The commissionning agenda
If the Health Bill goes to plan, the future of funding in the NHS lies with the CCGs and their commissioning boards at group area level and practice managers for individual practices – there will of course be some cross-over with PMs who also represent at board level. PCTs are now involving CCGs in NHS contracting, with a view to transferring functions in full by April 2013 (when the PCT will be completely abolished). But transferring of functions is happening now, with more advanced CCGs already powering forward and implementing strategy for commissioning. This year will see a high shift in funds transferred to CCGs with plans and outlines already in place. This is why it is important to begin discussions with CCGs now, and be in the minds of commissioning boards who will overlook budget transferring. Commissioning Success is leading the way to provide that communication path. With the implementation of commissioning in the NHS, the former PCTs will eventually slide away to be replaced by Clinical Commissioning Groups (CCG). The listening exercise earlier the year resulted in the changes to the levels of responsibility being placed at the CCG (then known as GP consortia) – at present a £60bn budget for primary, secondary and acute care will rest with the board members of the CCG, who will work under their respective commissioning board.
What is Commissioning Success?
e published Practice Business as the first monthly magazine of its kind for the health sector more than seven years ago and stands firm as a champion of anyone in a business, financial or management role in health. Commissioning Success, brought to you by the Practice Business team, is a magazine that supports individuals involved with the new commissioning agenda. The CCG agenda and the future of NHS funding means an increased opportunity for healthcare service providers and suppliers – a more fragmented point of influence, with more local knowledge, equates to a much bigger opportunity – the only challenge is finding a route to the decision-maker audience. That’s where Commissioning Success comes in.
We guarantee a captive audience for your marketing message. We have a dedicated team of health journalists in-house. Their focus is always on the best content for the CCG board audience. Coupled with our excellent specialist contirbutor list, the Commissioning Success editorial content is bang on remit and of great interest to the reader. Our strapline, ‘supporting excellence in healthcare’, drives everything that makes us unique and leading in this sector. We feature a host of editorial content to help decision-makers involved with CCGs choose the right options to ensure they do best by their patient population. From case studies to in-depth sector analyses, quick tips to news, Commissioning Success has all the information to help make those decisions,
whether they be financial, managerial or strategic in nature. The face of healthcare in the UK is changing, and will continue to change, Commissioning Success will walk the path with its readers, offering insight, support and information along the way, helping them to be at the very top of their game. At Commissioning Success, we ensure our on-target and meaningful editorial delivers a captive audience to our advertising partners. Associating with our publication in front of our captive audience will be crucial in delivering your marketing message to the commissioning groups. This means your marketing spend works harder by not only hitting the relevant people, but ensuring itâ€™s placed within a framework that is extremely effective.
There is a difference between knowing who you need to reach and reaching them effectively
The magazine COMMISSIONING
This section features news, views, analysis and commentary surrounding the progress of clinically-led commissioning and the Health and Social Care Act. Here we take an in-depth look at budget handovers, clinical commissioning group mergers and any news surrounding best practice in commissioning and policies from the NHS Commissioning Board.
The Commissioners in Action section focuses on movers and shakers and forward-thinkers in the clinical-commissioning sector. It includes interviews with commissioning leaders, diary pages from commissioners and CCG case studies. Readers turn to this section for a look at how other people in the rest of the country are undertaking the commissioning task and learn by example.
COmmuNiTy Care Community Care features articles and case studies surrounding improved clinical pathways in the community, as well as moves towards better integrated care and any examples of a CCG that is undertaking a specific project or method to see their commissioning through in their local community. This section also features best-practice articles on improving patient engagement and outreach, alongside success stories on how CCGs are tackling conditions in their local area.
EMPOWERING PRACTICE MANAGERS IN CONSORTIA
MARKS, SET, GO! Practices are not acting fast enough to set themselves up for commissioning, according to a leading health sector law firm. Speaking at the ‘Commissioning: The Era of Opportunity’ event in Newmarket last month, Ross Clark, partner at specialist solicitors’ Hempsons, urged GPs and practice managers to get organised now or risk being forced into consortia they don’t want to be part of. “Generally, I don’t think GPs are dealing with this quickly enough,” he told delegates. “It’s like a relay race – the consortium you’re going to be part of needs to be ready as soon as it gets that baton, not just to walk or drop it, but to sprint off. “Time will shift and I think you’ll be fully tasked by 2012. The government [isn’t] going to take their foot off the pedal.”
The NHS commissioning board must grant a consortium application if its constitution complies with requirements laid out in schedule two of the Health and Social Care Bill, which stipulates what the constitution must include and that the geographical area specified is appropriate. Clark urged practices to draw up a constitution as a priority so their consortium can begin making collective decisions and organising itself while in shadow form. “You need one now [to] get on with facing up to the fact that by 2012 they need to be running with that baton.”
SCOTS KEEN TO COMMISSION
commissioning in context
COmmiSSiONerS iN aCTiON
Welcome to Commissioning Success, a new section to Practice Business where we aim to cover the latest news in the new world of GP commissioning to better prepare managers and primary care professionals forming GP consortia
GPs called for greater involvement in decision making within the NHS at BMA Scotland’s annual conference last month. While making clear they did not wish to follow the route being taken in England, GPs in Scotland agreed that models of commissioning should be explored. This would allow them to take a greater role in shaping the care path of their patients. Dr Dean Marshall, chairman of the BMA’s Scottish general practitioners committee said: “We do not support the market-based reforms being pushed through in England, where the consequences for patients could be severe. But we do believe that an enhanced role for GPs in Scotland in making decisions about patient care could deliver very real benefits.”
