PracticeBusiness december 2012 | issue 87
Practice INSPIRING BUSINESS SOLUTIONS FOR PRACTICE MANAGERS
DEC 2012 | ISSUE 87
FOREIGN NATIONALS | PRACTICE INCOME | PAY AND CONDITIONS
Reaching out to the outsiders What is required of practices when it comes to treating foreign nationals
GIVE YOURSELF A BOOST
When practice profits are down, what extra services can you offer to inrease income?
A PAY UPGRADE
With more work for less pay, there’s no better time for PMs to ask for a raise
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editor’s letter EXECUTIVE EDITOR Roy Lilley EDITOR julia.dennison@intelligentmedia.co.uk ASSISTANT EDITOR carrie.service@intelligentmedia.co.uk CLINICAL EDITOR dr paul lamden ACCOUNT MANAGER george.petrou@intelligentmedia.co.uk SALES EXECUTIVE nazia.chishty@intelligentmedia.co.uk PUBLISHER vicki.baloch@intelligentmedia.co.uk DESIGNER sarah.chivers@intelligentmedia.co.uk PRODUCTION/DESIGN peter.hope-parry@intelligentmedia.co.uk CIRCULATION MANAGER natalia.johnston@intelligentmedia.co.uk
CONTACT US Intelligent Media Solutions Suite 223, Business Design Centre 52 Upper Street, London, N1 0QH t: 020 7288 6833 f: 020 7979 0089 info@intelligentmedia.co.uk www.practicebusiness.co.uk www.intelligentmedia.co.uk twitter.com/practice_biz
Reach out, have faith
C
ommunication is everything in practice. Our executive editor Roy Lilley makes a really intriguing point in his column (p8) and that is that, according to the statistics, the best-paid practices are the ones whose patients are most satisfied with booking their appointments. It got me thinking that, while it’s obvious, a practice goes nowhere without its patients, and throughout all the upheaval of the NHS, it’s important to keep this in mind. At the NAPC conference last month, I heard another staggering point, this one from Professor Steve Field, deputy national medical director, NHS Commissioning Board. He spoke about inclusion in primary care and said practices were shutting their doors to hard-to-reach patients, like the homeless and travellers. Furthermore, PCTs were cutting services for these patients, to help ensure practices get the same amount of money. To help reduce inequalities, he believes, a practice with more affluent patients should not expect to get the same as one with more deprived patients and practices have a duty to their local populations, hard-to-reach or otherwise. Of course practices are businesses, but they are businesses with a social purpose. However difficult it is to get patients in, a happy, healthy community is the end-goal. It’s for this reason that much of the shift in the NHS is around outcomes. While changes to the QOF and funding for enhanced services make it harder for practices to get the same income for going through the bureaucratic motions, it only means that to make up for it, they end up, perhaps, doing more for their local populations through services they hadn’t previously considered. If this issue takes any angle, it’s an altruistic one. On page 14, we look at the issue of ‘health tourists’ and the pressure for practices to treat foreign nationals or risk breaching their human rights. On page 22 we look at ways to boost your practice income, which, these days, tends to be about helping your patients to be better rather than relying on ticking boxes for funding. On page 26, we interview a practice manager with a stellar PPG and on page 30 another practice tells us how they kept their patients happy and on-board despite a major premises shift. Lastly, on page 44 we look at what you as a practice manager can do to look out for your patients. After all, sometimes you are the only hope they’ve got.
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
22
10 Provider news A practice manager’s update on providing for commissioning 14 Health tourists Reaching out to the outsiders What is required of practices when it comes to treating foreign nationals? 17 Provision Tendering without tears More advice on making your practice attractive to the CCGs 20 Top tips Flu season How to run a tip top flu clinic 22 Income Give yourself a boost When practice profits are down, what extra services can you offer to boost income?
people
26
26 Case study Best practice management Setting a good example behind the front desk 30 Case study Investing in success A Taunton medical centre move into new facilities thanks to a ÂŁ1.7m loan
management 34 Patient records The picture of health What the General Practice Extraction Service (GPES) means for you 36 Top tips A guide to managing asbestos Older practices take note 38 Patients Hidden costs of sick leave Practice budgets bear the cost of employees taking stress sick leave 42 Clinical MFM This month: Scarlet fever
work/life
44
44 Patient relations Looking out for domestic violence If you see something, how should you say something? 46 HR A pay upgrade With practice managers doing more work for less pay, we look at how to get that raise 50 Diary Practice blogger Ann Boyle on how best to thank your practice staff this Christmas
your monthly lowdown on practice management
Massive disparity in pay for GP practices It has been revealed that some GP practices receive considerably more funding than others, apparently regardless of their patient population and demographic. HSJ evaluated the income of over a third of the country’s GP practices and found there to be huge variations in payments received, with little or no relation to the number of patients or the area the practice served. The majority of this income variation could be explained by the rewards received through QOF, and also practices providing additional services. However, even when this is taken out of the picture, there is still a huge variation, with income per needsweighted patient ranging from around £30-£300. Many of the higher-earning practices are those with local PMS contracts as opposed to national GMS contracts. Dr Shane Gordon, a GP and accountable officer for NHS North East Essex CCG told HSJ that having a more equal base of income for GP practices nationally would help drive up the quality of services. He said: “It is hard to see how commissioners, working with CCGs, can make big improvements in productivity when you’ve got such basic variation. It is hard to have a conversation with a practice when they can turn around and say: ‘You are paying these other guys four times as much.’” Professor Steve Field, deputy national medical director of the NHS Commissioning Board, highlighted the issue of inclusion in primary care at the NAPC conference in Birmingham last month. He said that PCTs were cutting services for hard-to-reach patients like the homeless to help ensure practices get the same amount of money. He said, to help reduce inequalities, a practice with more affluent patients should not expect to get the same as one with more deprived patients. “We’ve got the evidence,” he commented. “We need the CCGs to stand up and say we can’t give the same amount of money to every practice.”
fast facts Income per needs-weighted patient ranges from around £30 to £300 depending on the practice.
