Starting up an alliance of general practices in the Vale of York CCG area has been an interesting, challenging and ultimately fantastically rewarding process. Driven by a clearly developing message of collaboration in primary care, and integration throughout health and social care, emerged a doughty coalition of the willing. These courageous GP partners and their practice managers have invested time, money and optimism in making the Alliance work, culminating in the delivery of this business plan. The process has involved learning about governance and legal issues, practical considerations in running a board, developing multiple work streams, networking, communications, dealing with challenge, liaising with commissioners and other providers. Not least responding to a very fluid environment in health and social care both locally and nationally. Considerable effort was put into bidding for central funding for innovative projects and seeking local support from commissioners for our development. Suffice to say this has not been easy. I feel it is a major and notable success that we have not needed to return to practices for more financial support beyond the initial investment. During City & Vale's existence we have seen member practices working increasingly closely, and in some cases merging. At the same time we have seen the flourishing of the Practice Managers’ group whose activity has supported the functioning of both the merging practices and those choosing to maintain autonomy. Throughout this process, from the contemplation phase in Spring 2013 to date, through all the various challenges, dead ends, successes and failures it has been the making and strengthening of relationships that has kept us going. I have enjoyed an ever deepening richness of experience in interacting with great characters along the way. It has been my great privilege to meet so many excellent people; the
board, the practice leads, the practice managers, and supporting organisations. I am hugely grateful to those individuals and teams who have supported us along the way, shown faith in our project and given us encouragement and constructive feedback at key junctures. In particular the network of individuals who have supported the development of this business plan, produced in association with Blue River Consulting, deserve all of our gratitude. I could not deliver this Chair's message without expressing huge gratitude and appreciation to my fellow Clinical Director Dr Lorraine Boyd for her incredible support, diligence and steadfastness along the way. None of this would have happened without Lorraine. Thank you. This business plan is an expression of our members’ desire to continue to provide excellent care to our patients. Moreover to rationalise and develop our services into the fittest state to stride onwards into the 21st century as NHS providers. There is a balance between statutory and commercial activity with a pronounced emphasis on recognising our commercial opportunities. We will hold back, for now, on getting involved in delivery of complex contracts beyond GMS. We aim to lead the City & Vale Alliance family proactively in clinical service provision, workforce development, primary care research and commercial activity by acting at scale, as one, together stronger than the sum of our parts. I commend this business plan to you.
Dr Andrew Field BSc MBBS FRCS MA Chair
The practices of the City & Vale GP Alliance have the opportunity to determine a bright future. The ten practices have nearly 300 employed staff with many hundreds of years of experience between them. Throughout engagement with practices, sharing knowledge and experience ranked as the highest priority for Alliance membership. Working together we can help all practices improve, and provide an environment that nurtures and supports. This will be attractive to not only the doctors of the future but anyone who wants to develop a career in healthcare.
The next priority for practices was securing their futures. The workforce is a vital part of that but the Alliance also presents the opportunity for economies of scale. Practice costs continue to rise and it is extremely difficult for individual practices to address this. Similarly, new income streams are not easy to generate alone. The Alliance will bring financial stability. We have access to data, technology and opportunities like never before. These together allow us to develop our service provision to target more specifically those who need it, in the most cost effective way. We do however need to
be able to develop the skills to harness these. Only through collaboration will real change be delivered. Our collective of nearly 100,000 patients provides an attractive sample for clinical researchers. Even from early activity, we have already identified potential partners and revenue streams to enhance Alliance and practice income. We are developing a network with other organisations keen to further healthcare through innovation. Not only will practices benefit from having access to latest technologies but involvement in pilot projects will bring exposure and raise the Alliance’s profile. This in turn will bring opportunities that practices could not access individually. Most importantly, this work is being done. Over the next few pages you will see a picture of where we have come from, what we have already achieved and how the Alliance will develop over the next twelve months and beyond as we bring structure to this good work.
