Practice Business October 2012

practicebusiness october 2012

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october 2012 energy saving | cqc inspections | pms contracts

See the light Save energy, save funding

CQC inspections

What’s the worst that could happen?

General rules

The future of the PMS contract

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Editor’s letter EXECUTIVE EDITOR www.roylilley.co.uk MANAGING 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 | tel: 020 7288 6833 | fax: 020 7288 6834 | email: info@intelligentmedia.co.uk | web: www.practicebusiness.co.uk | web: www.intelligentmedia.co.uk | twitter: twitter.com/practice_biz

Expecting the inspectors

As practices prepare for CQC, there are a lot of murmurs making the rounds as to what needs to be done in preparation. What I’ve gathered quickly is that if you have any questions – whatsoever – it’s worth contacting CQC themselves, since they have been very accommodating.

They would encourage practices to get in touch before they do anything drastic, like pull up their carpets. The best way to do so is by emailing 2012registration@cqc.org.uk.

To try and answer some of your CQC questions, we run a couple of articles in this issue on the registration process. One on page 13 looks at the worst that could happen. Of course, we all know the answer to this one.

However, before practices are put out of business, the CQC has said it will work with practices to help get them complaint, giving them guidelines on how to improve. However much support there is for the practice manager and the accountable officer, the inspection process is bound to be a source of anxiety and stress. With this in mind, on page 48, we look at ways you can prepare yourself mentally for inspections.

Compliance aside, there are admirable practices out there – two of which we interview in this issue – that would inspire any practice to go above and beyond the call of duty. The Jericho Health Centre in Oxford has bagged a brand new building, and while this has its challenges, they acknowledge how lucky they are to have a bit more space to stretch out (p24). (Keep a close eye on how this article looks – the partner interviewed is our designer’s father.) Also in our People section we visit Spinney Medical Centre in Merseyside (p28) where the practice manager and partners take a big picture approach to general practice, prioritising education and training to ensure the next generation is as equipped to serve their patients as they are. PM Katie Power stays busy juggling this alongside her role as practice manager representative on the local CCG board.

I hope you enjoy this issue – it’s a bumper one. If you have any feedback or story ideas, or would like to be featured yourself, get in touch on editor@practicebusiness.co.uk.

editor

Contents SECTOR 06

news Top news for practice managers this month

08

executive editor comment The latest from controversial columnist Roy Lilley

PRIMARY PROVIDER 10

provider news A practice manager’s update on providing for commissioning

13

CQC What’s the worst that could happen? We find out

17

PMS General rules Is there a future for the PMS contract?

20

access Caught in the web Web bookings: the right idea or patient access nightmare?

PEOPLE 24

case study The walls of Jericho Oxford’s Jericho Health Centre gets used to new digs

28

case study Train to gain How an altruistic approach at Spinney Medical Centre keeps giving back

MANAGEMENT 32

HR Keeping the peace How to avoid staff redundancies when faced with slashed budgets and busier times

37

energy See the light How to save towards that 15% through reducing energy costs

40

clinical MFM This month: Whiplash

WORK/LIFE 44

up-skill

48

CQC

Speak their language A quick guide to clinical conversation An inspector calls Prepare yourself, and your staff, for a future of inspections

50

diary Could the DH’s IT strategy signal the end of practice managers? Hopefully not

sector

06

UK practices losing money

your monthly lowdown on practice management

Nearly half of practices in the UK took in less income from private and professional fees this past year, according to a survey of 568 GPs and practice managers, carried out by Medeconomics.

Of those surveyed, only six per cent said private and professional fees income had risen in the past 12 months, while 47% said income from these sources had fallen.

In certain parts of the UK, up to two-thirds of practices reported a decline in income from fees. The losses compound falling income across the board as expenses rise and GP funding remains frozen.

Responding to the findings, GPC negotiator Dr Peter Holden told GP Online: “It’s volume that is down, not prices. The problem is that a lot of what GPs do is insurance reports and that is directly related to the housing market. Many people are not moving, or have decided life insurance is a luxury they will do without.”

GPC practice finance subcommittee chairman Dr Ian Hume said practices and GP

news

Surgeries missing out on 10% funding boost GPs who do not challenge their rent review in 2012 could be paying 10% too much, leading surveyors warn.

GP Surveyors has reported average notional rent increases for doctors’ surgeries of 9.68%, above the PCT’s valuation, in the first two quarters of 2012, with some increases as much as 100% in some cases.

“These strong figures are very promising for healthcare property,” commented Chris Johnson, director at GP Surveyors. “They demonstrate that, despite the economic downturn and reports about the challenges that the commercial property market is facing, the UK continues to see the value and importance of GP surgeries to the economic and social future of the UK.” However, he said, some practices are reluctant to pursue their rent reviews because they are concerned their level of rent reimbursement would be reduced. He urges them to be proactive and initate the process with the PCT or risk missing out on a 10% funding boost.

october 2012 | practicebusiness.co.uk

leaders, would have to “diversify” to counteract “a reduction in payments across the board”.

He said companies are increasingly only asking for relevant information from patient records for a lower fee, rather than paying for practices to complete reports.

The poll found 33% of practices planned to take steps to increase income from private and professional fees, including increasing fees, advertising their services more, being consistent about charging and offering occupational health medicals or cosmetic injections.

Fast Facts n 47% of practices have less income sources n 2/3 have less income from fees n 33% plan to try and increase that income.

Confusion over patient complaints The Medical Protection Society has found there is confusion among GP practices about the current patient complaints process, despite its coming into force in 2009.

In the past 18 months, MPS received more than 4,500 calls relating to complaints with a significant number of practices still unsure of the complaints handling process. This confusion was further highlighted during a series of workshops at its conferences earlier this year.

There is a divergence in approach between practices when addressing the complaining patient. Requirements include appointing a responsible person at the practice; negotiating with the patient as to the timescale of response; seeking appropriate consent from the patient if they have not made the complaint; and informing them of their right to advocacy.

07

SECTOR | news

clinical news Survey shows patients prefer phone to online

A national survey of GPs suggests patients would rather use an automated telephone system to book appointments than a practice’s website.

According to a study by Voice Connect, a third of surgeries that offer telephone and online automatic bookings report a substantially higher uptake of the latter.

The research, which looked at how patients book appointments, also found that over three-quarters of GP respondents believe their automated telephone appointment booking system is accessible to all patients.

In light of government plans to make the NHS more ‘customer-friendly’ by requiring all surgeries to offer facilities for booking appointments online by 2015, the survey was designed to investigate the use of current online systems, indicating how successful such systems are likely to be.

While over 65% of respondents rated an automated telephone system as easy to use, only 17% stated that patients found the online system easier. However, the popularity of online bookings could increase with a little publicity, said Stefan Olsberg, MD of Voice Connect. “If surgeries want their online booking to be a success, it needs to be publicised to patients,” he advised.

diary 18 October

BUILDING THE PATIENT INTO SERVICE DESIGN – BIRMINGHAM Holiday Inn Birmingham City Centre PCC.nhs.uk 25 October

BUILDING THE PATIENT INTO SERVICE DESIGN – MANCHESTER The Lowry Arts & Entertainment Centre PCC.nhs.uk

They said…

“”

“With the advent of more portable communication devices, such as smartphones and laptops, we’ve already seen a number of MPS members receive patient complaints about confidentiality breaches – for example, a doctor reading a patient’s file on their laptop in a cafe, or a mobile phone with patients’ phone numbers being left on a train. The ability for doctors to upload patient notes and add to their record via a tablet device has obvious benefits; however doctors using such tools need to remember that all the normal rules of confidentiality apply.”

MPS head of medical services, Dr Nick Clements, on the increased use of tablets in general practice

PATIENT COMPLAINTS AT RECORD HIGH. A recent General Medical Council report shows one in 64 doctors now face the possibility of investigation by the regulator, as patient complaints rise by 24%.

What we learned

New recommendations for diabetes injections WISE (Workshop on Injection Safety in Endocrinology) has published new global recommendations on ensuring the safety of injections in diabetes.