06 december 2012
Practice sale makes millions Five practice partners became millionaires last month when they sold their NHS-funded firm to a private healthcare giant, revealing how practitioners can potentially profit from new government policy. Care UK announced the £48m purchase last month of England’s biggest out-of-hours GP service, Harmoni, originally set up as a GP cooperative. The sale creates a new private health concern that could treat 15 million. Harmoni had won 12 contracts to run the new 111 non-urgent phone line, beating off competition from NHS Direct. Its finances are complex, with hundreds of shareholders and different classes of stocks. According to an analysis of documents filed with Companies House, five GPs figure prominently and own a quarter of the company between them. If each share has an equal stake, the GP founders of the company, David Lloyd and Nizar Merali, would share £2.8m.
diary
sector
sector news
27 February 2013
Obesity and Related Conditions: Tackling an Epidemic Manchester Conference Centre PublicServiceEvents.co.uk
22-23 May 2013 Primary Care 2013 NEC Birmingham
STATS
Complaints on the rise
FACTS
According to a report by the new health service ombudsman, Julie Mellor, there has been a:
&
50% 42% 61%
rise in incidents of unacknowledged mistakes in care – up from 1,014 to 1,523 incidents rise in complaints about inadequate solutions, such as unsatisfactory apologies, up from 1,163 to 1,655 rise in complaints about independent service providers – up from 169 to 272
PMS contract here to stay PAC report condemns PFI deals
what we learned
clinical news
NHS services around the country face being merged, closed or moved to address the financial crisis, a Public Accounts Committee (PAC) report reveals, and crippling PFI debts mean the Government will have to hand over £1.5bn of bailouts. The paper claims every NHS organisation will have to make significant changes to patient services for the health service to become financial sustainable. It pointed to dozens of hospitals and other NHS organisations that are in debt with more only kept out of deficit through government handouts worth a total of more than £1bn. One area of particular concern is ‘unaffordable private finance initiative’ deals, which it says make it impossible for hospitals to break even once their annual repayments have been made. Seven trusts with PFI deals will need £1.5bn worth of government assistance over the life of the contracts, the equivalent of £60m a year. Mike Farrar, NHS Confederation chief executive, said the Government, the NHS, regulators and the Department of Health should take heed of the report. He said that government needed to open a “frank conversation” with the public about the issues raised by the PAC. He said: “Solving these problems requires a fundamental overhaul of where and how NHS services are provided. Propping up struggling trusts with short-term solutions is not the answer. We need to take action before we reach crisis point.” Farrar urged that rules developed to deal with ‘failing trusts’ should be clear and flexible enough to allow organisations to act quickly. He pointed to the need for a “whole-system solution” to the health services financial problems that needed to be dealt with on a macro scale rather than looking at individual organisations. Farrar opined that rather than bailouts, the commissioning board should remedy the problems “by releasing money to new clinical commissioning groups so they can work with providers to help put them on a sustainable footing by changing the type and range of services they provide”. He concluded by saying that while PFI was part of the problem, it was important not to exaggerate its role in the financial difficulties: “PFI is not the sole reason why organisations find themselves in financial distress.”
The PMS contract isn’t going anywhere yet, Earl Howe told delegates at the NAPC conference in October. Following the publication of a letter from Dame Barbara Hakin to SHA and PCT clusters, reporting on the terms of the Government’s proposals for the future of the GMS contract and the treatment of PMS contracts, many members contacted NAPC to express their concerns. At the conference, the Parliamentary under secretary for health, Earl Howe, reassured concerned delegates that PMS contracts would continue to exist. In addition, he explicitly added that he would be willing to discuss, face to face, the detail of the continuation of such contracts with Dr Charles Alessi, chairman of the NAPC. Dr Alessi said he was “enormously reassured” by Earl Howe’s promise and would be taking up his invitation and report back. He commented: “The survival of PMS is of such importance as a contractual tool for the delivery of locally sensitive services in the 21st century, particularly so for atypical populations, that without its availability to general practice, and other contractor professions, primary care in this country would face a serious setback in addressing the challenges faced by the National Health Service and its changing demographics in this seriously challenged financial climate.”
A hundred thousand people are set to benefit from telehealth over the next year. Speaking at the Age UK conference last month, Health Secretary Jeremy Hunt set out his vision for improving the lives of people with long-term conditions using technology. He said seven CCGs are to agree contracts with industry suppliers that will mean that 100,000 people will be able to benefit from telehealth in the course of next year. Tenders for the work are being developed with the NHS Commissioning Board.
THEY
SAID
Diabetes QOFs to be bundled together
MPs have backed Department of Health plans to group the majority of diabetes points in QOF to create a single indicator worth over £5,000. The Public Accounts Committee said the National Diabetes Audit showed the existing system was not producing improved outcomes and GPs needed tougher targets. The proposal has been condemned by the General Practioner’s Committee as demotivating for GPs, but the MPs’ backing means it is very likely to be put into action anyway. In its report, the PAC said the DH was not ‘effectively incentivising delivery of all aspects of its recommended standards of care through the payments systems’. The committee pointed to evidence from the NDA that only around 50% of patients with diabetes were receiving all nine checks from GPs.
“Increasing patient expectations, greater regulation and a changing workforce – with more part time working – will test the adaptability of those working within general practice” Dr Arvind Madan, managing partner of strategy and business development at Hurley Group, commenting on the Lloyds TSB Commercial Healthcare Confidence Index, which revealed that confidence among GPs has continued its slow decline in the second half of 2012
december 2012 07
sector
sector news
sector
comment
Some practices are paid a lot more than others. Why? ROY LILLEY looks at the figures
Income tactics ROY LILLEY
is executive editor of Practice Business. He is also an independent health and policy analyst, writer and broadcaster and commentator on health and social issues.
