don’t acknowledge the other person’s view, and don’t explore issues to uncover the real reasons behind issues. Consider this: In my opinion, you are not in a position to comment until you understand the full picture. If you use the ‘listen – respond – propose’ model in a conversation, you will find yourself moving elegantly out of many a tricky situation:

n Steps

2. Respond – say what you think and feel about the situation Describe how the situation has an impact on you, using appropriate language.

Do not use ‘but’. Be open, honest and straightforward. Assign your feelings/ problem to behaviour or events – not the other person.

3. Propose – say what you would like to happen next, considering the consequences for yourself and the other person Be clear and specific about your needs – dropping hints or assuming may not work.

Give the other person an opportunity to do the same. Be realistic. Define roles, time scales, etc. Be prepared to meet the other person half way. Offer a joint solution.

Knowing the steps you need to take during a discussion can make a difficult meeting much more straightforward.

Have an ordered checklist to help keep you on track.

n On the hop

1. Listen until you understand where the other person is coming from Gather all the facts, feelings and circumstances. Try to get to the bottom of the other person’s interests and motivation. Let them know you have heard and understood.

Sometimes the planning is simply getting organised, at other times there are deeper questions to consider, so allow yourself thinking time. How might the other person respond? How much flexibility do you have? What questions will get to the heart of the matter? What order is logical to discuss things in?

Of course, we don’t always have the opportunity to plan for conversations, but as a general rule of thumb, the more important the conversation, the more thought should go into thinking how to handle it. If you find yourself caught ‘on the hop’, don’t feel you have to respond right away. You can still acknowledge the other person, thank them for raising the issue, and say you will get back to them within the hour, or tomorrow – whatever you need to stop yourself making snap decisions that you might regret later.

It’s a fact of life that the busier we are, the more we tend to rush in with insufficient thought.

Make your conversations good ones, for both parties involved. Treat face-toface skills like any other ability you want to develop; learn, reflect on your performance, improve. You will see the rewards sooner than you think.

This is an extract from Face to Face in the Workplace, available for £20 from FacetoFaceintheWorkplace.com

november 2012 49

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Practice diary IT manager GRANT BURFORD discusses the process to becoming ‘paper-light’ and how it has benefited his practice

GRANT BURFORD is IT manager of the Imperial College Health Centre

I

’m not a fan of paper, so it was a terrible shock when I took my first job in primary care to find so much of it still in circulation. Despite some electronic alternatives already being available, paper remained the primary media for many practice processes. This hard-wired attachment to endless A4 sheets and sticky notes was a trusted way of working, and so a strong resistance to electronic alternatives existed.

The catalyst for change came through us signing up for the information management and technology DES, a major component of which was achieving ‘paper light’ accreditation. We put together a team of clinical and administrative staff and arranged to meet regularly to discuss opportunities to reduce paper-based processes and investigate what we could achieve with our existing hardware and software packages.

Gone are the days of frantically searching through in-trays and files looking for discharge summaries

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50 november 2012

It was agreed that incoming post was a source of many issues and that we should focus on what we could do to improve this. Our initial step was to look at reducing the volume of post being received and to investigate if electronic alternatives were available. We contacted local hospitals and screening services and found that many alternatives already existed. New interfaces were created that enabled secondary care systems to ‘talk’ directly with our own. Not only did this significantly reduce the amount of post being

received, it meant important patient information was available much sooner than before. And a smaller pile of post was a welcome site for the admin team. What’s left of our incoming mail is now scanned on arrival and distributed electronically using our document management system. It allows us to maintain a record of where a document is and any actions that have been taken. Gone are the days of frantically searching through in-trays and files looking for discharge summaries.

With our initial project complete and everyone agreed that electronic records offered so many advantages both internally and to our patients, the momentum for change was now present. Our most recent project saw the transition of our practice survey into an online format. We were able to collect substantial amounts of feedback in a very short timeframe, with the results all collated for us.

We now intend to run more regular surveys which will assist greatly in our preparation for the patient participation DES. We’re noticing more and more services are now available through electronic means and are always keen to exploit them wherever possible.

With a bold statement this week from the NHS Commissioning Board national director of patients and information, Tim Kelsey, pledging to make the NHS ‘paperless’ by 2015 there’s a lot still to be done to make this a reality. It’s time to fling your fax machine, put away your pen and paper and embrace the changes.

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