- NHS Five Year Forward View
The City & Vale GP Alliance contains practices of different sizes, has a diverse patient demographic, and a broad range of clinical and non-clinical skills. This plan aims to combine all these elements to support an Alliance that can deliver high quality health care, now and in the future to our collective 94,000 patients. The business planning process has taken some five months, and with the support of Blue River Consulting we have explored most areas of practice operations and service delivery. The practice managers’ group has taken the lead in prioritising areas for focus, and in doing so produced some powerful results and examples of how working at scale can benefit us all. This document starts by summarising the progress so far on the Alliance work streams. You will then see the proposed organisation structure, with the plan for how we will work together in a structured way. This demonstrates how responsibility and accountability will be ensured, finally setting out the financial forecast for the year ahead. We all recognise the potential of working together to share knowledge and experience, and to benefit from economies of scale. It is time now to realise this potential.
10 practices
94,000 patients
Two clinical systems
44 GP partners
ÂŁ12 million Annual Budget
279 staff
750 square miles
One future
Arguably the most important work stream, the Governance team will ensure the Alliance is run fairly, properly and transparently. This will not only serve practices and staff but also give patients confidence in the knowledge that their practice is operating in a sound and professional manner.
Structure The Alliance has to date had a nominal structure, comprising a board of four directors. While this does satisfy the legal requirements of the company it has not been the most operationally effective structure. The Governance team has identified that to clarify responsibilities and allow directors to work more effectively, this structure has needed revision.
Accountability To be an effective organisation, objectives must be set and held to account. The Alliance has lacked some clarity over its strategy, which has meant practices have been unable to hold the board or managers to account. It is time now to change this so practices feel more connected with, and able to influence, Alliance work. Transparency There have been no concerns raised over Alliance business, however we wish to excel in every capacity. It is important that all business is conducted in the right spirit and visible to all, and the Governance team has been looking at several areas such as contract management and handling Freedom of Information requests so that we are confident our actions are acceptable. Regulation The Alliance must ensure that it is registered with all the requisite statutory bodies. While not currently needing to report to any, we need to be conscious that certain activities could precipitate this need. Failure to do so will incur severe penalties so the Governance team can provide guidance here. Communication Within any organisation this is paramount. The Governance team needs to ensure that internal and external communication is appropriate in both medium and content. Likewise they will provide guidance on Information Governance to ensure any data sharing is done so properly and legally.
Review of the Articles of Association Review of the Memorandum of Understanding Board composition, roles and length of appointments Updating the AGM format Evaluation of commercial proposals Identification of information governance risks
Development of a risk analysis protocol Development of a complaints procedure Understanding freedom of information requests
Clarity over Alliance structure and communication Improved engagement and satisfaction among member practices Avoidance of any legal or regulatory issues
Approval of business plan
Vote at AGM
12th May
Revised MOU signed by all practices
Returned in time for AGM
12th May
Completion of review of every contract
Audit of contracting process
Annually
The Alliance practices between them spend over £1million each year procuring supplies and services to support their operation. This is predominantly spent individually with suppliers as ten independent small businesses. Working as one purchasing unit will deliver significant savings.
We have already seen over £25,000 savings from the Alliance’s group purchasing arrangement with one supplier, Dene Healthcare. This represented a saving in 2014/15 of over 25% of the costs if we had not been purchasing collectively. While this level of saving may not realistically be achieved with every supplier, an overall average of 10% should be. From our total Alliance spend of £1million, this represents £100,000 that can be invested in developing primary care. Procurement is not simply buying stationery and couch rolls, it extends to insurance, cleaners’ services, PAT testing and professional subscriptions. Wherever money is being spent, there is the potential for savings to be made. No practice manager has the time to review this all, so many costs go unchallenged and creep up year-to-year. A dedicated procurement team would not only bring immediate savings through supplier switches, but would have the capacity to regularly review all contracts and areas of spend to ensure optimal value. For large purchasing decisions this team could run competitive tenders to encourage lower pricing while also introducing service level agreements for suppliers to ensure quality of service and supply are maintained. Finally, developing relationships with suppliers brings further opportunities. By working at scale the Alliance can attract companies who are looking to pilot new products, services or added benefits. For example Dene Healthcare now offer free Basic Life Support & AED training for practices and have offered support with website development and practice process improvement.