The new recommendations are designed to ensure the safety of patients, professionals and all persons in potential contact with sharps used in the treatment of diabetes following a new European directive that came into force. The key topics covered in the report include: risks diabetes healthcare workers are exposed to; the impending EU legislation; injury implications of different devices; injection technique implications; education and training to create a safety culture; the cost effectiveness of safety devices; and awareness and responsibility of safe sharps disposal.

The recommendations are based on a review and analysis of all peer-reviewed studies and publications which bear on the subject of sharps safety in diabetes.

The new WISE recommendations can be found at: ScienceDirect.com/science/ article/pii/S1262363612709758.

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practicebusiness.co.uk | october 2012

08

SECTOR | comment

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.

october 2012 | practicebusiness.co.uk

The graveyard shift

It’s all change at the top at NHS HQ. Is this a sign that all is not well? Roy Lilley worries that schemes like ‘lift and shift’ are disguising a less welcome truth Do you ever get the impression that things aren’t going too well? Not quite as planned? Not as tickey-boo as they could be?

I read in the NHS trade press that some of the authorisations for clinical commissioning groups are likely to be delayed. Some of them are still too small, some have Mickey Mouse constitutions and others don’t seem to be sharing the National Commissioning Board’s (NHSCB) sense of urgency.

I have also read reports that the NHSCB is having trouble recruiting the right amount of staff. Not all the job functions seem to be defined with quite the precision required and to an outsider it looks like they don’t know how many people they are likely to want to do the jobs they are not yet sure they want done, if you catch my drift.

To resolve that little conundrum they have a new policy. Existing staff are going to be moved, wholesale, under a scheme called ‘lift and shift’. When I first saw the phrase I thought it was an advert for Marks and Sparks’s new elasticated underwear.

Then we have the no-little-matter of foundation trusts. A substantial number of NHS trusts are struggling to become FTs. There was a time when an FT was the crème de la crème.

Now it is a bruised brand and a repository for the bewildered. To help them jump the hoops and hurdles (and in the interests of cutting bureaucracy) a new strategic health authority-type organisation has been set up: the NHS FT Authority, or some such name. I understand they have a very big hammer to pound square pegs into round holes.

Call me cynical, call me oldfashioned, but I don’t think things are going so well. Aren’t you pleased that you are working in an oasis of calm called primary care?

Enjoy it whilst it lasts – if it does.

Existing staff are going to be moved, wholesale, under a scheme called ‘lift and shift’. When I first saw the phrase I thought it was an advert for Marks and Sparks’s new elasticated underwear

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How the Olympic Games could impact your practice

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Keeping schtum

Quick ways to improve patient confidentiality

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primary provider

10

‘SIGNIFICANT OPPORTUNITY’ FOR PRIVATE PROVIDERS Financial firm predicts more competition from private companies entering the primary care provider market Changes in healthcare policy and pressures on public finances will present major opportunities for private healthcare providers, according to a new research report from finance firm Catalyst.

The report points to “significant opportunity” for the private sector in primary and secondary care.

It says the introduction of GP commissioning and interest in healthcare models offers alternatives to hospital care that will require a higher proportion of services to be delivered by the private sector. The markets for these services are estimated to be worth around £20bn.

It says private contracts, like those awarded to Circle, Virgin Care and Serco, demonstrate

Empowering practices in a commissioning landscape

Future of special services revealed

A report recommends that specialised health services, which treat rare and uncommon conditions and illnesses like AIDs, cleft lips and certain genetic conditions, be commissioned nationally come April.

Although clinical commissioning groups will be responsible for buying and planning the majority of services, specialised ones need to be organised differently and commissioned on a wider scale, says a report by the Clinical Advisory Group for Prescribed Services. This is because the conditions they cover are unusual and the health services that treat them are not provided by every local hospital.

A new national model for these services, aimed at improving service access, quality and efficiency, and reducing variation, is being developed by the NHS Commissioning Board. This will be led by ten of the NHS Commissioning Board’s Local Area Teams working closely with the health care providers of specialised treatments and CCGs to ensure that all patients have equal access to high quality services irrespective of where they live.

october 2012 | practicebusiness.co.uk

“increasing recognition from the public sector that leveraging the private sector’s ability to invest capital and use more efficient delivery models is necessary for the Government to reduce costs”.

Justin Crowther, director at Catalyst and coauthor of the report, said: “Despite many challenges, the private sector is increasingly providing healthcare services, whether paid for by the taxpayer or directly by consumers at the point of use.”

clinicalnews Whooping cough on the rise The number of whooping cough cases for the first seven months of 2012 was three times higher than the annual total number of cases reported in 2011 (1,118) and in 2008 (908) – the last ‘peak’ year before this current outbreak. The disease, also known as pertussis, affects all ages. This on-going outbreak is mainly in teenagers and young adults, however, there are high numbers of cases in very young babies – 235 reported in infants under three months so far this year, compared to 112 in 2008. There have also been six pertussis-related deaths in infants up to the end of July compared to five in 2008.

Young infants are at highest risk of severe complications and death from whooping cough as babies do not get the benefits from vaccination until they are around four months old. In older children and adults whooping cough can be an unpleasant illness but it does not usually lead to serious complications.

Ten tips for tenders With commissioner contracts up for renewal, here are 10 tending tips from law firm Ward Hadaway 1. Do your research. Tenders are listed at Supply2health.nhs. uk. Designate someone to check this on a regular basis, since there is often a brief period between the announcement and deadline.

2. Play to your strengths. Before bidding, look at your set-up to examine whether you are capable of taking the work. Bidding for the wrong service at the wrong time could prove costly.

3. Be clear. When submitting a bid, make sure you correctly identify the organisation that is bidding, e.g. a GP partnership, individual practice or joint venture company. If successful, the contract will be awarded to the organisation named in the bid.

4. Prepare thoroughly. Commissioners look for well-organised bidders with all the right policies and procedures in place. Put together a core bid team to streamline processes.

5. Follow the rules. The tender process needs to be followed to the letter, especially when it comes to deadlines.

6. Carry out due diligence. To ensure there are no surprises, it is crucial to make formal inquiries and investigations into the liabilities you will be taking on, particularly property and staffing.

7. Establish your base. Know where the service will be provided.

If it is your property, ensure it meets the requirements. If it is a property provided by the commissioner, get legal advice on the terms and ensure it will enable you to do the work.

8. Consider staffing. If you take over an existing service or part of one, it is likely that Transfer of Undertakings (Protection of Employment) (TUPE) Regulations 2006 will apply. As a result, the employment contracts of the employees providing the service will transfer to your organisation, as well as any liabilities relating to those transferring employees.

9. Read the small print. Check the terms of the proposed contract when it is issued at the invitation to tender stage.

10. Don’t get trapped. If you feel at any stage that a particular contract is not for you, do not feel afraid to walk away from the bidding process.

DO YOU KNOW ABOUT OUR COMMISSIONING MAGAZINE?

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”.

13

provision | CQC

Worst case scenario?

While practices can’t fail CQC registration – they can register with areas of noncompliance. Polly Ellison finds out what could happen Once more, GP practices have to dig deep, both from the financial and human resource point of view, in order to jump through another set of hoops. This time, however, the stakes are high, since registering with the Care Quality Commission is a very legal process. A practice is practising illegally if it fails to register with the CQC by April 2013. Failure to register means practices are potentially at risk of prosecution and it may also mean that they are in breach of their contract. Once a practice is

registered, is it subject to inspection and subsequent reports placed on the CQC website. Failure to comply to guidelines on registration may subject them to a series of inspections or, at the very worst, it may mean suspension.

When the CQC has evidence of risk to patients, it may inspect practices unannounced. Inspections will only result in a warning notice if the CQC has serious concerns about the quality of care being provided. However, on registration, the practice may need to make urgent improvements, which could take up a great deal of practice time and money.

This could affect the whole practice, for example, most existing checklists will ask questions such as “Do you have practice meetings?” or “How often do you have practice meetings?” The CQC will want to know what happens as a result of a practice meeting and also how a practice ensures that agreed actions happen within an agreed timescale. Alternatively, if some kind of problem is identified, such as a patient complains as a result of not being able to get an

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practicebusiness.co.uk | october 2012

14

provision | CQC

emergency appointment, has this been identified as a one-off or is there something systematically wrong?