A new website called ‘The Commissioning Community’ (www. commissioningcommunity.co.uk) has been launched by Practice Business columnist Roger Hymas to help raise the commissioning game in general practice. The website aims to bring together commissioning practices and techniques from across the NHS for consortia. PCT staff are also being invited to participate through an initiative called www. pctlegacy.co.uk, launching this month. Much of the reference material will be taken from individual PCT projects created under the World Class Commissioning Assurance programme, which ran from 2008 to 2010. PCTs are being asked to help identify their best work, which can be picked up by consortia and developed in the future in a wiki environment. The launch of the website focuses initially on the 2011/12 national contracts activity.
COMMISSIONING | analysis
Forget the Olympics, or 21/12/12, are you ready for 1/4/13 – commissioning’s day of reckoning? ROGER HYMAS reminds us that it’s 240 working days away
Roger Hymas Roger Hymas is a former MD of Bupa and director of commissioning for Hampshire PCT. He is the founder of the Commissioning Community website, www. commissioningcommunity. co.uk and a regular columnist on commissioning for Practice Business. You can reach him to clarify any issue at email@example.com
This is the year of the countdown clock. If you’re reading this on 14 February, it’s 164 days to the opening ceremony of the London Olympics. I’m pretty sure we’ll be reminded by the media as we hit every milestone: 200, 100, 50 and 30 days to go. But the other countdown in which we are all involved in is the run-up to the start of GP-led commissioning, scheduled for 1 April 2013. That’s 411 days away. Of course, it’s really much closer because I’m assuming that most commissioner weeks only have five days, not seven. Then there are bank holidays, Christmas, the New Year, Diamond Jubilee celebrations – all of which have to be deducted – plus four weeks’ annual leave, which means that there may be as few as 240 working days between now and 1.4.2013. Regular readers will know how much I witter on about how complicated commissioning is. Why I make this point is that it’s going to be a huge challenge for most CCGs to be in good enough shape to be effective commissioners by the due date. There is so much that has to be learned and implemented and for those involved – GPs and practices included – and on top there are the competing and familiar demands of the day job which just won’t go away. The other big issue is the shrinking resource to execute the commissioning challenge. If we go back two years ago to the halcyon days of PCT commissioning, you’d find that 250 people would have been employed in commissioning in each trust. Multiply 240 days by 250 people and you get close to 60,000 man days a year. Since then, PCTs and SHAs have been clustered and practically, but not quite, decimated. I’d guess headcount is around 40% of the numbers involved at their peak. This means that the 60,000 man days might now be no more than 36,000, about 7,000 per PCT cluster. Now it doesn’t stop there. The number of NHS administrative people actively involved in commissioning proper is destined to fall again. A critical milestone in the countdown process is the passing of the Health and Social Care Bill, which has to happen in the next 60 days or so before this session of Parliament ends. The passing of the act will be the starting gun for the inception of the NHS Commissioning Board and for the appointment of around 4,000 jobs at board headquarters and across the NHS in England. Most of these will be current PCT staff. It also means that if there are 100 CCGs by the year-end (and I’m betting it could be even fewer) there would be 40 NCB supervisors for each CCG. Perversely, this means that we could find ourselves with a headcount number that is greater than for individual CCG staffing. Think of it as a bit like the Navy having more admirals than ships. NCB people will have to fill their days with ‘useful’ work. Expect, then, that there will be lots of important authorisation questions that need to be answered by CCGs. The NCB will invoke good governance and due process, so I’m expecting that there will not be a lot of time for a great deal of real commissioning to get done in CCGs. Of course, it’s not the job of the NCB to do commissioning. Its job is to supervise the commissioning process, which is the job of the CCGs. All this means that there’s going to be significant disruption for CCGs just when they need lots of time in the run-up to taking over commissioning.
february 2012 | practicebusiness.co.uk
COMMISSIONING | case study
COMMISSIONING | case study
Swan song NHS Worcestershire brings end of life care out of anonymous hospitals and into the community. HELEN NORTHALL, CEO of PCC, explains how better commissioning can improve people’s lives until the very end
Health services have an understandable focus on getting sick people better, but recent years have seen a drive to improve the care of dying people. NHS Worcestershire has put itself at the forefront of that drive, partly by signing up to the Marie Curie Delivering Choice (MCDC) Programme. One of the key indicators for improving end of life care (EoLC) is how many people are able to die in the setting of their choice. Although most people say they would prefer to die in a setting other than hospital – usually their own home – more than half of deaths still take place in hospital. Using the MCDC programme as a starting point, NHS Worcestershire has reduced acute admission costs by an estimated £400,000 in 18 months by introducing a range of initiatives covering primary care, community nursing, ambulance services and acute care.The percentage of deaths taking place in hospital has fallen from 45% to 42% as a result. Both the savings in acute care – which are reinvested in community services – and the improved record in meeting people’s wishes to die at home are particularly impressive. Felix Blaine, the local GP who has been one of two clinical champions for the initiative, says: “We really wanted to engage with primary care and that is why we came up with a local enhanced service specification. In the LES we are trying to enshrine standard good practice but also highlight new ways of doing things and change the culture.” The LES draws heavily on the national tool for EoLC in the community, the Gold Standards Framework. It includes a requirement for a lead GP from each practice to attend a full day’s training and for other GPs to undertake two one-hour modules developed by consultants in palliative medicine. The primary care initiative is credited with a three-fold increase in the numbers of patients on the palliative care register in 18 months. Being on the register appears to significantly increase the prospect of a patient dying in his or her preferred setting. Fewer than one in five patients on a register die in hospital. The registers help ensure that anyone involved in making decisions about an individual’s care is aware that they are nearing the end of life. It is an important factor in encouraging professionals, the individual and family to engage in advance care planning. Such advance planning can help professionals and carers respond to a deterioration in the individual’s condition in a way that respects their wishes and preferences. Too often the response