H
ere’s a question: “Why do some practices earn a shed-load more money than others?” Different types of patients perhaps? No, even adjusting for that, some practices earn more than others. What about success in such things as reducing emergency admissions? No, it makes no difference. Some practices just earn a lot more than others. How do I know? The Health Service Journal has been busy with its calculator. It examined details of the 2011-12 NHS income of more than a third of England’s 8,300 GP practices. It was a remarkably simple methodology: They divided the total NHS income of 3,046 practices by the number of patients on their practice lists. They used DH weighting to allow for variations such as age and the health. Specialist GP practices and extreme outliers were removed. The answer? The incomes ranged from about £65-£320 per head of population. Ok, it’s a bit of fun but it does have a serious sting in the tail. The DH has recently announced they are going to have another go at standardising part of GPs income…and the answer is: ouch! Using the HSJ calculations, it is possible to deduce what a standardised income would look like. If income was standardised, with practices earning above the average rate reduced to the average, then high earners might see their income slashed by a total of £566m a year. This is around seven per cent of the total GP services budget. I know you will be shouting at the page: “Roy, the variation is due to QOF and practices providing services beyond core contract requirements.” Well, stop shouting; I know. I also know there are payments for unusual services such as walk-in centres. However, as the HSJ points out, even if performance rewards and enhanced services are excluded from calculations, there is huge variation, with income-per-needs-weighted-patient ranging from about £30-£300. Of course, practices receive payments for a long list of factors that vary dramatically between practices and areas. They include payments that are national policy but not universally applied, for example for dispensing drugs; reimbursement for payment for their premises; seniority of GPs; the Carr-Hill formula; and IT and premises maintenance.
08 december 2012
Of course, there is cash tied up in schemes such as ‘practice innovation’; ‘transforming primary care’; use of locums; referral management; dispensing drugs; reimbursement for payment for their premises; seniority of GPs; IT and premises maintenance. HSJ also compared practices’ income with the rate of emergency bed days related to long-term conditions among their patients; with how patients rated the practice; and with the proportion of patients they had seen in the past six months. Most of the measures showed no apparent link, which you can take to mean those paid more may not be providing better services. Unplanned hospital admissions fall into this category. However, for all but the best-paid practices, there was a positive relationship between practice income and satisfaction with booking appointments. Well, well: It’s the little things that matter.
For all but the bestpaid practices, there was a relationship between income and booking appointments
primary provider
news
CCGs need practice managers to succeed
empowering practices in a commissioning landscape
Speaking at the annual Practice Managers Conference in Suffolk in October, Gary Belfield, associate partner at KPMG Management Consulting, warned that CCGs need time and space to develop before they become excellent commissioners of healthcare and needed practice managers by their side to do so. Belfield said: “It’s something of an understatement to say that the advent of CCGs has polarised opinions, but whether viewed with anticipation or trepidation, they must be given every chance to succeed. Assuming control of a healthcare budget of £64bn is a huge responsibility and it comes with more than the usual challenges of change – but these can all be met with a consistent and transparent approach to healthcare decisions. “I worry that the pressure on the CCG clinical board members is significant and the succession planning to ‘spread the load’ is not yet in place. The more advanced CCGs have shown that they can link practices together to share the commissioning decision making. This will, in my view, bring long term success for the CCG.” He said it meant that practice managers had a critical role to play. “They can prevent an unwarranted variation in practice by partnering with neighbouring CCGs, sharing critical information and engaging in peer review programmes,” he said. |It’s all about setting clear expectations and having demonstrable measures to ensure equality in the way CCGs are held to account. “Ultimately the key will be in how the power of CCGs is made to work for patients. A relentless focus on priorities that are consistent across every CCG and maximise the effectiveness of every NHS pound is a good place to start.”
CCGs invest in LES funding UK-wide spending on local enhanced services (LESs) is set to rise by 3.2% to £318m by 2012/13, a Freedom of Information request has revealed. This comes as commissioning groups invest further in community-based services. The request, made by GP, shows a wide variation in the amount invested across the UK, however, which means practices in some areas may have to work harder for their LES money. In Derbyshire, for example, LES funding per practice will rise by £30,142 on average, while in Cornwall and Isles of Scilly, LES funding will drop by £24,610 on average by the end of 2013. Some swings in funding were put down to PCOs rebranding work once funded under directed enhanced services (DESs), but in other areas, practices are having to think of other sources of income to make up for it. Experts have said even small changes in funding could have an impact. “As time has gone on, growth has outstripped core funding,” Dr Nigel Watson, Wessex LMC chief executive and GPC member, told GP. “If they take another £20,000 to £30,000 from a practice, that would be catastrophic.” Despite a rise in LES funding overall, senior GPs have warned practices face tougher targets as PCTs cut services like smoking cessation, LARC fitting and phlebotomy to save money. Meanwhile, others are investing in more services, like care home visits and ECG services. The investigation also found LESs removed from practices and given to private providers under Any Qualified Provider. Accountant Laurence Slavin of Ramsay Brown and Partners warned that practices would inevitably have to make difficult decisions about personnel when faced with the cuts and said they would need to plan for this.