A significant piece of work is underway to gather information from practices on their spend within specified categories covering all areas of expenditure. This will also incorporate contract end dates and current suppliers. Once this part of the process is complete, there will be an exercise to analyse this to identify priorities by highest total spend, contract renewal dates, and according to common suppliers. Some qualitative discussion around service quality will also be held as it is important that costs are not cut at the expense of quality. Also, improving quality may be the main driver for some practices wishing to change supplier. This can be done whilst also reducing cost. After analysis is complete and priorities have been established, the procurement team will invite suppliers to make presentations or submit quotations. These will be shared among the manager group along with a recommendation. When a new supplier has been nominated, any contract will be passed on to the Governance team to ensure it is satisfactory from financial, operational and regulatory perspectives. This will become a rolling process, managed centrally for as many procurement areas as possible.
Cost savings for practices Consistency and improvement in quality and service Reduction in administrative workload for practices
Cost savings
Year-on-year comparison
Annual
Consistency of pricing
Practice by practice analysis
Annual
Reduction in workload
Audit of hours spent
Monthly
Service delivery can only be high quality and consistent if the training that supports it is. Training can be costly, unwieldy and varying in quality. Working as an alliance gives practices an opportunity to coordinate a common programme of training for both clinical and non-clinical staff.
Practices spent an average of £3,000 on training in 2014/15. Much of this involved arranging courses of statutory and mandatory training for staff within individual ‘classroom’ sessions. When the cost of staff time, overtime and practice closures is taken into account the true cost of carrying out even this basic level of training is much higher. This was quickly identified as a priority area for collaboration as the coordination of a ‘stat & man’ programme is something that can be done on behalf of practices. The requirement is the same for all, and additional models for delivery can be explored when working at scale. There are many accredited organisations who deliver programmes that cover all the core and supplementary training needs of practices. There are many media used in delivery, from the traditional classroom format to online e-learning, with many variations of blended learning in between. The task of the Training work stream has not only been to identify the most cost effective solution to the delivery of mandated units, but to consider the operational and educational impact of the different models. Practice staff are pushed for time, so cannot afford hours away from their work to attend training sessions. At the same time the IT literacy of staff varies greatly which is a consideration in using online formats. Importantly, all training must deliver improved capability for its audience. The key objectives from this initial Training work stream have been cost saving, quality improvement, and reduction in impact on practices. Several steps have already been completed in achieving the strategic objective of an Alliance-wide training programme. This has involved mapping out required modules, inviting providers to present their solutions, and selecting one to provide core training to all practices. Blue Stream Academy have been chosen, unanimously by the managers on the recommendation of the work group, to provide statutory & mandatory training for all practices from April 1st.
Over the next twelve months this group will build on its success so far to develop its work according to the below milestones. 1.
Work with chosen provider, Blue Stream Academy, to roll out Stat & Man training
2.
Look to develop Blue Stream offering across Alliance to support GP & Nurse revalidation
3.
Review practice training plans & agree common training areas
4.
Arrange collective delivery of training
5.
Analyse workforce to determine development and recruitment needs across Alliance
6.
Look at skills gaps and design subsequent training programmes
7.
Identify training needs within management team
8.
Source suitable training for successful work stream delivery
Beyond this, as part of a broader Human Resources work stream, will be extensive exploration of our workforce to ensure: all staff are trained to a consistent level for their role, any organisational recruitment needs are addressed, and also that the Alliance is in a position to be an effective employer for when the time comes to start taking on staff. One vision is the development of a sustainable new model of recruitment and training for aspiring clinicians. This maps out a pathway from apprentice HCA, through nursing and on to further clinical training. We will develop this in conjunction with established partner organisations and further education institutions. It is hoped that proactive management will mitigate any recruitment crises and work in conjunction with the redistribution of work to make general practice less ‘top heavy’. It will support new ways of working to ensure sustainability while providing an attractive career path within a large organisation, so that ambitious and successful staff can be retained rather than leaving to seek development elsewhere.
Cost and time savings for practices Improvement in quality of training delivered Reduction of gaps or shortages in staff skills
Timely completion of ‘stat & man’ training
Blue Stream reporting
Annual
Cost reduction in training
Practice accounts
Annual
Improvement in training quality
Management review
Quarterly
Data underpins everything we do. £2million of Alliance practices’ income depends on accurate reporting. 300 hours are spent by practices on reporting each month. This work stream was set up to reduce the work load across the Alliance, and to standardise coding and templates ensuring good data quality to support business operations.