to such crises is an emergency admission to hospital. The project and local commissioners have targeted the high rates of emergency admissions out of hours that meant people were admitted to hospital to die. Regular meetings with clinical staff from the out-of-hours provider and district nursing teams, coordinated by the MCDC project team, identified how such admissions could be reduced and the education needs of OOH GPs. Every OOH GP completes an EoLC module developed by the palliative care team. The initiative has also created new posts or expanded roles and responsibilities, particularly for several specialist palliative care nurses and health care assistants. Nurse specialists in palliative care now provide a weekend service that is aimed at preventing emergency hospital admissions. The nurses have averaged around 100 contacts a month, assessing and supporting patients face-to-face but also advising clinicians. In response to demand from both clinicians and relatives, two health care assistants are available each night to support patients and families where planned care arrangements had suddenly become untenable. The Rapid Access to Trained Carers at the End of Life (RACE) service has cared for 60 patients in six months and is thought to have prevented at least 20 admissions – with overwhelmingly positive feedback from service users. Other steps include: n New forms filled in by GPs and held by the ambulance hub. These inform crews of any advance care plans or the preferences of any patient nearing the end of life. This information can influence whether the person is taken to hospital by ambulance – resulting in the form saving £74,000 in its first six months. n Supporting the local Dying Matters campaign to encourage more conversations – and therefore planning – about death and dying. n Improved anticipatory prescribing – including the use of justin-case boxes containing drugs that are kept in a patient’s home in case their needs change suddenly. An audit at six months showed 48 of 66 patients had accessed the drugs – saving £65,000 through admission avoidance, fewer calls to OOH pharmacies and hospice admissions. n Improved arrangements for dying patients being discharged from the acute trust. The memory of how a loved one dies stays with relatives and friends for many years. There is only one chance to get it right and health services are working together in Worcestershire to ensure that happens for a lot more families.
The memory of how a loved one dies stays with relatives and friends for many years. There is only one chance to get it right
» february 2012 | practicebusiness.co.uk
practicebusiness.co.uk | february 2012
COMMISSIONING | analysis
COMMISSIONING | analysis
Roger Hymas Roger Hymas is a former MD of Bupa and director of commissioning for Hampshire PCT. He is the founder of the Commissioning Community website, commissioningcommunity. co.uk and a regular columnist on commissioning for Practice Business. You can reach him to clarify any issue at rogerhymas@ btinternet.com
Or why we need more of them
RogeR Hymas looks at whether the DH’s draft plans for commissioning do enough to help CCgs get statutory status and why we should be looking to america for inspiration
This section focuses on the logistics behind delivering better commissioning. It aims to help readers see-through their commissioning plans succinctly and successfully. It focuses on budgetary issues, and ensuring CCGs make the most of the Government’s £25 per patient management allowance. Here we also feature interviews and advice from PCTs and SHAs invested in seeing the NHS succeed under the reforms. It also touches upon how to get the member practices of your CCG to get involved in commissioning and contribute their support.
What is it they say about March – comes in like a lion and out like a lamb? What a load of crock! I was frenzied trying to get it all together for the end of March: QOF and financial year-end, incentive scheme evidence, enhanced services quarter and end-of-year and then, because we are part of a pathfinder, some bright spark decided to set up a programme for commissioning development where the PCT brains tell us what we will all have to do in the future (unless we employ them of course, there’s always that option). As that is fortnightly and more or less mandatory, particularly if you are on the board or simply a bog-standard PM who wants to know what’s happening, it takes a lot of time. Now I appreciate that someone has thought to do something to help us all out so we can hit the ground running, however I am still having a strop because everyone seems to want a piece of me. Attendances to all and sundry because I am on the board are multiplying at a rapid pace, I get emails everyday asking if I can help (and if it is one of my PM mates I always do). I have queues of pharma-type people wanting to understand it all (I never help them unless I am substantially paid an appropriate honorarium). However despite it all, we still find ways to help each other – one of my fellow PMs on the PM network steering group sent an email just days ago asking whether we could share what PMs were valued at in different parts of the country for commissioning work and did anyone have job descriptions or competencies of PMs on boards. Within 10 minutes she had all the information she needed. It was suggested she asked what competencies the GPs had to be on the board and to view their job roles. In my naivety I thought all boards had done that and had the evidence to support it, though maybe not?
iNFOrmaTiON aNd TeCHNOlOgy Data management and technology is playing a huge part in successful clinician-led commissioning. Here we look at innovations in managing information and IT that will help a CCG succeed at delivering care to its local population – whether it be procuring better machines for clinics or improving the back-office system used across practices.