10 december 2012
news
Government gives practices dementia support Alongside the publication of the Dementia Challenge progress report, and the launch of the Dementia Friends programme, the Government has announced a number of measures as part of the next phase of the Dementia Challenge. These include: • Extra support for GPs on dementia to better equip them to spot and diagnose dementia, and to help people with dementia and their carers manage the condition. There will be a dementia toolkit for surgeries, and a requirement on healthcare professionals to ask patients aged between 65 and 74 about their memory as part of every standard health check. • £9.6m for dementia research to fund the expansion of the UK Biobank, which holds biological data from 500,000 individuals aged 40-69 years. This expansion will include 8,000 brain scans to help scientists discover why some people develop dementia and others do not. • and a £1m prize fund for ways to increase diagnosis. Funding will be awarded to NHS organisations that find groundbreaking ways to drastically reduce the number of people with dementia who are undiagnosed by health care professionals. Find out more about these and other initiatives on the Dementia Challenge website at DementiaChallenge.dh.gov.uk.
clinical news
Eye health becomes a priority Eye health costs the UK £22bn each year, through care costs, absenteeism, unemployment and other issues associated or caused by poor eye health, according to figures. In a bid to combat this, the RCGP plans to give GPs help to increase referrals for eye conditions by providing them with the tools to identify them earlier on. Over a million people suffering with eye conditions could have had their sight issues prevented had they been diagnosed and treated earlier. In the initiative to be launched next year, GPs will be up-skilled in order to identify sight issues earlier. Dr Waqaar Shah, an advisor from the Department of Health told GP Online it’s time that eye health was in the spotlight. He said: “Sight loss is quite a big problem in this country. Up until now, eye health hasn’t always been prioritised by various bodies – it’s a ‘Cinderella’ condition, much as mental health was 10 to 15 years ago. Now it’s prominent in people’s minds.” Reducing sight loss could have a positive impact on costs to secondary care; by increasing mobility, reducing frailty and depression and therefore minimising the stress placed on carers.
news
us t c a t Con y to toda for fy i l a u q e e r f r you iption r c s b u ) s UB12 e CSS (quot
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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.
primary provider
health tourism
THE TOURIST TRAP
Millions of pounds of taxpayers’ money is lost through so-called ‘health tourism’ each year. CARRIE SERVICE looks at the implications of the recent BBC documentary and what is required of practices when it comes to treating foreign nationals
14 december 2012
A
recent Panorama investigation by the BBC revealed that the NHS has lost at least £40m over four years from failing to identify health tourists – foreign nationals who are not eligible for free health care – being given access to NHS services and treatments. The documentary followed undercover journalists posing as foreign nationals with no proof of ID, being sold access to the NHS by ‘middle men’, and in one case, a practice manager. He was secretly filmed selling patient registrations at a health centre in Birmingham to an undercover reporter for up to £800 a time. The reporter went on to have an MRI scan, which should have cost £800 via private healthcare. None of the undercover reporters who gained access to NHS treatment during the investigation were asked to prove their entitlement to free health care when they arrived at the hospital. When the trusts were confronted afterwards, they claimed that the responsibility lay with the referring GP practice.
Confused? With new guidelines from NHS London stating that GPs in England must register any foreignborn patient in a bid to promote human rights, it’s unclear how practices are supposed to react to overseas patients looking to register. According to guidance published by the PCC this year, treatment can be provided to overseas visitors as follows: n A person may register with a practice as a permanent patient or be accepted as a temporary resident. A person is a temporary resident if they live in an area for more than 24 hours but not more than three months. A person who is accepted onto a practice’s list of patients is entitled to free NHS primary medical services. n A person who has not been accepted onto a GP practice list, or accepted as a temporary resident, can still be treated by a GP practice – it is required to offer free NHS treatment to anyone who requests it if, in the opinion of a healthcare professional, it is immediately necessary. Immediately necessary treatment includes treatment of a pre-existing condition that has become exacerbated during a person’s stay in the UK. If this isn’t confusing enough for you, a practice is also required to offer free treatment to a person who has been refused registration on the practice’s list of patients for up to 14 days after refusal or until registered elsewhere – whichever is sooner. The same time frame applies if the patient has been refused as a temporary resident, or is in an area for up to less than 24 hours.
In plain English, please Dr Charles Alessi agrees that the guidelines need to be made clearer and simpler,
otherwise we could see a surge of ineligible patients coming into the NHS, with practices being afraid to turn them away in case they get it wrong. “The present system of accepting all for treatment if their condition is deemed to be an emergency, is a recipe for confusion,” he told Practice Business. “The practices exposed in Panorama, whereby a practice manager appeared to sell access to primary care, is clearly illegal. However the present anomalous situation where practice managers are put in impossible situations to determine eligibility on a case-by-case basis, based upon the urgency of a patient’s condition, is prone to lead to opening up access for more patients than perhaps envisaged, since most people would err on supplying treatment.”
Accepting all for treatment if their condition is an emergency is a recipe for confusion A legal dilemma So where do practices stand legally and how can they be sure that they are acting appropriately? “At the moment, whilst in theory GPs have discretion on whether to admit patients, in practice that discretion is rather limited,” says Richard Buono, associate solicitor at Blacks Solicitors. “Practices may not refuse an application
to register if emergency or immediately necessary treatment is required, irrespective of the patient’s eligibility to live in the UK. Practices also may not refuse an application on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition. Practices may however turn down an application on reasonable grounds, for example if the patient is violent, if the practice is closed to new applications or if the patient lives outside the practice area.” Putting these guidelines into practice however, could create a whole other set of problems. Whilst eligibility for secondary care treatment is restricted to people ordinarily residing in the UK, there is no such requirement primary care. “GPs who have refused to admit foreign nationals as patients have found that such decisions are being challenged,” says Buono. There is also the issue of discrimination and racism – how can you justify asking a patient for their records simply because you ‘think’ they might not eligible for treatment? “Practices can ask for a patient’s ID or proof of residence, but must apply any such policies to all patients, regardless of whether they are believed to be from overseas,” advises Buono. Michael Boyd, head of DWF’s healthcare group believes that health tourism isn’t a major issue for primary care, because health tourists tend to be looking for treatment of more serious conditions that will be dealt with through secondary care providers. “GPs should bear in mind that entitlement to free secondary care services is not a pre-condition to registration for primary care services,” he says. “It is the responsibility of the provider of such services to ascertain whether services can be provided to an overseas visitor free of charge.” He adds, however, that practices need to be careful not to misinform patients that they could receive free NHS hospital care where this may not be the case. A major issue is the sheer lack of clarity around whether primary or secondary care are responsible for requesting that patients produce documents before access to treatment is granted, and until this is made transparent, the NHS will continue to lose money through health tourism. “What we need is clarity around eligibility and a simple method of determining who can access free care,” concludes Alessi. “It is unacceptable that practice managers are put in this invidious situation.” n
december 2012 15
primary provider
health tourism
Making plans for locum cover Those who work in the medical profession know that anyone can be struck down with illness or injury out of the blue. In GP surgeries hiring a locum is often the only solution if one of the doctors falls ill.