A good GP practice should be doing this already.

how can practices ensure they pass?

The approach to CQC is all important. CQC registration and on-going monitoring of compliance is unlike any other system of checks or inspections that have gone before. Almost all checklists used by the different bodies that inspect, assess or appraise practices focus almost entirely on structure and process, that is questions around ‘Do you have?’ and ‘Do you do?’ The CQC focuses on the outcome for the patient as a result of having the structures and processes in place.

Practices need to start off as they mean to go on, applying themselves to each section of registration with great care. The CQC has no desire to close practices. Its principle concern is to assess where your practice is today in terms of performance for patients, what can be improved and by when. The CQC will open a quality risk profile (QRP) as a tool to identify risks within practices and will help inspectors target inspections, which it will begin to compile when you complete your registration and will want to collect evidence of good practice (and bad) from any other sources. This may include PCTs, CCGs, patients and anyone who enters your practice.

The CQC will expect you to assess yourself and verify that you have the structure, process and are measuring how successful you are in a wide variety of outcomes. Before ticking the compliant box, or non-compliant box, it is important to remember that you are completing a legally binding document and will be signing to declare that you have answered all sections truthfully and completely. Depending on circumstances, you may be signing on behalf of other clinicians in your practice. The registering manager will also be signing to accept significant responsibilities. The person signing the form should be in a position to submit the form on behalf of the provider. So in a partnership, that would be a partner.

Providing you feel confident that it is the case, you can tick the compliant box. However, if you are still left undecided, then you should focus on the aspects you feel are lacking and decide upon a realistic action plan. This could result in many hours’ work, so the practice needs to consider how it is going to achieve this work in the most cost-effective, efficient way with minimum disruption for the practice.

A practice has a variety of ways to progress its CQC registration. Unless the CQC manager is october 2012 | practicebusiness.co.uk

experienced in CQC, it might be best to look at the various CQC toolkits available, however, these vary and may only act as a prompt for practices to aid them through registration. It is also worth checking CQC.org.uk for the registration of primary care services, which has been set with the help of GPs and has all the information they will need to successfully register with the Commission. Again, for those experienced in CQC it may be all that is required to become compliant, however, it may lack sufficient detail for those unfamiliar with CQC and its registration. There are a variety of firms offering a more supportive service to practices, which again vary enormously in what they offer.

The support practices need and the budgets they have available will vary enormously. Each practice will be an individual, so even the sharing of information via practice groups will require adaption to individual needs. CQC focuses on the outcome for the patient by having the structures and processes in place, so financial investment for the right support is essential. If approached in this way, it is likely that, in time, practices will find that a system that looks at outcomes is much more helpful for building a truly patient-centred approach to care and this will ultimately result in increased patient satisfaction and profitability.

The standards exist to protect people being put at risk of harm, and providers have a duty to be compliant

16

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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.

october 2012 | practicebusiness.co.uk

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

17

provision | contracts

C O N T R AC T KILLERS rtedly o p e r t n vernme o G e h t h ational n Wit a g n i t nto crea i g n i k o o es, the l c i t c a r p for GP contract ntract o c S M P the ARRIE C . r future of e v e n aker tha e l b s k o lo reports SE RVICE

At present, there are two main types of GP contracts: The nGMS (new general medical services) contract where the GP has a national contract with the Department of Health to provide primary care services. And the PMS (personal medical services) contract where the GP has a local contract with the primary care trust.

PMS contracts have been the subject of much contention in recent months. The NAPC has been in discussions with ministers at the Department of Health after major concerns were raised by GP practices across the country about cuts to PMS budgets and PCTs’ insistence on practices reverting to GMS contracts. As I write this article, it has emerged that PMS contracts may be abolished altogether before the coalition government’s term is even out. Chair of the GPC, Dr Laurence Buckman has confirmed that negotiations are underway to create a single national contract, similar to GMS, for all GP practices – except for those holding APMS contracts (alternative providers of medical services), which won’t be affected. Dr Jane Lothian, a GP in Ashington and medical secretary of Northumberland LMC, who has a PMS contract, told Pulse that the nGMS contract is outdated. “The new GMS

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practicebusiness.co.uk | october 2012

18

provision | contracts

contract looks very much like the PMS contract that we negotiated in the late 1990s. I still think there should be room for local flexibility if there is one single contract. It is time for change and I would welcome any change, which I think has become too fragmented and is no longer acting in the best interest of patients.”

It was hoped that PMS contracts could allow practices to offer services specific to the needs of their local population. The first wave of PMS pilot schemes, introduced in April 1998, trialled a totally new method of paying GPs for primary care to patients. The PMS payments replaced GMS payments based on the ‘Red Book’ Statement of Fees and Allowances (SFA) with effectively a fixed price contract. Dr Charles Alessi, chairman of NAPC, has said that the original concept of the PMS contract embodied the principle of localism that is so key to the tailoring of healthcare services needed to reflect the specific needs of local patients. He says: “Patient groups are not homogenous and one contract does not fit all requirements. Moreover, there are patients in various parts of the country who would be and are being seriously failed by the insistence upon the adoption of the GMS national contract.”

The model should not be condemned just because it was unsuccessful in a number of instances Maggie Marum from the NAPC believes that PMS contracts have been given a bad reputation simply because of a few failed examples, and that the model should not be condemned just because it was unsuccessful in a number of instances. She wrote in a recent article for GP magazine on the subject: “These contracts were poorly implemented and poorly performance-managed. And, it was these that gave PMS a bad name and are responsible for the siege under which it now finds itself.” Whether or not you agree that perceptions of PMS contracts have been skewed by a minority, there is no denying that the PMS model fits the criteria of the locally inspired, patient-centred NHS that the reforms are supposed to be striving towards. So doesn’t it seem counterintuitive to back-track on one of the few october 2012 | practicebusiness.co.uk

elements of the NHS that already leans towards this ideology? Val Hempsey, another executive member of the NAPC, agrees with Marum: “Of course, there have been administrative failures in the negotiating and oversight of some of the later PMS contracts, which have done little to address local needs. But, as we move forward, it will be important to ensure that the principle of localism…is the cornerstone of any future contracts which the Government introduces.”

She adds that it is also important that practices understand this concept so that local contracts are not “debased” and therefore “devalued by those with responsibility for their monitoring”.

Neil Jessop, director of Health Solutions Partnership, wrote an article last year, predicting that issues would emerge with PMS contracts. “Although the article was written last September it forecasted a very unstable future for PMS – which is now being borne out,” he tells me. The piece highlighted that at the time some PCTs had felt the provision of either nGMS or PMS contractors were “confusing and divisive”; and “rigorously challenged the value of PMS contractors both in fiscal and service terms.” He asked: “What happens to the PMS contractor when from April 2013 PCTs will be abolished?” He also asked whether or not the DH would take the plunge and provide a new national GP contract – which it looks like they are well on their way towards doing.

Another question he raised was, “will current PMS practices welcome such change?” and also whether or not relevant bodies would support the changes.

Many of these questions will remain unanswered for the time being. However, one thing is clear: Change to how services in GP practices are funded is inevitable. And with Andrew Lansley recently relieved of his duties as health secretary, your guess is as good as mine how it will all turn out.

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20

PROVISION | patient access

ONLINE The Government’s move to encourage online booking hasn’t been greeted with universal enthusiasm. GEORGE CAREY debates the merits of practices conducting a digital relationship with their patients Before he was recently reshuffled, the former health secretary, Andrew Lansley announced in May that every GP surgery should provide online appointment booking and a secure email system for patients to contact their practice by 2015. This particular part of the Government’s ten-year NHS Information Strategy was, according to Lansley, aimed at eradicating the ‘8am rush’ of people phoning GP surgeries and promised that repeat prescriptions and test results would be accessible online. The Government is also said to be keen for the public to use tablets and apps to contact their GP. In addition, a new NHS website will be launched by 2013 to act as a ‘one-stop shop’ where patients can access information about the quality and performance of their local health services, and will be encouraged to give feedback.