A new start VAL HEMPSEY of the Practice Management Network survives the end of the financial year – just
april 2010 | practicebusiness.co.uk
The final countdown
december 2011 | practicebusiness.co.uk
We’re practically at the end of the year. How was it for you? Somehow, I’m feeling rather glum, but maybe it’s because I’m the eternal optimist, a glass-halffull kind of person, and I had high hopes that 2011 would be a breakthrough year, one that we’d always remember as the starting point of something really big and worthwhile happening for the NHS. But, here we are at the end of the year and my impression is that we spent the time not making any meaningful progress. It’s my job in Practice Business to look at the strategic aspects of commissioning – to anticipate how the 2010 white paper (doesn’t it seem so long ago and so full of promise?) would move through stages, become a bill, then an act and lead us to a fundamentally different brave new world of GP-led commissioning. But what I observe at present is commissioning falling between the cracks of the old PCT system, which is disintegrating, and the GP-led version, which is a long way off being properly formed. The consequence, and it’s a very dangerous one in my opinion, will be that, for some time yet, the controlling influence in the NHS will continue to be the acute trusts, which will have the largest, disproportionate influence over care design, delivery and finances. These are big businesses that need to keep growing their incomes; it’s not unreasonable for their senior management to be ambitious for their organisations. However, from the commissioner’s perspective, I don’t see how it’s possible to maintain cost control and improve care design if you don’t have adequate commissioning, contracting and performance management processes. If not, acutes stay in the dominant position and the real losers in this scenario will be the patients of community care and mental health organisations as the money is gobbled up by their sophisticated FT colleagues. I know I’ve been harsh on PCTs for their lack of rigour and professionalism in pursuing the commissioning agenda, but PCTs were getting better – a lot better – before the decimation and
clustering that has taken place in the past year. We now face a situation where, as we go into the 2012/13 commissioner/provider contracting season, we’ll be in a worse state of negotiating equilibrium than last year, in fact any year since 2006/07 when PCTs were invented. This will mean that powerful provider interest will largely maintain its grip in local healthcare ‘markets’. Let me give you just one small example. Last year’s DH contract guidance made a plea that GPs should be involved in the annual contracting process. This year, they have been told to lead it. I’d like to ask you: How many of you in GP practices and CCGs have been involved over the past couple of months in developing your local ‘commissioning intentions’ for 2012/13? These set out the local framework for the next NHS financial year, establish the commissioning priorities and start to lay down the rules of engagement ahead of the contracting round. They are also intended to get stakeholder feedback – information from the local authority, voluntary organisations, the public and patient groups – on what is good and bad in the local provider scene and how improved contracts, signed next March, can get the best out of the resources available. Putting commissioning intentions into the public domain is also a practical demonstration of the transparency that is a major feature of the 2010 white paper. I write this article at the beginning of November, but as I Googled “commissioning intentions 2012/13”, I didn’t find more than a handful of recent references to the subject. Arguably, there should have been a minimum of 51 – for all ‘clustered’ PCTs – and a maximum of 152, representing the original number of PCT organisations. If these programmes had been executed – and they are an essential part of any commissioner’s patient and public engagement programme – they should by now be within the view of the eagle eye of Google. There are, however, some examples of excellent commissioning intentions initiatives out there on the internet. Full marks go to Kingston – one of my favourite PCTs for a long time. The Kingston CCG got its commissioning intentions out as early as October. (Take a look at: http:// www.kingstonpct.nhs.uk/Downloads/KCC%20 papers/4%20October%202011/Att%20D%20-%20 KCC%20Commissioning%20Intentions%20-%20 working%20draft%20_2_.pdf.) I think the 21-page document is a beacon in what seems otherwise to be a very dark, empty commissioning landscape. Hats off
practicebusiness.co.uk | december 2011
The facts YO U R G U I D E TO
Commissioning Success is a bi-monthly magazine aimed at helping clinical commissioners get the best outcomes Launching in March 2012, Commissioning Success will be the only commissioning title specifically targeted at helping CCG board members, participants in commissioning, and all related health networks and shadow boards manage the NHS reforms successfully. It will be a must-read for anyone interested in clinically-led commissioning. Whether they’re on a the board of a clinical commissioning group, participating in commissioning, a provider or interested from the side-lines, Commissioning Success magazine will help them stay one step ahead of the Government’s plans to give clinicians power over £60bn of the NHS’s budget. Commissioning Success is a unique proposition. It’s a focused publication for a focused audience; a management agenda magazine, with relevant and useful information covering all aspects affecting commissioning. Editorial is never sold, it’s written for the audience and not the sector suppliers – we make no apologies for that – because the more people that read it, the more beneficial it is to everyone.
commissioning HAS LANDED A bi-monthly magazine from the Practice team to help Business you succeed in commissioni ng Commissionin g Success prom ises to be the management only title speciﬁcally targeted at CCG members, part board icipants in com missioning, and related health all networks and shadow boar ds
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.
Be one of the ﬁrst to sign up and receive a six-month subscription for free (worth £69.99) commissioningsuccess.com firstname.lastname@example.org BROUGHT TO YOU BY THE TEAM BEHIND
Circulation 2,500 board members of CCGs 2,000 other individuals active within the CCG arena 500 NHS trust executives 200 PCT executives* *Contact us for the most up-to-date circulation figures
Readership CCG board members, participants in commissioning, and all related health networks and shadow boards .
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Change is good With so much happening in healthcare, it’s important to have your practice team on board. Jonathan hills seeks some good advice on how to motivate your team, put changes in place and assert your authority as practice manager and within the CCG
vendor profile | pelican
vendor profile | pelican
You train them up and you m welfare is at the heart of wha at it is then you have usually
management | legal Pelican Feminine Healthcare is a name GP practices trust. Practice Business finds
out more about the company and just what makes it such a trustworthy name in the world of disposable feminine health supplies as the nhs cuts start to take hold, your practice
Pelican Feminine Healthcare Limited underwent a rebranding; separating from the stoma care side of the business, and further emphasising its speciality in gynaecological and obstetric products. Pelican has also embarked on an ambitious development plan intended to transform its spacious premises in Cardiff to a state-of-the-art manufacturing and distribution centre and shares a joint research and development facility, based in Northern Ireland, with its sister company, committed to bringing innovative, quality products to market for the benefit of its customers.