Practices spend varying amounts of time undertaking monthly, quarterly and annual reporting. This variation is influenced by the size of the practice, and also the skills available within the practice. The people carrying this out vary widely, from admin staff to GP partners. Aside from data submissions, interrogation of data to identify exceptions and missed income is important. This in particular is likely to get missed as it requires an extra level of training, and greater time commitment. Wherever there is an opportunity to maximise income, this must be exploited. Introducing a centralised function to examine reporting specifications, and create and disseminate searches, will greatly reduce the burden on practices. Whenever a new GP contract, enhanced service or QOF update is issued this work is currently done by each practice individually, and unnecessarily. Effective reporting is also entirely dependent on the information available from which to extract. As such the standardisation of coding across the Alliance is a vast but vital piece of work that must be undertaken.
The Alliance wishes to support practices in improving their ability to deliver GMS services effectively. To do this effectively requires an effective Business Intelligence platform that allows us to compare performance and demographics. This work stream has identified a new software platform, OpenDocc, that enables the automation of elements of reporting. It also allows for reporting specifications to be analysed once, and searches set up centrally to ensure all practices are able to run comprehensive reports each month, maximising practice income. It is estimated that this would save 50-75% of time spent each month on practice reporting. Those days gained can be spent on qualitative work analysing exceptions, or simply on other jobs that might not be getting done.
The system has the capability of predicting performance to help with financial forecasting. It will add new functionality based upon tracking patients through a payment schedule, such as the various stages of an enhanced service at which each payment is triggered. At a glance, practices will be able to see what work still needs to be done for the year, and what the expected payment is at any given time on the basis of work completed. We are now working with the CCG to determine the best source of funding for this solution. The procurement will initially be as a pilot site and OpenDocc team will work with the Alliance to develop a case study. This will then be used nationally to promote their system, raising the profile of the Alliance.
Through our work with Blue River Consulting, we have identified commercial audits as a sustainable revenue stream. These entail searches of practice clinical systems to produce aggregated totals of numbers of patients with a certain diagnosis, medication, test result range, or other similar data. Nothing is identifiable and the workload is minimal. These searches generate a few thousand pounds each time for the Alliance, and are reliant upon our ability to coordinate this across our ten practices. As we develop our data and reporting capabilities, this could be done centrally to increase the profitability of this activity.
Reduction in time spent by each practice on reporting & data Improvement in data quality across Alliance Increased income for practices
Reduction in time on reporting
Management audit
Quarterly
Improvement in practice income
Practice accounts
Annually
Increase in Alliance audit income
Alliance accounts
Annually
97% of the public believe it’s important for the NHS to support research into new treatments 93% want their local NHS to be encouraged or required to support research
72% would like to be offered opportunities to be involved in trials of new medicines or treatments, if they suffered from a health condition that affects their day-to-day life.
The above statistics alone provide a good basis for wanting to increase our research activity. With limited capacity and little experience it is however easier said than done for most practices. The Alliance will provide the support needed to get involved in significant research projects in a manageable timeframe.
Finance Research has the potential to provide a significant and sustainable revenue stream for the Alliance. It is one of the very few areas in which practices can increase their income to invest in improving patient care. As most activity can be coordinated centrally by the Alliance there will be a low impact on practice workload, but with potential for development for those who wish to play a greater part. Practices will retain income from studies that come directly from NIHR, but with the benefit of funded Alliance research nurse support to manage these. The Alliance will retain income from trials it introduces, with a proportion of this returned to practices according to the level of input required from them. This will be calculated on a trial-by-trial basis.
Quality & Support There is a disparity across the Alliance in experience and involvement in research. One key benefit of being part of the Alliance is the ability to share knowledge and to help each other develop. Sharing research policies and protocols is a quick way of bringing in a consistent and high quality level of practice. Those interested in being more involved in research will have a supportive environment in which to do so.
The City & Vale GP Alliance will operate its research activity on a hub and spoke model. The two hubs each have distinct demographics, complementing each other to maximise our attractiveness to partners. Each hub has a GP Primary Investigator providing oversight for their research programmes, and research nurses to support the practice teams. Practices each have a GP research lead who contributes to the research strategy to ensure the quality and appropriateness of trials is maintained. There will be a structured meetings, with reimbursement for GP time, and a clear reporting schedule to ensure engagement from all practices.