Here are some of the most frequently asked questions about locum protection. Q: What are typical rates for a locum? A: Locum prices can vary dramatically across the country. A Medeconomics UK Survey of locum rates for 2011 showed the daily rate can range between £770 in London and £150 in South and East Wales. Over long periods it will become an expensive resource and it becomes clear that taking out locum insurance is essential. Q: Who is liable for locum costs? A: All GP practices are required to provide cover for absent doctors for up to 12 months and the responsibility of who meets these costs is usually determined by the practice’s partnership agreement. Typically, this agreement creates a mix of shared business liabilities for partners, including salaried GP and other staff costs, and personal liabilities. Many agreements make paying for locum cover the personal responsibility of the partner and it will be their individual decision whether or not to take out locum insurance.
Worried about rising locum costs? Talk to a specialist… We’re the experts in locum insurance With daily locum costs of up to £700*, unexpected staff absence can have a serious financial impact on any GP practice. Our permanent locum insurance, Practice Protector Plus can protect you against the cost and disruption with cover that’s tailored to your budget and staffing needs: • Up to £3,000 per week for locum cover • Up to £2,000 per week for sick pay insurance
Q: What should be included in a policy? A: Whoever takes out the locum policy needs to ensure it suits their needs and circumstances.
• Ideal for both temporary and long term sickness cover • Valuable options to cover many contingencies. We can provide the full package of cover, and adapt your policy to suit you. Why not see the in-depth guide to locum insurance on our website or speak to your local Financial Consultant?
Arrange a no-obligation appointment with an expert
www.wesleyan.co.uk/ppplus
@
Q: Who should pay the premiums for any cover? A: This again is usually dictated by the partnership agreement and what liability is being covered. Insurance premiums for shared business liabilities are usually met by the practice, but premiums for personal liabilities are generally met by the individual Partners. A single plan can cover all of your practice’s shared business liabilities for locum cover, role replacement cover and sick pay, as well as the Partner’s individual personal liabilities. The kind of insurance taken out, either an individual or group policy, shouldn’t be decided by any of the practice staff as it is a key part of the family income protection planning for most GP partners.
practicereview@wesleyan.co.uk
0800 009 3675 Quote reference 45664
• Check the policy includes an ‘own occupation’ definition. This ensures there will still be a payout even if they can still do other types of work based on their knowledge and experience. • Confirm the terms and conditions are permanent throughout the entire term of the policy, no matter how many claims are made or if their condition deteriorates. • Ensure the plan comes with guaranteed options so they can increase the cover without having to provide further medical evidence. • Check the length of the ‘deferred’ period. It may be cheaper to have a longer period between the date they’re taken ill and the date that payments are made, but it may not always be the best option. Ideally, the deferred period ties in with their circumstances and how long they can cover payments.
Conclusion
As a practice manager you will want to ensure the surgery runs smoothly and remains in good financial health. If you’re not clear, check the practice agreement to see who is responsible for providing cover and ensure cover is in place, up-to-date and meets the needs of your surgery. Talk to a financial adviser who has experience of working with GP practices to make sure the right cover is in place to protect both the business and your Partners. *UK survey of GP locum earnings, May 2011. Wesleyan Medical Sickness is a trading name of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Limited is wholly owned by Wesleyan Assurance Society. Registered No. 1651212. Head Office: Colmore Circus, Birmingham, B4 6AR. Telephone calls may be recorded for monitoring and training purposes. GP-AD-33-11/12
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The above does not constitute financial advice and is for general information only.
Tendering without tears Want to look your best for the commissioners? We bring you another detailed update on how to prep your GP practice for the tendering process With many commissioner contracts coming up for renewal, GP practices need to stay alert if they are to take advantage of new opportunities – and, in certain cases, safeguard their existing work, according to experts at law firm Ward Hadaway. Alison Oliver, associate in the medical and dental practices team, says increasing competition within the NHS means GP practices cannot afford to be complacent when it comes to winning and retaining contracts. Hadaway says: “A number of the fixed term APMS contracts awarded five years ago are now coming to an end and PCTs are also disposing of practices that they have been running in advance of their dissolution next year. “We have already seen a number of these practice contracts being awarded to companies such as Care UK who are starting to make their presence felt in the sector and who may have more experience of competitive tendering processes. “GP practices often struggle when pitching for contracts because they are not used to the competitive processes involved. But with talk of enhanced services being procured differently, GP practices may need to be prepared to compete against more commercially oriented organisations not just for new work, but also for work which has traditionally been ‘bolted on’ to core GMS and PMS services. “GP practices of all kinds therefore need to be really ‘on their game’ when it comes to tendering for NHS services.” Hadaway has put together this 10-point plan for GP practices to help them prepare for new opportunities:
Play to your strengths.
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Before bidding or applying to be a qualified provider for a service, look carefully at your current set-up to examine whether you
are capable of taking the prospective work on. Bidding for the wrong service at the wrong time could prove costly.
Be clear. When submitting a bid for a contract, make sure you correctly identify the organisation that is bidding for
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the work, e.g. a GP partnership, an individual practice or a joint venture company. If successful, the contract will be awarded to the organisation named in the bid.