ProduCts you Can trust Pelican’s primary care customers are particularly loyal to its gynaecological products. One of Pelican’s most popular and well-known products is its PELIspec disposable vaginal speculum, which is the leading product of its kind with 70% market share and is available on NHS contracts. Pelican’s newest addition to the PELIspec range is the PELIspec with Light Source, which uses an attached light source to visualise the cervix, ensuring maximum visibility for the professional to carry out any gynaecological procedure. The PELIspec with Light Source was mainly created using feedback from nurses and doctors, who complained of awkwardness when using separate, unwieldy light devices and, in some cases, the inability to see the cervix, which resulted in expensive hospital referrals. Ensuring everything runs smoothly is imperative when patients undergo what can be such a sensitive procedure, but it can save money too. The ability for a clinician to see what they’re doing can cut down on time, reduce the need to have another person in the room and also reduce repeat referrals.
vendor profile | pelican
of its products, and a dedicated customer services team, helps to explain why some of Pelican’s customers have been buying from them for all 18 years it’s been in business. Particularly for practice managers who are not doing the actual clinical procedures but are buying the products, having the support of a company they can trust is priceless. So while going for a smear test is probably last on the list of pleasant experiences for female patients, high quality products from companies like Pelican are there to ensure it’s as comfortable and efficient a procedure as possible, which not only helps the patients but the practice too.
For practice managers who are not doing the actual clinical procedures but are
will be money coming inbuying to the practice, then you are going to the products, having the support of aresources.” company they can trust is priceless forced into finding more innovative means by which to have to pool your keep an effective patient service running with growing Wright believes his staff have an altruistic approach costs and a reducing budget. like in any business, to dealing with patients, and therefore is something this will result in you needing to find more and more that can be used when reasoning with staff about taking innovate ways to cut spending and reduce costs. over roles and financial changes within the practice. it is a time to be pragmatic and learn new skills to “i think it is seeing what appeals to staff,” he ensure that your practice does not suffer as a result; standing bycontinues. “What motivates them to come in and do their values you will need to ensure that your staff are flexible and the work? Most, even 90%, of staff are very patient accommodating, ready for a challenge and prepared centered so they are very much dealing with the public Contact details to move into areas of responsibility that they might be and like speaking to them. in fact, most of them would thus far unfamiliar with. rather speak to them than do a lot of paperwork, and some practices particularly might have certain staff practice managers should think about this when remembers who are extremely proficient at the job they allocating roles in the practice. ordinarily perform, but when asked to move into a new “You train them up and you make sure that patient arena might become apathetic or reluctant to excel. welfare is at the heart of what they do, and as long at it Michael Wright, practice manager at Whyburn is then you have usually got their buy-in,” he added. Medical Practice thinks that practices working the integration of technology will also have a together will be key in tackling the implementation of profound effect on the running of your practice, the CCGs. and you and your staff will have to be prepared to “one of the main things, and one of the learn how to use it – and with the introduction of 38 39 things which is really going to come out of all the the CCGs the role of technology looks to become work/life | change management commissioning going on now, is working together,” more prominent. he says. Wright that use of the same back office You train them up and states you make sure the that patient welfare is at the heart of what they do, and as long “there are going to be times in your locality system is vital in the smooth running of a practice, and at it is then you have usually got their buy-in when you can share some of the back office functions. especially between consortium members: “one of the there is going to be pressure and there is talk of a problems at the moment is that there are a lot of it new contract, so if that means there is going to be less systems out there – if you have an it system, everyone
A negative impact
MANAGEMENT | service redesign
Quality has always been a priority for buyers of healthcare products. Purchasing high-calibre clinical supplies is instrumental to the health and wellbeing of patients and with the onset of increased patient choice of GP practice, never has this been more important. A debate at the BMA’s annual conference last month further reiterated the importance of the subject when it called on the NHS to take a firmer stance on procuring products from trustworthy sources. One company that has always prided itself on the trustworthiness and reliability of its products Pelican Feminine Healthcare is Pelican Healthcare. Under the mission statement ‘quality, service, trust, innovation and value’, 02920 747400 email@example.com Pelican has a loyal fan-base of GPs, nurses and practice managers who are confident in the fact its www.pelicanfh.co.uk disposable medical products will not let them or the patient down. Pelican started life in 1994 and from the outset manufactured disposable products for stoma care and feminine healthcare. The following year, the company
acquired Nightingale Limited which has since become the Pelican Home Delivery Service that supplies its stoma customers and serves all parts of the UK. In 2007, the company was bought by TG Eakin Limited, a world-renowned producer of specialist medical adhesives and wound care products, and is now part of the Eakin Group of companies. Its stoma care products are now available in the UK under the Pelican brand with an increasing number of international customers served by Eakin under the Eakin brand. This year Eakin went on to further acquire Clinical Innovations Europe Limited, which extensively added to Pelican’s obstetric and gynaecological product range. One of the more popular products brought on board was the Kiwi Vacuum Delivery System, essentially a single-use ventouse that works with an integral hand-held pump. Since the acquisition, the feminine health division of Pelican Healthcare has become its own entity.