Urban population 54,000 patients SystmOne Prescribing
Rural population 40,000 patients Primarily EMIS Web Dispensing
Increased participation in research among Alliance patients Increased revenue from research for both Alliance and practices Development of research network with other trusted organisations
Every practice Research Ready & active
NIHR reporting
Quarterly
Number of patients recruited to trials
NIHR reporting
Quarterly
Income received from trials
Practice/Alliance accounts
Monthly
The website is the public face of any organisation. For the Alliance it has a dual purpose, not only raising awareness of who we are and what we do, but also providing a central point for member practices to get updates on Alliance progress and access resources.
This was identified as a priority area as it had been initiated nearly 12 months ago but laid incomplete as its purpose had not been clear. As the Alliance has revisited and redefined its own position, so the future of the website has become more clear. The website was designed by Castlegate IT, a York-based web design company, with content contributed through the practice manager group. The Alliance logo and branding was created last year and provided the basis for the format of the site. The Castlegate team quickly understood the brief and have created a bold, simple and effective design.
In its current form the website works as a repository for information, but with the scope for it to be enhanced and developed along with the Alliance. The home page is centred on the member practices, to reinforce that the primary purpose of the Alliance is to serve its members. Users can link to individual practice pages from here to find out more information. Also on the home page are brief summaries of the areas in which the Alliance works. These use imagery of York to ensure the identity of the Alliance is reinforced. Much of the content is aimed at external organisations, demonstrating the benefits of working with the Alliance. Our future success lies in our ability to develop strong relationships with commissioners, suppliers and funders. The collective size, scope and expertise of our practices gives us both power and attractiveness in working with others, something we need to exploit.
Alongside the website comes the development of a broader communications and engagement strategy, to ensure that practices and all other interested parties are appraised of Alliance success. Intradoc will be used as the Alliance intranet, where the calendar of all Alliance meetings and events is accessible. All Alliance documents will also be kept here to ensure transparency, so that anyone authorised can view them at any time. The use of a central resource helps to reduce email traffic as documents are not circulated, however it does require active engagement from practices. Intradoc should be checked as the first point of call for any queries over meetings or updates.
Increase number and diversity of organisational partners Raise awareness of the Alliance and its activities Improve member engagement
Number of unique visitors to the site
Via analytics tool
Monthly
Number of submissions via contact form
Count of verified messages
Monthly
Number of click-throughs to Intradoc
Via analytics tool
Monthly
The greatest improvement in the productive powers of labour, and the greatest part of skill,
dexterity, and judgment with which it is any where directed, or applied, seem to have been the effects of the division of labour.
Clear lines of responsibility and accountability underpin the success of any organisation, and below is the proposed organisational model for the Alliance. The members, via their nominated Practice Lead, have the overall influence on the direction of the Alliance while the elected Board retain authority on decision making in accordance with the original Articles of Association. Four directorates will be created, each with a responsible Director. The Chair has oversight for all areas and the casting vote in board meetings. In addition, a non-executive director, lay member and patient representative will be recruited to the board to provide independent scrutiny and challenge. Details of the directors can be found on the Alliance website.
Non-Executive Directors
Reporting to the board is the Chief Executive. This postholder will coordinate the activity of the managers group, and provide an objective viewpoint by virtue of not being an employee of any one practice. An apprentice Executive Assistant will manage administrative duties of the Alliance such as minute taking and committee support. This role will develop to provide support to all directorates. As well as providing cost effective staffing, it fits the Alliance ethos of developing our own workforce. For year one, contracts for these staff will be held by member practices with clear job requirements and accountabilities. This delays the administrative and financial burden of becoming an employer.