While only the most devoted ostrich would be able to keep its head subterranean on the issue of taking practices online, the plans were greeted with hostility from some, who disagreed with the uncompromising nature of the plans. So is this the dawn of a new era, or another potential minefield for practices already straining to cope with a raft of other policy changes?

october 2012 | practicebusiness.co.uk

When the plans were first announced, one voice of caution was from Dr Laurence Buckman, The British Medical Association’s GP leader. Dr Buckman says that the BMA GP Committee cautioned against the potential use of email for consultations, because “compared to a telephone or face-to-face consultation, it is difficult for GPs to assess someone quickly and safely this way”. He says the BMA supported the wider implementation of online booking and ordering repeat prescriptions online, as long as patients without internet access can still contact their surgery in the usual way. Elaborating, he says: “When it comes to patients being able to view their records online, we believe patients should have access to their health records, but we’d want to be satisfied that their records would remain secure before this was implemented.”

When we talk about moving forward with new technology, it is easier to only picture the elderly when it is mentioned that some people may not have access to it. When looking into online booking however, this is not always the case. There are huge swaths of the population who don’t spend their

21

PROVISION | patient access

DATING working day in front of a computer, and may be disadvantaged by this approach. People working in retail or construction, for example, who don’t own a smartphone, and despite certain manufacturer’s best efforts there are still plenty, have no access to the internet for their entire working day. This could alienate a large portion of a practice’s patient population and be a real spanner in the works for one trying to operate purely online.

This is an opinion shared by Stefan Olsberg, MD of Voice Connect, a company specialising in automated phone systems. He says: “It must seem very simple for office based MPs or civil servants to assume that everybody sits in front of a computer all day, or has the use of a smartphone. But by skewing ease of access towards this sector of the population, i.e. young professionals, there will actually be fewer appointments available to the elderly who account for the largest proportion of routine and emergency appointments, by some way. Offering a combination of both automated phone booking and internet booking will improve access for all groups, reduce missed appointments and improve the overall patient experience.”

This is not to say that online booking isn’t useful as part of an integrated approach to patient interaction but there is still a significant part of the patient population that is unwilling or unable to book appointments purely online. However, for those with the means, it can prove to be a fast and convenient way to book appointments. Olsberg is an advocate of the combined approach, he says: “I would agree

that offering the choice is certainly the best solution for improving access to GPs’ surgeries. Furthermore, if reception staff time can be freed up from booking routine appointments, they will then be able to spend more time helping patients who need extra assistance.” He also believes that the benefits are not purely for the practice: “It means that patients experience less of a bottleneck at peak times and the overall frustration of arranging a surgery visit is greatly reduced.”

Only the most devoted ostrich could keep its head subterranean on the issue of online As with the rest of the myriad changes affecting practices at the moment, there are clear advantages and disadvantages to online booking. The extra time afforded to receptionists no longer inundated with early morning calls from, sometimes understandably annoyed, patients would be welcomed in most cases by both sides. However, the lack of human interaction could prove just as frustrating for others and there may be some sections of society who are excluded entirely. The best practices will be those that embrace change while not losing sight of those who are less inclined to do so.

practicebusiness.co.uk | october 2012

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PEOPLE

24

THE WALLS OF JERICHO After years of working in a building unfit for purpose, the doctors and staff at the Jericho Health Centre in Oxford have finally got the new building they deserve. But does it meet expectations? JULIA DENNISON visits partner DR ANDY CHIVERS and practice manager NICKY WHITE to find out october 2012 | practicebusiness.co.uk

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PEOPLE | case study

It’s not often an NHS-funded institution finds itself the beneficiary of a compliment from a newspaper columnist. So it is little wonder that when the Jericho Health Centre was heralded, almost sycophantically, by the Oxford Mail’s ‘Man About Town’ Jeremy Smith as “the best doctors’ surgery this side of Atlanta’s Centre for Disease Control” (don’t ask – he was on a US v.

UK roll) they would sit up and take note.

Smith was so impressed with his recent experience of the health centre, home to three practices and located in Oxford’s bohemian Jericho district, he felt “proud to be sick”. The reception, he called the most beautiful doctor’s waiting room he’d ever seen, “wallowing in its cruise liner opulence”, and could not help dedicating all his column inches to how wonderful it and the NHS could be. (If you don’t believe me, you can see for yourself at Oxfordmail.co.uk/yoursay/columns/9868610.MAN_ABOUT_ TOWN__Surgery_made_me_proud_to_be_sick/).

Any practice manager reading this will know this health centre must have done a lot to win anyone’s kind regards, let alone a journalist’s. So, what is Jericho Health Centre doing that is so special? Having visited it myself, I can safely say: a lot. The reception matches Smith’s description and then some – and it’s about to get even more opulent with the addition of design details on the skylights and artwork on the walls. But it hasn’t always been this good. This new building was a long time coming. Being a business magazine, we have the luck of taking a look behind the scenes, and suffice to say it is not all sunshine and rainbows (though if the patients think it is, surely that’s all that matters?). However beautiful it is to the outside world, working from a building designed on your behalf by Oxford University and the local PCT has its challenges for the clinicians and staff that call it their professional home. I met up with Dr Andy Chivers, one of the practice partners, and his practice manager Nicky White, to find out a bit more.

IN NEED OF A NEW HOME Before the Jericho Health Centre moved into its new building a few months ago, it occupied a squat 1970s brick building around the corner (patients who turn up to the old building are faced with a mere minute’s walk to get to the new one). “It should have been a very straightforward procedure,” says Dr Chivers of the move. “With the way the NHS is at the moment, it’s not a great time for such initiatives to be happening.”

Of course, it was not an overnight decision – for the practices at Jericho, a move to a new health centre was nine years in the making. “It was a very old and cramped, with three practices in there,” White says of the old building. “I didn’t have an office and we all worked within an area even smaller than this room,” she adds, pointing to the confines of the average-sized consulting room we sit in. This meant patient services were cramped too, with the nurses’ treatment room doubling as a phlebotomy clinic, “so patient confidentiality was a problem as well,” says White.

It was clearly not fit for purpose and with no room to expand, “we needed to move, there was no argument about that,” says Dr Chivers. The challenge was finding an appropriate and affordable site. Originally intended as a LIFT project, the practices approached their PCT for a new building.

When the LIFT fell through, it became a private investment by Oxford University. They would own the three-storey building, the PCT lease the ground floor and the practices sublease it.

»

practicebusiness.co.uk | october 2012

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PEOPLE | case study

ALL SYSTEMS GO? With this structure in place, seven years after putting out the SOS, a new Jericho Health Centre got the green light. But it was almost too late. “By the time we had to design things in detail, we had passed the initial enthusiasm stage, almost,” says Dr Chivers.

“It was very difficult to keep up the interest.”

Luckily, with Oxford University in the driving seat, the practices didn’t have to worry too much about the detail. However, this had its own problems.

Without general practitioners making the decisions about layout, the layout isn’t always entirely fit for general practice. Seemingly little things add up: The consulting desks are on the wrong side for righthanded GPs and the curtain on the wrong side of the sink for convenient use, though the architects assured them this was OK from a hygiene point of view. The phlebotomy room, albeit now singlepurpose, has no windows, which is not conducive to fainting-prone patients, and the cleaners’ room is not much bigger than a closet. “With specialist architects involved in the detailed designs of rooms, we assumed that would be perfect and we couldn’t improve on it,” says Dr Chivers, “but of course they’re working within the constraints imposed by the primary design of the whole building.”

As these building kinks work themselves out, the practices have other things to worry about – like the phone system. Provided by Oxfordshire Health information service as part of the national N3 network’s Community of Interest Networks (COIN) system, the practice’s phone lines run as voice over internet protocol (VOIP) on a fibre optic broadband network connected with local hospitals. While this does not affect the quality of calls, it does mean a new system to get used to. It also means the phone line was not immediately transferred on moving – a glitch that resulted in the university lending the practices temporary lines – and, perhaps worst of all for patient relations, they had to change their number, despite being assured otherwise.

SPACE/TIME CONTINUUM The upside of the new building is the new space. Health visitors and district nurses are now based on site, in their own rooms, and the practice benefits from a staff area with room to stretch out. It also means the three practices are better able to share services, and from a practice manager’s point of view, having three colleagues in the same role on one site can prove endlessly supportive. “The whole place buzzes,” says Dr october 2012 | practicebusiness.co.uk

The great improvement has been being able to work, but it means we see far less of each other Chivers. “And that glorious waiting room! It is, I think, even larger than we needed, but everybody comments on that amazing space.”