Ensuring quality of product, particularly in the field of gynaecology, is so important to patient relations. One bad experience can put a patient off from returning to that practice or going for a future smear test altogether. With this in mind, Pelican also supports Jo’s Cervical Cancer Trust, by donating 5p to the cause from every box of speculums sold. Jo’s Trust offers information and support to help women understand the importance of cervical screening and encourage them to attend their smear test appointment. Pelican offers free delivery to its customers and is also the only company in its market to manufacture its products in the UK, which not only ensures a certain quality standard, but also reduces the risk of damage to the product en route. This, the reliability
july 2011 | practicebusiness.co.uk
practicebusiness.co.uk | july 2011
advice for busy lives
Is negative equity once again rearing its ugly head? OlIver POOl, an associate at veale Wasbrough vizards, asks the question, and discusses the implications for GPs owning surgery premises
Rising to the challenge work/life
These can be horizontal, vertical, double- or single-page, running Change across the bottom or along the outside edge of the page. Banners is good can run in multiples of three, five, eight or just on their own, on consecutive pages or scattered throughout the magazine – a great Practical approaches to improvement in the NHS need alternative to standard page advertising for brand recognition. to be combined with strategic thinking, says MARK EATON advice for busy lives
Recent concerns over the future values of commercial may be unwilling to participate if they are risking being october 2011 | practicebusiness.co.uk property raises the spectre of negative equity in surgery bought out for a loss in a few years’ time (the best idea With so much happening in healthcare, it’s important to have your practice team premises. There is no doubt that values have fallen, even for partners nearing retirement is not to participate on board. Jonathan hills seeks some when valuers take account of the fact that notional rent atyour all,team, but to allow the others to ‘get on with it’ and good advice on how to motivate put changes in place and assert your authority is paid when coming up with valuations.as Partners in indemnify them). practice manager and within the CCG the middle of careers should be in for long enough to Incoming partners may be reluctant about buying ‘ride out the blip’, but for incoming partners, and those into negative equity. We often hear incoming approaching retirement, it is important. partners asking why they should have to take In the last recession, it often came as a nasty over the share of a liability not of their own surprise to retiring partners who owned a share of the making. The answer is that partnership ‘comes surgery premises that they would be expected to buy as whole’ – if you want to be a partner you themselves out on retirement. But this is what happened have to accept the whole package and can’t in a number of cases, especially partnership the bits you don’t like –now the alternative Withwhere a £20bn challenge onreject the table for the NHS, is not the time to be deeds were silent on the issue, and especially where is toare finddone. a different or toachieve be a tinkering with the way things Thepartnership, NHS cannot this level of partners had been involved in costly new-builds, where salaried GP. improvement through buying cheaper paper clips or banning the purchase of the price of the development had exceeded the market At the same time, what cannot be achieved sticky tape. value. This situation may be rearing its head again. by the partnership deed is to bind incoming partners Just ‘working harder’ will only deliver incremental improvements in performance It is not uncommon for a partnership to ‘shield’ to buy in at a certain price unless they specifically andequity even by applying of ‘working smarter notincoming harder’partners will only pay off if what retiring partners from negative includingthe clichéagree to it, because of course you arethat working in the place.of the partnership provisions in the partnership deed provide on for is the right aren’tthing yet bound byfirst the terms Now is least the time for thinking differently about how andforwhere retiring partners to be bought out for at what they deed. Further, it may be permissible the services are contributed, or at least the delivered. previous acquisition cost. having partnership buy a retiring partner outevidence above This means to make to tough, but logical and based, choices management | legal This raises the issue of the goodwill rulesservices – paying above market locally. value, butIttomeans insist that an incoming about how are organised having to tell some people they the market value for surgery premises can beadeemed partner pays more than market value isservices much will be getting lot less money than previously and shifting between to be a transfer of goodwill, which is, of course, illegal. more likely to be a breach of the goodwill rules. organisations to ensure they are delivered both safely and productively. It means However, in practice these arrangements have not been The best way for this to be dealt with is to having to work with unproductive organisations to help them improve, but also called into question, as long as there is a clear presee the transaction as one in which partnership having the courage toany move the funding if they can’t or won’t rise to the challenge. again rearing its ugly head? OlIver POOl, existing agreement, and to dateIs negative there equity haveonce not been protects retiring partners from negative equity, rather an associate at veale Wasbrough vizards, asks the question, and The keys that will enable leaders at all levels in all organisations to rise prosecutions under the goodwill rules. than the incoming partnerand directly taking on the discusses the implications for GPs owning surgery premises to in thethechallenges unlockpartner’s improvements are going to case be found Including such provisions partnershipahead deed andoutgoing share of liability. In any it may in two strategically actions. will be particularly important for practicesimportant that are be worth checking the partnership deed to see if it deals contemplating new-builds – older partners in particular adequately these issues. The first action will be to create awith structure that enables teams and organisations
vendor CASE STUDIES
as the nhs cuts start to take hold, your practice will be forced into finding more innovative means by which to keep an effective patient service running with growing costs and a reducing budget. like in any business, this will result in you needing to find more and more innovate ways to cut spending and reduce costs. it is a time to be pragmatic and learn new skills to ensure that your practice does not suffer as a result; you will need to ensure that your staff are flexible and accommodating, ready for a challenge and prepared to move into areas of responsibility that they might be thus far unfamiliar with. some practices particularly might have certain staff members who are extremely proficient at the job they ordinarily perform, but when asked to move into a new arena might become apathetic or reluctant to excel. Michael Wright, practice manager at Whyburn Medical Practice thinks that practices working together will be key in tackling the implementation of the CCGs. “one of the main things, and one of the things which is really going to come out of all the commissioning going on now, is working together,” he says. “there are going to be times in your locality when you can share some of the back office functions. there is going to be pressure and there is talk of a new contract, so if that means there is going to be less