Each practice manager, each of whom is currently doing much of the same work on a regular basis. Working together, we have the ability to share common tasks to reshape individual workloads while also bringing collective benefits through quality improvement and cost reduction. The Alliance has to date operated largely on time contributed in good will, and in anticipation of the receipt of future benefits of either finance or efficiency. As the organisation grows so does the need for structure. Within the new organisational structure each manager will work in one of the directorates. The success of this model relies upon all managers being given the time by their practice to work on Alliance projects. This time will be repaid through the work of other managers on other areas of the business. Working in this way, on behalf of others, is the quickest way to start reducing duplication. As managers specialise more, their knowledge and skill level will increase. Practices will therefore see an improvement in the quality of work being done. Practice management is incredibly complex and requires a very diverse range of skills, which between us we have but no one manager is expert in all. The Alliance is keen to ensure that managers with areas of responsibility are competent to act for others. As such we will cover the cost of professional development relating to these duties, and it is expected that managers will identify any training needs they have. Practices will thereby benefit from a more highly developed practice manager. Another advantage of the managers’ close working is the development of supportive relationships. It can be an isolating role which often throws up the unexpected. The benefit of having a group of trusted colleagues to call on cannot be underestimated. When considering the sustainability of general practice, it is important that practice managers are not forgotten. Workload and lack of support were cited as two of the biggest demotivators for practice managers in a recent First Practice Management workforce survey. The Alliance can help to mitigate both of these. Practices can’t independently afford to put the robust structure of specialised staff in place that is necessary for any significant change in service delivery and cost improvement. The Alliance can, by deploying our workforce in a more effective way.
The success of the work streams summarised earlier should give practices the confidence that their managers have the ability and drive to work for the collective benefit of Alliance practices. With the backing of members, these work streams will expand within the Alliance directorates. Managers will then specialise within one directorate. It is important that every manager is given the freedom by their practice to carry out this work on behalf of the Alliance, on the understanding that practices will receive a greater benefit from the work being undertaken across the other areas. Directorates will undertake reviews of practice activity, much of which has already begun. These reviews will prioritise Alliance work streams to deliver the greatest benefits early. Examples of the work anticipated is included in the example below.
From the focus on practice managers in year one, from year two there will be a move towards sharing other functions. As with managers’ work, much other regular work within practices is duplicated, and most staff have broad roles as practices do not have the resources to dedicate staff to each task. It is the job of the managers’ group to identify which areas of the practice can be shared, and how they can be prioritised. As this work develops, managers will take on more focused areas of responsibility and use the existing workforce wherever possible to implement improvements. Outsourcing will also be considered where appropriate. Where a function becomes shared, practices will contribute proportionately to the cost via a ‘pooled budget’ in place of their own spend. Wherever a budget is pooled the Alliance will endeavour to subsidise this to some degree. Working in this way, every practice would benefit from both cost saving and quality improvement. If subsidy is not possible, practices will see greater value being delivered for the same cost. The Alliance will also be able to protect more effectively against rising costs. The work undertaken during the next twelve months will establish timeframes and implementation plans for the sharing of practice functions, including the need for dedicated Alliance staff. Roles will be identified and advertised internally to ensure continuity of existing staff where possible. All Alliance activity will be mapped out, with specified outcomes and measures to enable us to monitor success. Through regular reporting to Practice Leads members will therefore have a clear picture of how the Alliance is progressing and how they themselves will benefit.
The Alliance will help practices in their engagement with and responsibility to other groups such as: – Managing patient expectations and understanding is central to the sustainability of general practice. Time will be put into exploring the effectiveness of methods of communicating with patients. This is often time consuming and costly but of limited impact. Sharing knowledge and functions will help practices maintain readiness for CQC inspections. Having dedicated management time will provide the capacity to explore ‘Outstanding’ practice to bring the best ideas to the Alliance. This of course will primarily serve to improve patients’ experiences. The Alliance will continue to represent members on the VCN. This provider body aims to develop community hubs to facilitate local service delivery, and it is vital that practice all have input into decisions which will affect them and their patients.
The Alliance comprises ten practices, all with different demographics, clinical skillsets and resources. As a result, each practice manages patients in what they perceive to be the best way. This perception will also differ between practices. A rural practice, for example, might be less inclined to refer than an urban practice because of the logistical implications for the patient. We have produced, with the help of Blue River Consulting, a report with A&E, Non-Elective and GP Referral Data for 2014/15 to provide a snapshot of Alliance practices. The data sets have been chosen as they are illustrative of the volume of work done, and also the variation between practices. The intention of this is not to introduce competition, but to inform ways in which we can share practice to improve clinical management and therefore patient outcomes. This kind of work is not something practices have done before, and would not have the resource to do. Working together as an Alliance gives us the ability to access powerful data like this, and start the conversation about how we can target specific areas to help manage workloads and improve quality.