But this amazing space can also be a downside.

There is something to be said for smaller working conditions. “The great improvement has been being able to work in a suitable environment, but it means we see far less of each other,” says Dr Chivers, of the other doctors. “We were absolutely cheek by jowl.

We have to make some adjustments to our working day to be able to see each other a bit more. It’s fine within the practice, but the other practices are spread around our huge new waiting room.” These wide open spaces can also affect services: “This morning I did a minor op and it took me about 10 minutes to go around the building to collect all the bits,” quips Dr Chivers. The hope had been to offer more patient services, like ultrasound or physical therapy, but with parking and transport restrictions, services like these have been limited.

Problems aside, the Jericho surgeries are more fortunate than many others to have the space.

However, theirs is a good lesson that you don’t always get everything you want, especially if you have a building designed for you. But as far as patients are concerned, it is a state-of-the-art new health centre that is cause for celebration – as seen in the Oxford Mail column. This good feeling, coupled with access to great doctors like Dr Chivers and partner Dr Claire Parker, is perhaps all they really need.

Practice manager, Nicki White and Dr Andy Chivers

Reception and the new phlebotomy room

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people | case study

The learned few

october 2012 | practicebusiness.co.uk

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people | case study

As a training practice, Merseyside’s Spinney Medical Centre understands the importance of the big picture. But teaching can be hard.

Julia Dennison asks manager Katie Power (pictured) and Dr Michael Van Dessel why they do it

Like the grouping of trees outside its doors that gives it its name, Spinney Medical Centre’s approach to general practice relies on a few unalienable elements that make it what it is. Namely three selfproclaimed cornerstones: teaching and learning; compassionate patient-centred care; and innovation. “That’s a tripod on which good general practice sits,” says partner Dr Michael Van Dessel on the day of my visit to his practice, so well-known for reaching out to its community.

Gaining with training There are plenty of practices out there that would focus on the patient care and innovation corners of that tripod, but it is discernibly less common to see practices so focused on giving back to the next generation.

But Dr Van Dessel, a long-standing champion of healthcare in the St Helens, Merseyside community, actually sees it as an important aspect of looking after his patients.

“The training is a fundamental part of the patient care,” he explains. “As the clock ticks, the time for somebody to move on and somebody else to move in comes, and we want people to move in who are hopefully well trained and experienced and at the same time, this keeps us up to date as well.”

This philosophy runs through everything Spinney does. All four partners are trainers, and one of the two salaried GPs also shares their interest in education by looking after fifth year and A-level students in need of general practice experience. The practice has capacity for up to four registrars at any one time and runs an apprenticeship programme, offering NVQs to local college students. The surgery also gets involved in local policy-making, with partner Dr Steve Cox the clinical accountable officer (AO) for St Helens CCG and practice manager Katie Power sitting on its board. Meanwhile, three of the partners are QOF assessors and three are appraisers.

Extended services The practice is in its fourth generation – same area, three different venues. Over the years, it has become well known in the community for its personal approach to family care. When Dr Michael Van Dessel started in 1990, he introduced a number of different services, including the well-baby and well-woman clinics, as well as some minor surgery, such as joint injections, and an adult and travel vaccination clinic. Furthermore, when his colleague Dr Steve Cox joined two years later, with expertise in psychiatry, further mental health services were added to the practice roster.

At the backbone of Spinney Medical Centre is its practice manager Katie Power, who is two years into the role but ten years into working for the NHS. Prior to her decade-long career in healthcare, she was employed by a software company and she maintains a business-like approach even in her practice management. “I came from a very corporate background that was very big on process,” she explains of when she transitioned from the private to the public sector. “That was quite timely because the NHS, and in particular primary care, was starting to think like that also.” It was also around ten years ago that the role of practice manager really began to evolve into what it is today. “They were becoming business managers,” she remembers. “What was being asked of general practice by the Government tied in nicely with what I was quite used to – increased customer service, competition, and slightly more of a slick, corporate package. It came naturally and I just moved my way up.”

When she took the role at Spinney Medical Centre, Power was looking for a larger practice with more patients – and a bigger challenge. “The services that you provide and the work that goes into designing those services and providing them, or project managing them, is harder when you’re providing them to considerably more people,” she says of her current workload. “But I would say more of the challenges would be around the team that you’re managing, the volume of doctors that you’re managing and the work that that

Training is a fundamental part of the patient care. As the clock ticks, the time for somebody to move on and somebody else to move in comes, and we want people who are well trained and experienced

»

practicebusiness.co.uk | october 2012

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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?

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people | case study

creates.” Bearing in mind the doctors and staff at this practice take pride in the big picture of primary care, the details, like patient record upkeep, needed some work.

FACTS Practice: Spinney Medical Centre Partners: 4 Salaried GPs: 2

CCG involvement One of the reasons Power was attracted to the job at Spinney was a chance to get involved with commissioning. In her previous role, the local practice-based commissioning group did not appear to acknowledge the need for practice managers on its board. “The more articles I was reading saying I was supposed to be a vanguard of this process, the more I tried – I wrote business plans, I designed clinics and I would submit them and not get a reply,” she says of her experience. “I started to think that [being on a commissioning board] is a feather you need in your cap if you’re serious about progressing in this role and it wasn’t going to happen there, so that was one of the reasons that I considered moving practice.”

Being a practice manager in St Helens, not only is she allowed to get involved, but she now sits on the CCG board. When she applied for the practice manager representative role on the CCG, there was already a person in place, but they encouraged others to apply anyway and she landed a position on the board. She explains: “I’m assuming that because of the efforts that I’d made in the prior role they thought that while I hadn’t had the governance background at that point and I hadn’t had any experience, other than trying to get involved in PBC, they would take me on in a development role.”

A year or so into the developmental role, she understands that she may not be allowed to automatically keep it. “I expect there to be an election at some point; I’m here by default,” she explains, having been the only other practice manager to apply for the board role at the time – though, it should be noted, they didn’t have to take anyone on board. “At some point, I do believe that my job will be advertised and others will be invited to attend. If we had more than one person with the right criteria, then an election would be called.” She feels remarkably calm about this prospect: “The constitution of the CCG has to be just right, and if there’s somebody out there who can do it better than I can, that’s fine.”

Until then, she is working steadfastly on the CCG’s finance and performance board to get the group ready for authorisation.

Nurses: 2 Non-clinical staff: 12 Patients: 6,800 CCG: St Helens Contract: PMS Practice manager: Katie Power Time in role: Just over two years Background: She has worked in the NHS for 10 years, mostly as a practice manager. Prior to that, she worked in the private sector for a software company.

Future plans CCG work aside, Power keeps herself very much grounded at her practice. Future plans for Spinney Medical Centre include growing the patient list from 6,800, while maintaining that compassionate patient care mentioned earlier. “The aim is to increase,” says Power.

“Whenever we have our away day or review what is going to be happening over the next five years, I do raise it, because I know it’s the general aim but there’s no hard and fast plan to do that because of the potential workforce impact that it has. And the current financial climate is making us wary of expanding the team and expanding the workload. As a non-clinician I can take a very black and white view, I’ll say let’s get to 7,200 and then let’s see.” practicebusiness.co.uk | october 2012

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management | reducing costs

Saving money and jobs The coalition’s commitment to a £20bn saving in the NHS is, unsurprisingly, having a significant impact on primary care. With the threat of redundancies looming, George Carey identifies money-saving ideas that could save jobs

october 2012 | practicebusiness.co.uk

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management | reducing costs

The financial problems that practices face at the moment were exemplified by the news in July that NHS Lambeth is looking to make £7.71m of savings between 2012 and 2013, compared to 2011 to 2012. The bottom line is that the savings represent, on average, a 10% funding cut for practices. These savings include the termination of seven LESs, including provision of services at five care homes, GPSI minor surgery and the endof-life gold standard framework. The PCT is also reviewing services in physiotherapy and osteopathy.

Professor Azeem Majeed is head of primary care at Imperial College and a part-time GP in Lambeth.