money coming in to the practice, then you are going to have to pool your resources.” Wright believes his staff have an altruistic approach to dealing with patients, and therefore is something that can be used when reasoning with staff about taking over roles and financial changes within the practice. “i think it is seeing what appeals to staff,” he continues. “What motivates them to come in and do the work? Most, even 90%, of staff are very patient centered so they are very much dealing with the public and like speaking to them. in fact, most of them would rather speak to them than do a lot of paperwork, and practice managers should think about this when reallocating roles in the practice. “You train them up and you make sure that patient welfare is at the heart of what they do, and as long at it is then you have usually got their buy-in,” he added. the integration of technology will also have a profound effect on the running of your practice, and you and your staff will have to be prepared to learn how to use it – and with the introduction of the CCGs the role of technology looks to become more prominent. Wright states that the use of the same back office system is vital in the smooth running of a practice, and especially between consortium members: “one of the problems at the moment is that there are a lot of it systems out there – if you have an it system, everyone
should be able to use it, trained up and able to access your surgery regardless of what practice you belong to,” he said. Emphasising that practices need to be braced for the plunge, Webster argues that both personnel and financial steadiness are required for the transition if practices are to survive it. her advice on how the practice can ready itself for the financial implications of the transition is quite different, however while managing staff often reuires a tailored, individual approach, managing finances relies upon uniformity. whereas in managing staff importance in management should come with individualism, when it comes to finances, the greatest importance is upon uniformity. “it’s about adjusting roles within the practice because actually, certain elements of commissioning like scrutinising data and making sure everyone’s referral patterns and prescribing habits are the same, all takes time, so you have to adjust your workload accordingly – making sure the practice finances are robust enough, in case the worst happens and
october 2011 | practicebusiness.co.uk
Written and designed by the Commissioning Success editorial team,
practicebusiness.co.uk | october 2011
a vendor case study is an effective way to get company messages A negative impact and services in front of our readers. Featuring a commissioner in an interview style, it allows you to really promote your services in a meaningful and interesting way. Case studies are one of the best JARGON BUSTER Legal update sponsored by Veale Wasbrough Vizards Transformation read parts of our magazine, great for exposure. mapping Recent concerns over the future values of commercial property raises the spectre of negative equity in surgery premises. There is no doubt that values have fallen, even when valuers take account of the fact that notional rent is paid when coming up with valuations. Partners in the middle of careers should be in for long enough to ‘ride out the blip’, but for incoming partners, and those approaching retirement, it is important. In the last recession, it often came as a nasty surprise to retiring partners who owned a share of the surgery premises that they would be expected to buy themselves out on retirement. But this is what happened in a number of cases, especially where partnership deeds were silent on the issue, and especially where partners had been involved in costly new-builds, where the price of the development had exceeded the market
may be unwilling to participate if they are risking being bought out for a loss in a few years’ time (the best idea for partners nearing retirement is not to participate at all, but to allow the others to ‘get on with it’ and indemnify them). Incoming partners may be reluctant about buying into negative equity. We often hear incoming partners asking why they should have to take over the share of a liability not of their own making. The answer is that partnership ‘comes as whole’ – if you want to be a partner you have to accept the whole package and can’t reject the bits you don’t like – the alternative is to find a different partnership, or to be a salaried GP. At the same time, what cannot be achieved
provisions in the partnership deed that provide for retiring partners to be bought out for at least what they contributed, or at least the previous acquisition cost. This raises the issue of the goodwill rules – paying above the market value for surgery premises can be deemed to be a transfer of goodwill, which is, of course, illegal. However, in practice these arrangements have not been called into question, as long as there is a clear preexisting agreement, and to date there have not been any prosecutions under the goodwill rules. Including such provisions in the partnership deed will be particularly important for practices that are contemplating new-builds – older partners in particular
aren’t yet bound by the terms of the partnership deed. Further, it may be permissible for the partnership to buy a retiring partner out above market value, but to insist that an incoming partner pays more than market value is much more likely to be a breach of the goodwill rules. The best way for this to be dealt with is to see the transaction as one in which partnership protects retiring partners from negative equity, rather than the incoming partner directly taking on the outgoing partner’s share of liability. In any case it may be worth checking the partnership deed to see if it deals adequately with these issues.
to work together. This doesn’t mean a monthly meeting where the normal procedure is to send substitutes and where the energy levels start at mediocre levels and then go downhill. This means working together to create a clearly structured transformation map (see box out) that sets out the roadmap for local improvement by clarifying the local strategic objectives and the outcomes that need to be achieved to deliver each of them. The second action will be to create a structured, logical and pragmatic approach to implementation that will both deliver the roadmap and enable organisations to work together to realise the benefits. Legal update sponsored by Veale Wasbrough Vizards Answering the £20bn challenge will not only involve the delivery of organisational improvements such as shorter hospital stays, faster diagnostic turnaround times and fewer patient safety incidents. Changes will also have to be made in areas that need a different and often more collaborative approach such as providing care in new settings, improving end-to-end pathways and tackling the underlying issues that prevent the flow of information. MANAGEMENT redesign Rising| service to the challenge will need new types of thinking, something that can be delivered successfully by combining practical approaches to improvement, such as ‘lean’, with a strategic edge to it from such concepts as transformation mapping.
value. This situationto may be rearing its head again. contact by the partnership deed is to bind incoming For further information on legal issues relevant GPs, please Oliver Pool, anpartners associate at Veale Wasbrough Vizards It is not uncommon for a partnership to ‘shield’ to buy in at a certain price unless they specifically from negative equitythose by including advising agree to it, because who offers specialist legal advice to theretiring GPpartners sector and GPs,of course on incoming 0117partners 314 5429 or firstname.lastname@example.org
Transformation mapping is a visual way of developing and linking strategy to implementation plans. Typically, this is achieved using a large diagram that depicts where an organisation wants or needs to be within a specific timescale, along with the associated implementation plans.