Prepare thoroughly.
Do your research. Forthcoming tenders are listed on the Supply2Health website at Supply2Health.nhs.uk, which also
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4
Commissioners will be looking for bidders who are well organised with all the right policies and procedures in place for good clinical
governance, health and safety and so on. Put together
contains details on contracts that
a core bid team to streamline processes and ensure
have been awarded. It is a good idea
everyone knows their role.
to designate someone within your practice group to check the website on a regular basis, particularly since there is often a relatively brief period of
time between the announcement of a tender and the initial deadline for bids.
december 2012 17
primary provider
tendering
primary provider
tendering
Follow the rules. The
5
tender process needs
Read the small print. Check and
to be followed to the
check again the terms of the
letter, especially when it comes to deadlines.
9
proposed contract when it is issued at the invitation to tender stage. As with step eight, getting good quality legal advice at an early stage will
ensure that you know what your obligations will Carry out due diligence. To ensure there are no nasty surprises awaiting if your bid is successful, it is
6
be under the contract and whether you can get out of the contract if the service is no longer viable for you.
crucial to make formal inquiries and investigations into the liabilities that you will be taking on, particularly when it comes to property and staffing.
Establish your base. When bidding for a contract, make sure you know where the service will be provided from. If it is an existing property of yours, ensure it meets the requirements for the service. If it is a property provided
7
by the commissioner or if you will have to take on an existing lease from the previous provider, get proper
legal advice on the terms and ensure they will enable you to do the work you are bidding for.
Consider staffing issues. If you are taking over an existing service or part of one, it is likely that TUPE – Transfer of Undertakings (Protection of Employment) Regulations 2006 – will apply. As a result, the employment
8
contracts of the employees providing the service will transfer to your organisation, as well as any liabilities relating to those transferring employees or arising from the acts and omissions of the existing service provider. TUPE transfers can
result in a wide range of issues too complex to go into in detail here. It is vital to get professional legal advice at an early stage.
18 december 2012
Don’t get yourself trapped. If you feel at any stage that a particular contract is not for you, particularly if numbers
10
eight and nine above have thrown up serious issues, do not feel afraid to walk away from the bidding process. While this may result in some time and resources being lost, it is better to cut your losses than take on something that could seriously damage the rest of your practice. n
primary provider
top tips
Flu season top tips With the Government’s recent push to increase uptake of flu jabs for at-risk groups, practices on the front line are tasked with putting the initiative into action. Follow our top tips to get you through the flu season – they’re not to be sniffed at
Get up to date
The Department of Health has released a checklist to help GP practices increase vaccine uptake among clinical risk groups. This includes ensuring all registers are up to date and maintained, such as a register that can identify all patients in the under 65s at-risk groups, those who are over 65 and pregnant women. Practices are expected to maintain this database and update when women fall pregnant so become eligible for the vaccine, or make a note when a patient receives it from outside of the practice, i.e. some employers offer to pay for the service through private providers etc.
Think outside of the box
To really boost your chances of increasing uptake of the vaccine and cashing in on those allimportant QOF points, consider whether your practice could offer the service outside of your usual opening hours, for example on a Saturday or during the evenings. This will help combat the ‘I didn’t have time’ excuse, making the service far more accessible.
Don’t take no for an answer
If your at-risk patients aren’t responding to letters or phone calls requesting them to come and get the vaccine, have you considered a home visit? This may not always be necessary or desired, but for patients who are less able-bodied or have mental health or clinical issues that make it difficult for them to come to the practice, a domiciliary visit may be the best solution. This will again require good management of data so that these patients can be easily identified and dealt with accordingly.
Information is power
Informing patients of the importance of the flu vaccine for certain groups of individuals is a good way of encouraging them to be proactive about getting the jab. Including information leaflets with prescriptions that identify who is considered to be at-risk – in clear and concise terms – will help get the message across to busy patients. Some practices stamp repeat prescriptions with ‘Don’t forget to have your flu jab’ or include a copy of the ‘Is Your Child at Risk?’ leaflet. Last but not least, don’t forget your own staff – including a reminder on their pay slip is effective, as you can almost guarantee it will be read! n
20 december 2012
Consider whether your practice could offer the service outside of your usual opening hours
primary provider
enhanced services
Boostin g t he bottom l i n e With the very real possibility of a lean year ahead, it’s worth looking into extra services that can improve your practice’s profitability. GEORGE CAREY investigates the opportunities and how to incorporate them into your practice
A
gainst the backdrop of £2bn in NHS cuts and the threat of a tripledip recession, practices are rightly concerned about prosperity in the near future. According to a survey of 167 GPs conducted by BDRC consultants on behalf of Lloyds TSB Commercial between October 2011 and January 2012, 91% expected financial pressures to increase. A total of 73% said they expected practice profits to decrease. In addition, chair of the GPC, Dr Laurence Buckman, recently wrote a letter to practices, warning them to prepare for a tough 2013. This was the result of the committee’s estimation that practices could face a £31,000 gap in QOF funding next year unless they work much harder under the Government’s proposed contract deal for 2013/14. The figures from BMA analysts show the average practice stands to lose £11,000 in QOF income under government proposals for QOF thresholds to increase in line with the upper
22 december 2012
quartile of average current achievement, and achievement remains the same. It also shows the average practice stands to lose £20,000 from the removal of the organisational points in QOF. With these issues in mind, it’s more important than ever for practices to look at new ways of maximising their profitability. Offering extra services is a great way to achieve this and could also boost the reputation of your practice.