Describing the effects of the cuts, he says: “Some practices have been telling their staff to prepare for cuts. Clearly people want to avoid making redundancies, but some clinics have said their staff are at risk of redundancy. What is more likely is that people leaving will not be replaced. We have someone leaving soon and we will not be replacing them in the short-term until we understand what is happening to finances.”

With this extent of cuts widespread across the UK, it can’t be long until some practices have to start making some unwelcome decisions. This is clearly a last resort, but for some there may be no other way.

So, if practices are to avoid redundancies, where will the savings come from that will make that possible? There may be more options open to you than you think.

make a big difference to available space is digitising your records. The software and personnel hours required may put some off this particular solution, but those will pale in comparison to the revenue that could be achieved by an in-house pharmacy.

Once the requisite space has been made available, and subject to planning permission, it shouldn’t be difficult to find a willing tenant.

Many pharmacy owners will actively compete to position themselves within NHS buildings, including practices, because it should enable them to capitalise on the majority of prescriptions handed out at that practice. In addition to the rent your new tenant will pay, they will also make a contribution to expensive overheads. One note of caution is to make sure that you have vetted your new resident carefully, as you will have to see a lot of them for the foreseeable future and they could have an impact patient’s perception of your practice.

Saving with technology While new technology may evoke images of a practice haemorrhaging money, it can actually help to make huge savings in the medium- and even short-term.

The ‘NHS digital technology essentials guide’ offers a range of helpful tips on saving through improved technology and includes a list of 10 technologies it says will help practices to save money fast. One technology that the guide singles out for praise is digital clinical correspondence, which allows the transfer of information between healthcare organisations.

Because the consumables associated with hardcopy mail are eradicated, practices can save time and money in a short space of time. Also, digital dictation is something that may not seem very new anymore, but it is still unused by many and can have far-reaching benefits. Because of the improvements in turnaround times and greatly reduced time spent by staff typing out lengthy reports, there are considerable savings to be made.

Another technology upgrade that could offer massive savings in the long run is voice over internet protocol. Under this system, voice calls

Clearly people want to avoid making redundancies, but some clinics have said their staff are at risk of redundancy

In-practice pharmacy If the partners in your practice own the medical centre or surgery that you’re in and part of the building is not being used, or used inefficiently, you may be able to free-up enough space to accommodate a pharmacy. The benefits of this are twofold: patients find it convenient; and more importantly the rent from the pharmacy could be enough to make the difference between keeping a valued member of staff, or the ugly alternative.

While there may not instantly appear to be space begging to be filled in your building, careful planning and consideration of its layout can yield surprising results. One course of action that can

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practicebusiness.co.uk | october 2012

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management | reducing costs

are made on an existing computer network rather than on their own separate network. This means that practices can operate with one data network that can handle calls and data transfer. VOIP services are available on a number of commercial network providers, with enough of them offering the service to mean that you can shop around for the best deal. If those digital solutions still seem a little too costly, a very simple service provided by the NHS could still provide a much-needed boost to practice efficiency. NHS mail is a platform used for patient data transfer but it is the text message reminders to patients that have been a big money saver. The guide says that ‘did not attends’ can be reduced by up to 50%.

Reducing supplier costs It is crucial if you want to get a better deal from your suppliers that you first of all know what you are spending with them and identify areas in which you feel you may be able to save.

Once that has been established, you will be in a better position to talk through pricing with your providers. In addition to saving money on regular orders, it is also possible to save administration hours on ordering and time-consuming invoices by reducing the amount of suppliers that you use and, where possible, ordering in bulk. Apart from the added convenience, suppliers will offer better prices because your new bigger orders will make you a more valuable customer in their eyes.

Sit down with your existing suppliers and get a good idea of the full range of products that they can offer and establish the best price that they would be willing to offer for large orders and a degree of exclusivity. It is then just a matter of seeing how the price and offering from each supplier weighs up against the competition. If they seem reluctant to give significant discounts, one thing that may induce a change in attitude is committing to a minimum spend for the year. It is imperative that you have done your sums here, as agreeing to buy more than you usually would, simply for a cheaper unit price would ultimately be useless.

While increasing your own practices’ orders and committing to fewer suppliers will certainly yield savings, the next step up is to become part of a buying group. The economies of scale that can be achieved as part of a buying consortium are considerable. It is also worth considering the increased support that can be gained from your peers in other practices. The chance to swap experiences and the different skills that such a range of people bring to the negotiating table can be invaluable if you’re not used to the process.

While not everyone has a pharmacy-sized space in their building or don’t think that they have the time to form a buying group, it goes to show that there are savings available to those able to devote a bit of their busy schedule to the subject. Hopefully, armed with these solutions, you may be able to make the savings crucial to keeping a full complement of staff and therefore a well serviced group of patients. october 2012 | practicebusiness.co.uk

The economies of scale that can be achieved as part of a buying consortium are considerable

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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.

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37

management | energy saving

See the light

Energy consumption is something to which many smaller businesses, like GP practices, don’t tend to give much thought, but spend a lot of money on.

CARRIE SERVICE looks at small changes that make a big difference to energy bills We all know that switching off electrical appliances when they’re not being used and not turning on the heating when it isn’t necessary are sensible habits to get into when it comes to managing our energy consumption. It doesn’t take a genius to figure out that leaving your computer switched on overnight isn’t particularly eco-friendly either. Nor do we think it is clever to print out every single email or document we are sent or leave windows open when the air conditioning is on. So why is it so difficult to get staff to actually demonstrate this on a daily basis? In any office this can be a challenge, but in a GP practice, where staff are under a lot of pressure, often dealing with distressed patients and people with serious illnesses, it is understandable that saving energy is not at the forefront of most peoples’ minds.

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practicebusiness.co.uk | october 2012

38

management | energy saving

How much?!

Findings from research carried out by the Confederation of British Industry have found that the average UK business spends over £180,000 on energy per year. The Carbon Trust says that most businesses could save 10% on their energy bills, through free or relatively low cost measures. That’s a possible saving of £18,000 a year for some businesses. If that doesn’t make your staff sit up and listen, I don’t know what will.

One practice that has decided to take energy saving seriously is Honley Surgery in Huddersfield. I spoke to administration manager Jo Dawson, who explained how it had recently been transformed into an eco-friendly practice. Following attendance at an event for small businesses in 2010, organised by the Green Business Network at Kirklees Council, Dawson arranged for one of the team to visit the practice and carry out an environmental audit, and they took on board as many of the recommendations as finances would allow. These improvements were: to replace the old boiler with a brand new A-rated condensing boiler; invest in draft proofing; insulate the loft space; invest in solar panels to allow the practice to generate some of its own energy and install reflective panels behind radiators. Dawson was also advised to try and change the culture in the practice so that members of staff were thinking about energy saving as much as possible in their day-to-day routine. One method of achieving this that was recommended by the Green Business Network was to use stickers and posters around the practice to remind staff to be conscious of the way they used electronic appliances.

And Honley’s efforts to be greener didn’t end here. “A year later we were then fortunate to obtain a grant from Kirklees Council towards becoming more energy efficient,” Dawson tells me. “So we converted all our fluorescent lighting and spot lights to more energy efficient ones.” She is also pleased with the investment the practice made in solar panels: “We are now starting to reap the rewards with our FIT payments and our heating and lighting bills have significantly reduced.”

Target the source

In a GP practice, where staff are under a lot of pressure, it is understandable that saving energy is not at the forefront of most peoples’ minds

october 2012 | practicebusiness.co.uk

To really see results there needs to be a two-way approach to your energy saving initiative. Wayne Mitchell, industrial and commercial markets director at npower, says practices often overlook the savings that can be made through smarter energy procurement, and should be sure that they are getting the best deal out there if they really want to see a difference: “One of the straight-forward actions businesses can take is to ensure they buy their energy at a good time to avoid a peak in prices in the energy market. Many, often unpredictable, factors affect wholesale energy costs such as the weather, political and socio-economic changes and these can cause significant fluctuations in energy prices, even on a daily basis.” The challenge for many practices is being able to allocate the time to trawl through energy suppliers and compare prices, especially as they are so susceptible to change. In a survey of over 200 medium-sized businesses carried out by npower, it was found that just four per cent of medium-sized businesses have a dedicated energy specialist, despite the fact that 88% of businesses that do employ one have made savings. “Energy cost savings are often missed because many medium-sized businesses are on fixed contracts and when the time comes to renew, they may not consider that at that time there could be a peak in price,” explains Mitchell. Perhaps having a member of staff within the practice who is responsible for reviewing this periodically could be a worthwhile step towards becoming more aware of your energy consumption. Introducing energy efficiency into your employee handbook and keeping a record of the savings that have been made – perhaps even setting targets – would make it seem more relevant to staff and give them a reason to get involved. If you also publicise the fact that you are an eco-friendly practice on your website, as Honley Surgery has, this might help to maintain employee interest as the practice would have a public image to live up to – one they can be proud of.