From April 1st, the Alliance is responsible for managing the budget for dermatology referrals among its practices. The Alliance benefits from a gain share model, whereby a proportion of savings made by the CCG across our practices is returned to us. Our participation has involved developing the referral pathway in a manageable way so that any dermatology referrals passing to the RSS system are more easily assessed, and qualified when they reach the hospital. This is intended to reduce the overall cost of dermatology referrals to the CCG, and improve the management of patients so that only appropriate referrals end up seeing a consultant. This is a model that will be developed further, so that more dermatology patients can be managed within practices. Every referral avoided generates income for the Alliance, and patients managed effectively earlier will be less burdensome for practices.
Clinical Leadership The Alliance needs GPs to drive service improvements. To date most clinically-focused work has been the responsibility of the board however as the Alliance grows this will not be sustainable. GPSI’s are asked to put themselves forward for proposing and developing models that will help both patients and their fellow practices. In return the Alliance will present opportunities for career development, through providing training and enabling platforms for them to deliver education. A fully costed business plan will be written when considering any new models of service delivery to ensure they are cost effective for primary care delivery, which will include reimbursement of clinical time.
1.
To support the use of existing retained funds to implement this business plan.
2.
10% of practice managers’ time, as well as attendance of every monthly managers’ meeting.
3.
All practices will be have equalised their financial contribution.
4.
Practice leads, or a nominated deputy, are expected to attend quarterly Alliance strategic meetings.
5.
To contribute to work streams as they develop, in recognition of work undertaken on their behalf.
1.
Formalise the structure of the Alliance and adopt a strategic approach to the division of responsibilities
2.
Prioritise cost savings and service improvements.
3.
Establish and develop the research network, including recruitment of dedicated research nurses.
4.
Develop a central training structure, and plan for development of our workforce.
5.
Evaluate clinical data quality to standardise coding and templates, with centralised reporting.
1.
Practice manager capacity released for operational issues within their practice.
2.
A higher level of accessible knowledge among managers, reducing need for sourcing externally.
3.
There will be an increase in research income for practices.
4.
Greater value delivered within training costs and reductions in most areas of purchasing.
5.
Continued representation via the Alliance in the Vale of York Clinical Network and other bodies.
A greater proportion of practice managers’ time will be expected, notionally 50%, which we hope to be reimbursed in part Regular GP time to contribute to development of work streams and standardised clinical pathways Specialised practice staff (i.e. IT, Finance, Summarisers) may be asked to lead Alliance sub-groups, rather than simply focusing on practice work Practices will be expected to relinquish certain functions to enable centralised operation
Dedicated teams will undertake functions centrally, such as coding, IT and HR. Practices will retain control over Reception, Dispensary and clinical staff to ensure local needs are met. Undertake more ambitious projects such as a workforce review, estates strategy and comprehensive evaluation of practice systems and IT resources with reimbursed manager time.
Continued and sustainable research income Dedicated staff to manage specific work streams and specified practice functions Participation in pilots of innovative technologies Additional new revenue streams as the Alliance diversifies
The Alliance will employ core functions while practice-specific staff such as receptionists and dispensers remain practice responsibility, but with a central training platform. The Alliance will sustain its own management and staff costs. Pooled practice budgets for management shared functions such as a central coding team will result in overall cost and quality improvements. The Alliance will be a leading primary care research organisation, attracting significant income. We will also have developed a reputation as an innovative and reliable partner for other organisations.
An important part of the development of the Alliance is the network of partner organisations with whom we interact. We have already experienced a surge of interest from medical companies and IT suppliers among others, keen to work with us. It is however important that we retain focus on our strategic objectives and do not become susceptible to distractions. The organisations listed below have already demonstrated value to the Alliance in this respect, and have provided support in getting us to this stage as well as offering potential to help us develop further. They all mirror our ethos of openness and positivity. We will of course maintain a critical eye over all partners to ensure they continue to attain the levels of quality and reliability we demand. As well as commercial partners to help develop the Alliance financially, it is important that we expand the network to cover all aspects of general practice. Working with charitable organisations will help us to support ourselves but also our patients, by exploring how they can complement the care we provide.