Delectable diversity There is a vast array of services that an enterprising practice can offer its patients. Those that are most commonly offered include provision of child minder health forms; paternity tests; completing reports for insurance applicants; serving as an expert witness; writing character references; and providing certificates for drivers. All of these services can provide a much-needed boost to practice profits but need to be
properly considered, to ensure that they are a good fit for your practice and that you are approaching the process correctly. It’s also important to consider the tax implications of any profits made from these new procedures, to ascertain if the extra effort is worth it after deductions. A fundamental decision to make before you start offering these services is whether the income from the activity will be kept by the partner carrying out the work, or put towards the practice’s income. If you take the decision to treat it as personal income then you must establish how the partnership will be compensated for the use of resources, staff time, stationery, and space. A contribution of around ten per cent to the business would usually be appropriate, unless there are any services that put a particularly high demand on resources.
GPs could face a £31,000 gap in QOF funding next year The price is right As with any product, pricing is of vital importance, so it’s worth doing your research beforehand to make sure that you are offering value to patients, while making it a cost-effective use of your time. Think about realistic rates for the preparation of reports. If seeing a patient and completing the report would take you one hour, consider how much it would cost you to hire a locum for that time and base it on that. In addition to this, consider any time taken for administrative staff to process the report. On the subject of pricing, beware bullying insurance companies. These are notoriously parsimonious organisations, but if you don’t feel that what they are offering is sufficient, don’t accept simply to secure the work. This is where proper cost planning is crucial, because trying to agree an increased fee after the work will not end successfully, so you need to assess the time likely to be involved before you start. Supplying electronic notes can sound like a simple procedure, but it takes time to keep them updated and ensure that there is no confidential information left in.
december 2012 23
primary provider
enhanced services
Once you have settled on a realistic price for a service, it’s imperative that you publish your prices clearly and accessibly. Place a pricelist somewhere prominent in the practice, ideally the reception, so there can be no ambiguity about prices at a later date. If your practice is VAT-registered you should charge an extra 20% on top of the fee, where appropriate, for VAT. If you are at all unsure when to charge VAT, check with Inland Revenue. Assuming that these services become a successful part of the business and are long-running, it’s important to regulate prices, ideally with an annual increase. As a rule, it tends to be easier to increase the rates by a small percentage each year than to attempt large increases on a more sporadic basis. The annual review is also an ideal time to discuss prices with everyone in the practice and to ensure charges are being applied consistently. On the subject of pricing, it’s also important that you are charging for private prescriptions when applicable. While non-dispensing practices should charge for private prescriptions, some dispensing practices may decide to offer this free of charge if they can make a profit on the drugs supplied. It doesn’t matter what form of remuneration you opt for, as long as your practice doesn’t foot the bill. Some work is less worthwhile than others, and a good example of this is countersignature of passport application forms, which may not be work worth doing. A fundamental problem with this type of work is that it can be difficult to decide on an appropriate charge, because they don’t actually require specialist medical
24 december 2012
knowledge. The forms are regularly sent back for seemingly trivial problems, such as signatures that creep outside the preprinted box. Also the disclosure of your own passport number on the form may create a risk of identity fraud.
Getting paid
Place a pricelist somewhere prominent, so there can be no ambiguity about pricing later
As businesses that are generally government-funded, practices may find it a shock to realise how lengthy and painful the payment collection process can be. That’s why it is best to separate doctors from the payment process and remove the need to ask for payment in the consulting room. Patients should always be informed how much they will be charged for a report before they arrive, and the reception staff should deal with payment. If the issue of remuneration is left until the consulting room, some physicians may get a pang of hippocratic guilt and be reluctant to ask for payment. Then administrative staff can be left wasting valuable time chasing payment. It is far simpler for all concerned if payment is upfront. As with pricing, this requirement should be well advertised, prominently in the reception and waiting room. There is a lot to consider when looking into these new services but with the right preparation and safeguarding, they could make the difference between a lean year and a comfortable one. It’s crucial to discuss these extra provisions at length between the partners and perform a cost analysis on every proposed service. With the right level of foresight and efficient administration, they can be just the shot in the arm that you’ve been looking for. ¾
Photo: Jason and Bonnie Grower / Shutterstock.com
primary provider
enhanced services
ADVERTORIAL
people
practice profile
Friends in the know
one to ones with the people that matter
CARRIE SERVICE meets practice manager and chair of the West Sussex Practice Managers’ Association, JO WADEY, to talk about how the role has evolved and how staff and patients are the driving force behind improvements at her practice
J
o Wadey, practice manager at St Lawrence Surgery in Worthing, has been in the NHS for over 25 years, having originally trained as a medical secretary. She has worked in secondary care and at a PCT and joined the St Lawrence Surgery six-and-a-half years ago. As a member of the National Practice Manager Network and chair of the West Sussex Practice Managers’ Association (WSPMA), Wadey knows better than anyone the importance of having a good network of like-minded practice managers to turn to for support. The WSPMA has proven popular in the area, with around
26 december 2012
90 members to date, and has been given £15,000 from the PCT to fund its seminars and workshops. The association has recently launched an induction programme providing training and support for PMs who are new to the role. So far it has been well received. “Last week was the first one and the evaluations were brilliant,” Wadey says, “because people come into this role and they need to learn so much.” With the NHS now demanding more and more expertise around the business side of running a practice, a great many are taking on people with backgrounds in business and finance – but with little knowledge of the NHS.
Wadey believes that training and induction programmes are vital in filling this gap to better prepare the new breed of practice manager for the job: “The role has always been evolving but I think in this last year or two significantly – and CQC registration as well has caused practices a lot of anxiety and extra workload. With that and clinical commissioning, there are lots of practice managers getting more stressed.”