40

mfm | whiplash

Paul Lambden 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

october 2012 | practicebusiness.co.uk

Whiplash

In his regular medicines for managers series, clinical editor Paul Lambden provides easy to read skills-ups on key clinical areas. This month: whiplash These days, the usual answer to the question “What is a whiplash injury?” is “about £2,000 from the insurance company.” Certainly the incidence and profile of the injury has increased markedly in recent years and many associate the increase with the so-called accident-chasing solicitors.

A whiplash injury is an injury to the neck following a sudden distortion such as commonly occurs in a motor vehicle accident. Its proper name is a ‘cervical acceleration-deceleration injury’, which actually describes the nature of the event. Similar injuries can be caused in a variety of ways, including falls from horses, trampolines and stools, sudden lurches on a roller-coaster, skiing accidents and during shaken-baby syndrome. Interestingly, the injury was originally called ‘railroad spine’ in the days when accidents resulted from train crashes rather than motor accidents.

The most common symptoms associated with the condition are neck pain and stiffness, shoulder pain, arm pain and weakness, back pain and headache.

A variety of other symptoms may be reported including depression, anxiety, other emotional symptoms, sleepiness and post-traumatic stress syndrome.

Essentially the mechanism of injury is that, on suffering a rear impact, such as in a car, the car moves forward whilst the person stays still, the seat then accelerates the person’s body forward whilst the head remains stationary resulting in forcible hyper-extension of the neck (i.e. the head is tilted upwards). The head is then thrown or ‘whipped’ forward as it effectively catches up with the torso and is hyper-flexed. (i.e. the chin moves down towards the chest). Finally the head returns to the neutral position. This whole event happens in less than half a second. The degree of injury depends on the speed of impact and the position of the head amongst other things. The consequences vary from minor neck stiffness and tenderness to more severe pain in neck and back with nerve symptoms and headache. In the most severe accidents there may be a fracture or dislocation of the cervical spine with injury to the spinal cord.

Most patients involved in an accident end up at the A&E department or in the GP’s surgery. The usual findings are of neck ache or backache that developed 12 to 24 hours after the accident (as the muscle spasm increases).

Most display no serious features and can be treated with simple analgesia.

More severe cases may need a cervical collar for support and may be referred for X-ray to exclude more serious injury. Relatively few patients need further investigation, such as MRI or referral to a specialist orthopaedic surgeon or neurologist. Normally the more mild symptoms wear off in two to 12 weeks and benefit from self-help techniques, such as regular flexion, extension and rotational exercises half a dozen times a day.

There has been considerable work on reducing the frequency and severity of whiplash injuries, most notably through the development of head restraints. There are many designs but their principal purpose is to prevent the hyperextension of the neck with backwards movement of the head. Commonly the head restraint is incorrectly located with the result that it does not provide

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A correctly set head restraint may reduce the risk of whiplash by about a third the necessary protection. It should be set about three-and-ahalf inches below the top of the head and virtually touching the back of the head while driving. A correctly set head restraint may reduce the risk of whiplash by about a third.

Claims for personal injury are rising. A report in 2011 suggested that road accidents had declined by 11% in 2011 but claims for personal injury had risen by 18%. Nearly half a million people claim for whiplash injury every year and the costs add about one-seventh to the average insurance premium.

Undoubtedly there will be further In 2011 road developments in car seat design over accidents declined time and the severity of whiplash but by injuries will be further reduced, claims for personal although whether the number injury rose by of claims will diminish is quite a different question.

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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?

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Commissioning Success promises to be the only management title specifically targeted at CCG board members, participants in commissioning, and all related health networks and shadow boards

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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.

work/life

44

Learning the lingo advice for busy lives

When doctors get on a roll, they can appear to be speaking an entirely different language. George Carey finds out how non-clinical staff looking to get in on the conversation can get hold of a phrase book

According to the latest research from the Institute of Healthcare Management (IHM), more than three-quarters (78%) of managers surveyed in the healthcare sector believe that patient care is at risk due to a lack of proper staff training and development. Some 87% believe this training gap has resulted in low team morale while a further 87% cite a lack of confidence in staff as a direct consequence, resulting in slipping standards and ultimately, putting patients at risk. When it comes to training, almost six in 10 of those

october 2012 | practicebusiness.co.uk

45

work/life | clinical training

surveyed (58%) have only had mandatory training in the last year despite the vast majority (69%) calling for more leadership and management training to improve career and skill development in the NHS rather than just mandatory update courses.

These findings, drawn from across the healthcare sector, are nonetheless very representative of the issues facing practice managers. Most would love to continue improving their skills, which have to encompass many different areas, but simply don’t have the time. One area that is often overlooked is clinical training. While no would expect a manager to perform an emergency appendectomy, a basic knowledge of medical terms and procedures can provide you with a different view on matters and create a greater synergy between GPs and non-clinical staff.

So where can management or other administrative staff, turn to gain this extra training. Whether you are new to the sector or perhaps just need a little reminding, the old adage still applies: knowledge is power.

Going back to school There are organisations that managers looking for guidance can turn to, who are able to provide varying degrees of training.

The Association of Medical Secretaries, Practice Managers, Administrators and Receptionists (AMSPAR) works with the City and Guilds to provide qualifications recognised by Ofqual for the sector. One that is perfectly placed to help managers and other non-medical staff in this regard is the AMSPAR Level 2 Award in Medical Terminology. The course aims to provide learners, who have no previous knowledge of the subject, with a grounding in the correct construction, recognition and usage of medical terminology. The programme has been designed to be flexible enough to fit around people’s career, with options to study at

It’s the first time both doctors and administrators are talking the same language home or through a recognised centre. Assesment comes in the form of examinations, held in January and June. As the award is accredited by Ofqual it is listed in the board’s qualifications and credit framework, with a weighting of six points, meaning that it is eligible for public funding through the Learning and Skills Council.

Cancer is an unfortunately common part of day-to-day life in primary care and is an area of knowledge that could benefit all of those working in clinics and practices. To this end, in April, the NHS launched oncology training for NHS and public health non-clinical staff, which is professionally accredited by the IHM. It is an e-learning tool, aimed primarily at multi-disciplinary team co-ordinators and cancer registration staff. It covers a wide range of subjects, including: medical terminology, diagnostic tests and treatments; how cancer services are organised in the NHS; and information about cancer types. The latter giving information on key risks, including causes, risk factors, signs and symptoms, anatomy and physiology. Online quizzes provide on-going assessment and those that complete the process, receive a certificate of achievement in recognition of their newly acquired expertise.

Good all-rounder For those looking to brush up on their clinical knowledge and also feel the need for a more general refreshment of skills, the IHM

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practicebusiness.co.uk | october 2012

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work/life | clinical training

also runs the vocational training scheme for general practice managers. The course is delivered on a part-time basis over 36 weeks and with topics including: managing your practice; quality and regulation in primary care; introduction to commissioning; and medical terminology for practice managers. The qualification is accredited by Middlesex University at undergraduate diploma level, with an award of 60 points on completion that can be used to assist enrolment onto further education at a later date, as part of your career development.

For people who feel they have neither the budget or the time to commit to a formal course, it is worth approaching the GPs in your own practice. a small rota of training evenings would take very little time to arrange and the benefits available to both the GPs and non-clinical staff could be long lasting. With an administrative staff, newly equipped with basic but extremely useful medical knowledge, the practice should run a lot smoother.