Advertisers have the opportunity to brand or sponsor a feature or section. We choose our sponsorship partners very carefully because as a valued Commissioning Success partner, it follows that we’re also endorsing their brand. Placed on very targeted editorial sections of the magazine it’s a en extrenmelyt stategic and pretigious way to promote your brand. Something a bit different, a bespoke sponsorship position aligns you with the magazine’s message.
suddenly you are not able to pay the wages,” she says, mentioning that this year her staff had to deal with a pay freeze for the first time in preparation for the future. her advice concerning the management of staff and how to handle personnel centres upon trust and openness. she upholds that being honest, including asking staff for their opinions on changes in the practice, leads to greater respect in her team, and ultimately, a better practice. “When you tell people why and give them the option to come back with concerns or alternative proposals they will respect the decision you make,” she says. “if people think you are just the boss in the practice, people will not go out of their way for you.” Whatever the future holds for practices in the nhs - and truthfully everyone may have an indication but no one actually knows the repercussions that will come with the introduction of the CCGs – one thing is certain, and that is it’s best to have a tight and accountable financial structure, and a solid practice team around you when you make the change.
For further information on legal issues relevant to GPs, please contact Oliver Pool, an associate at Veale Wasbrough Vizards who offers specialist legal advice to the GP sector and those advising GPs, on 0117 314 5429 or email@example.com
In qu should be able to use it, trained up and able to access your surgery regardless of what practice you belong to,” he said. Emphasising that practices need to be braced for the plunge, Webster argues that both personnel and financial steadiness are required for the transition if practices are to survive it. her advice on how the practice can ready itself for the financial implications of the transition is quite different, however while managing staff often reuires a tailored, individual approach, managing finances relies upon uniformity. whereas in managing staff importance in management should come with individualism, when it comes to finances, the greatest importance is upon uniformity. “it’s about adjusting roles within the practice because actually, certain elements of commissioning like scrutinising data and making sure everyone’s referral patterns and prescribing habits are the same, all takes time, so you have to adjust your workload accordingly – making sure the practice finances are robust enough, in case the worst happens and
Quality has always been a prio of healthcare products. Purcha clinical supplies is instrumenta and wellbeing of patients and w increased patient choice of GP this been more important. A de annual conference last month f the importance of the subject w NHS to take a firmer stance on from trustworthy sources. One company that has alw Contact details the trustworthiness and reliabi Pelican Feminine Healthcare is Pelican Healthcare. Under th ‘quality, service, trust, innovati 02920 747400 firstname.lastname@example.org Pelican has a loyal fan-base of practice managers who are con www.pelicanfh.co.uk disposable medical products w patient down. Pelican started life in 1994 a manufactured disposable produ feminine healthcare. The followi
case study july 2011 | practicebusiness.co.uk
Rising to the challenge
Mark Eaton is MD of Amnis
nhs but will thin acco team
Practical approaches to improvement in the NHS need to be combined with strategic thinking, says MARK EATON
Transformation mapping is a visual way of developing and linking strategy to implementation plans. Typically, this is achieved using a large diagram that depicts where an organisation wants or needs to be within a specific timescale, along with the associated implementation plans.
opti prop she prac
Pelican Feminine Healthcare is a na out more about the company and ju the world of disposable feminine he
Mark Eaton is MD of Amnis
JARGON BUSTER Transformation mapping
and open aski prac ultim
With a £20bn challenge on the table for the NHS, now is not the time to be tinkering with the way things are done. The NHS cannot achieve this level of improvement through buying cheaper paper clips or banning the purchase of sticky tape. Just ‘working harder’ will only deliver incremental improvements in performance and even applying the cliché of ‘working smarter not harder’ will only pay off if what you are working on is the right thing in the first place. Now is the time for thinking differently about how and where services are delivered. This means having to make tough, but logical and evidence based, choices about how services are organised locally. It means having to tell some people they will be getting a lot less money than previously and shifting services between organisations to ensure they are delivered both safely and productively. It means having to work with unproductive organisations to help them improve, but also having the courage to move the funding if they can’t or won’t rise to the challenge. The keys that will enable leaders at all levels and in all organisations to rise to the challenges ahead and unlock improvements are going to be found in two strategically important actions. The first action will be to create a structure that enables teams and organisations to work together. This doesn’t mean a monthly meeting where the normal procedure is to send substitutes and where the energy levels start at mediocre levels and then go downhill. This means working together to create a clearly structured transformation map (see box out) that sets out the roadmap for local improvement by clarifying the local strategic objectives and the outcomes that need to be achieved to deliver each of them. The second action will be to create a structured, logical and pragmatic approach to implementation that will both deliver the roadmap and enable organisations to work together to realise the benefits. Answering the £20bn challenge will not only involve the delivery of organisational improvements such as shorter hospital stays, faster diagnostic turnaround times and fewer patient safety incidents. Changes will also have to be made in areas that need a different and often more collaborative approach such as providing care in new settings, improving end-to-end pathways and tackling the underlying issues that prevent the flow of information. Rising to the challenge will need new types of thinking, something that can be delivered successfully by combining practical approaches to improvement, such as ‘lean’, with a strategic edge to it from such concepts as transformation mapping.
sudd men a pa the f
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