In many cases this will mean that, for the first time, both doctors and administrators are talking the same language.

to Get You started on Your road to becoMinG an oMniscient Practice ManaGer, here’s an a-Z oF Medical terMinoloGY. aBG Bolus

arterial blood gas reading

a large dose of a drug that is given (usually intravenously) at the beginning of treatment to raise blood-level concentrations Cardiac tamponade Diuresis

compression of the heart from fluid such as an effusion or blood

the increased production of urine epidermis Fibrillation

the outer layer of the skin an uncoordinated, quivering of the heart muscle resulting in a completely irregular pulse

Gram’s stain

a stain test that identifies various forms of bacterial microorganisms Hypotension

IM

abbreviation for intramuscular (pertaining to injections)

KUB

shorthand for kidney, ureter, and bladder tests

Laryngoscope

an instrument for examining the larynx

Myocardial infarction

a heart attack abbreviation for a nonsteroid anti-inflammatory drug, e.g. ibuprofen

NSaID

an infection of the middle ear

otitis media

the lining around the lung

Pleura Q

every iteration, a med of Q5min would be every five minutes, or Q6h is every 6 hours reflux

moving backward in the esophagus

Sepsis Thrill U/a

abnormally low blood pressure

a very severe infection

a vibration a clinican can feel by touch, often used to describe cardiac murmurs that can be felt through the chest wall urinalysis, used to test for kidney failure, dehydration, diabetes, undernourishment, or bladder or kidney infection Venipuncture

the drawing of blood from a vein

WWC X-ray yellow drainage Zoonosis october 2012 | practicebusiness.co.uk

white cell count

we’ll let you have a guess at this one drainage from a wound that could indicate infection

an infection shared in nature by humans and other animals.

48

Work/life | CQC inspections

Surviving the

inspection With CQC inspections looming some practice managers will understandably be starting to feel the strain. George Carey helps you make sure that your paperwork is up-to-date and that you make it through inspection day with the minimum stress As we have now known for some time, your practice will be legally required to register with the Care Quality Commission by April 2013. So what does this mean for you as practice manager, and how can you get through the whole process with the minimum of new grey hairs? It’s going to require a lot of planning and preparation ahead of the deadline to prevent a last-minute rush, but the hoops you’ll be jumping through to demonstrate compliance with the regulations are not new and well-run practices should already be fairly well prepared. In theory it’s just a matter of showing that your existing good practice meets the CQC’s requirements. october 2012 | practicebusiness.co.uk

49

work/life | CQC inspections

It is essential that everyone knows the requirements your practice is expected to meet

There have been recent indications that inspections may now be carried out annually rather than biannually because the commission implied they felt GP practices were more similar to care homes, which are inspected annually, than to dentists. Whether or not this turns out to be the case, you can rest assured that practices only need to register once – it is not an annual process. The CQC has said it will investigate practices if the evidence they submit differs from that provided by the GMC, Local Involvement Network Groups or GP commissioners. Therefore it is essential that the evidence you rely on is readily available should the commission request to see it, and is consistent with that held by other organisations.

Since the start of September, practices have begun submitting applications. To avoid problems later, ensure that the application has been signed by all the partners, and fully checked through before submission. If it is incomplete, it will only come straight back to you and cause more work. At this point, it’s important to devise a plan for any areas you have deemed non- or partially-compliant with the CQC standards. While this may appear daunting at first, it’s much better to have an action plan in place than to feign compliance and be caught out later.

Providing that all has gone to plan, you should have submitted your application

by December at the latest. Once your application has been accepted, there will be other CQC-related tasks to consider such as training and budgeting for the costs of compliance and registration. Setting these elements in place as soon as possible will ensure that you are not left rushing around at the last minute with other problems mounting up. At this point, it’s also a good idea to start enacting the internal practice procedures that you will need to follow once registration commences. For example, any deaths or untoward incidents in the practice will need to be notified to the CQC from April.

Provided that everything has been done correctly to this point, you will be CQC-registered by April. As long as your application has been filled out in an entirely honest and timely manner, the majority of the stress should have been taken out of the inspection itself. Problems could arise if the information on your application doesn’t marry with the reality when inspectors come calling, but it’s worth keeping in mind that this isn’t a witch hunt. As the CQC’s David Haslam told Practice Business last month, in the majority of cases, his advice is simply to: “Keep calm and carry on.” A lot of the hysterical rumours about practices being forced to remove children’s toys from waiting rooms or rip up carpets, have been proven to be just that, so bear in mind that as long as everyone is doing what is required of them in a professional manner and all the boxes have been ticked on the paper work, the process should be relatively pain-free.

A crucial piece of planning that could make all the difference is adequate communication and training among all staff, regardless of roles, in the preceding months. Your receptionist, for example may not seem like someone who will have a great role to play in the inspection process, but they are likely to be the first person that the CQC’s finest run into and could be instrumental in creating the right impression from the beginning. It is essential that everyone knows the requirements your practice is expected to meet and what the inspection itself involves, so that nasty surprises on the day can be avoided.

If your workload seems to be building into an unmanageable amount, it’s important to break it down into manageable amounts, according to stress therapist Helen Wingstedt. As she explains: “When someone’s got lots of short-term tasks, it keeps stress down because you can achieve them quicker. Every time you achieve one, you dump a load of stress. As soon as you’ve completed something, your mind dumps the stress because you don’t need it anymore, which makes you feel really good and gives you a natural high.” Remember at all times that the inspectors aren’t looking to catch people out, and an organised practice, which I’m sure you run, will meet with a favourable result. practicebusiness.co.uk | october 2012

50

Work/life | diary

Practice diary Stephen Humphreys is a practice Manager in Hertfordshire. The opinions expressed in this article are his own and should not be read in any way as being endorsed by others at his practice.

If you would like to contribute to the diary page, please get in touch by emailing editor@ practicebusiness.co.uk october 2012 | practicebusiness.co.uk

Practice Business welcomes a different columnist each month to share their experiences and provide their view from the practice manager’s desk.

THIS MONTH: Practice manager Stephen Humphreys on why he believes the DH’s IT strategy could signal the demise of his profession This has been a busy year. The passing of the infamous Health and Social Care Act, the continuing Euro banking crisis and both the Olympic and Paralympic games in London have diverted our attention. It has thus been a good year for the government to release a strategy that it does not want much attention focused on and the Department of Health’s information technology strategy may be such a strategy. The strategy outlined in ‘The Power of Information: putting all of us in control of the health and care we need’ will certainly revolutionise primary care as we have come to know it in the UK and in the change, it will kill off the occupation of the practice manager. The IT strategy is another step on the path to the privatisation of public services.

The IT strategy’s intent is to give patients – not doctors – control of their medical records.

The records are to be ‘fully transportable’ meaning that health professionals ‘beyond those in the organisations which created them’ can access them. In other words, capitation is to end. Patients will be freed from the necessity to go to ‘their doctors’ or ‘their surgery’ and will be empowered to go to whichever healthcare provider can see them at a time and place that suits them. The Directory of Services is almost ready – this will enable patients to contact a

call centre anywhere in the world and book an appointment either with a practitioner of their choice or at least one who is available at a time to suit the patient. Others will want to see the clinician ‘on spec’ and they will literally be able to shop around to do this as the supermarkets will be amongst those who will host general practitioners in future. GPs will become free of premises and the headaches of staffing. They will rent rooms by the hour and be able to take holidays as they like and work as long and hard as they choose. If they want to increase their pay it will be largely down to them and not their partners – there will be few if any partnerships – their bedside manner will be a key to attract repeat business and the more they can do (rather than refer on) the more they will be paid. Their read code skills will also improve and they will be proactively seeking QOF points at every opportunity.

Everything is thus dependent upon moving towards better online access to records and services (especially email) for patients. If sufficient voluntary progress is not evident by 2018, then the government has already threatened to adopt “further steps such as using regulation or enforcement” to achieve their objectives.

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Let the games begin

How the Olympic Games could impact your practice

Redu

Work ce an eme ing with d del rgen cy ad CCGs to iveR c miss ions ut back

Keeping schtum

Quick ways to improve patien t confidentiality

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Fighting Fire with Fire

One practice recovers after an arson attack

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