Valuable input With the NHS in turbulent times and primary care bearing the brunt, Wadey stresses the importance of keeping staff
in the loop and ensuring they feel valued. With this in mind, she uses staff appraisals as an opportunity for people to put forward their ideas for improvement at the surgery – after all, they know better than anyone how small changes can make a big difference: “We write a business plan every year based on several elements. The partnership and I sit down to discuss the annual patient survey results, what the financial situation is and what our staff feel about the practice and the way forward. For example how we can continue to strive for excellence, and create efficiencies within the practice. The staff and patients come up with some really
good ideas.” The practice has six-monthly meetings where every member of staff is present so that any issues can be raised. One simple management tool that has proven popular with the staff at St Lawrence is the ‘90-second update’ email that Wadey sends out to all staff every morning. This is a short, to-the-point bulletin email that gives a quick run-down of what is happening that day – for example, if there is a locum doctor coming in; if any visitors are expected and the number of appointments for the day. This keeps everybody informed and takes next to no time to complete each morning.
december 2012 27
people
practice profile
people
practice profile
Patient power The surgery has a strong relationship with its patients and a very proactive patient participation group – Friends of St Lawrence – which organises numerous events for patients. At a recent community event organised by the group, one patient was overheard comparing the surgery to a community centre. On a tour of the practice, it’s easy to see why they felt that way. Student artwork and a colourful beach-hut play area brighten up the waiting room and the ‘education room’ – a spacious meeting room with its own kitchen, interactive whiteboard and separate access and toilet facilities – means the surgery can host a range of activities, including a Tai Chi class; a recentlylaunched walking group; and, at some point in the near future, a singing group.
Call for action So how can other PMs, inspired by the work of the Friends of St Lawrence, improve their own patient participation? Wadey suggests email as a good way of keeping in touch with busy patients and also those who can’t always come into the surgery. “We’ve got NHS.net distribution for our patients and we have a virtual patient reference group as well as a participation group,” she explains. “We’ve had someone with bipolar [disorder] on there, someone with agoraphobia, someone who has to care for someone with mental health [and] dementia problems. So people who can’t get down to the surgery and come to meetings – or don’t feel comfortable to do it – are still able to give their opinions from home.” To really benefit from a patient email database, Wadey advises that practices delegate a member of staff to be responsible for maintaining it, so that it is always accurate and up to date. If you’re trying to boost your PPG numbers, getting clinical staff to push the agenda is an effective way of convincing patients to get involved. “Get a GP or a nurse or a health visitor to actually ask someone personally – if you just put notices up and send letters out it’s not as personal as a doctor saying: ‘Do you know what, I think you’d be really good in our group,’” says Wadey. Having a clinician explain to the patient that the group isn’t just about fundraising and is a vital part of improving services could also improve uptake. “The GPs really have to be on board – and the practice nurses,” she adds. “When we have our PPG meetings I always go, but I always
28 december 2012
People who can’t get down to the surgery and come to meetings – or don’t feel comfortable to do it, are still able to give their opinions from home get a GP to come too. It’s only an hour and a half in the evening and the patients feel that they are being really appreciated and valued.”
A self-care mission Wadey’s next project is to encourage patients to manage their own health to reduce unnecessary appointments. “I’m on the locality for Worthing and I’ve been looking more at the Self Care Forum, how patients can access healthcare professionals most appropriately,” she tells me. Part of this drive involves teaching clinicians how to empower their patients by giving them sufficient information about their ailments. “Often GPs will say: ‘Oh yes it’s a chest infection, I won’t give you any antibiotics but if it gets worse come back and see me,’” explains Wadey. “But what they don’t say is it could last for three weeks and antibiotics might not make any difference. We don’t always tell or give patients enough information to empower them to self-care – so of course patients often come back.” Wadey hopes a new onsite pharmacy will help the initiative and has been working with the pharmacist to improve patients’ management of minor ailments. The pharmacy is open from 8am to 6.30pm, mirroring the surgery’s hours, and also features a machine for patients to take their own blood pressure (there are also a number of these located around the surgery itself). If Wadey and her team can get patients and GPs to take note, she believes it could have a real impact on the future of healthcare in the area: “The Self Care Forum has said that 20% of patients go to GPs for minor ailments – the top ones being back pain, sore throats, chest infections, eczema, that sort of thing – when actually they can look after themselves at home. We think if we can try to manage the demand in Worthing it will help the everincreasing demands on GP practices and hopefully this will have a knock-on effect and reduce the number of A&E attendances – and maybe even emergency admissions.”
fast facts Practice St Lawrence Surgery, Worthing Manager Jo Wadey Time in role Six and a half years Number of patients 13,500 Number of GPs 10
C us on to ta da ct y
“P quo BS ti U ng B6 r ” efe to r qu enc al e if y
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people
case study
A healthy future A growing Taunton medical centre has relocated to larger premises and invested in new facilities following a ÂŁ1.7m loan from the bank. JULIA DENNISON speaks to senior partner DR WILLEMIJN BALDER to find out why Creech Medical Centre needed to move and how they went about securing the funding for a new purpose-built practice
30 december 2012
C
reech Medical Centre is a small but well-established GP practice in Creech St Michael, outside of Taunton. The twodoctor surgery has a long history of delivering healthcare to the local community and is a familiar sight in the Somerset village. “There’s been a practice here, well, forever – well, not forever, of course, but as far [back] as we know,” says senior partner Dr Willemijn Balder, who runs the practice with one other partner. When she joined as partner in 2002, she had visions of bringing the long-existing practice into the 21st century, but its 1980s building at the time was cramped, aging and holding her and her team back. “It wasn’t at all fit for purpose,” she explains. “It was small and pokey, with not enough rooms and no facilities for disabled people. [It had] one loo for everybody, including the staff and the patients. We really, really needed a bigger place because we’re growing, you see.” Indeed, the surgery has developed significantly since Dr Balder took partnership, becoming one of the area’s fastest growing medical practices with over 3,000 patients now on the register, which proves a challenge with only two doctors. To help service this expanding patient base, the practices’ partners decided to relocate to larger premises, allowing them to increase the number of patients they care for, as well as clinicians, and offer a higher standard of amenities. Once the PCT was happy for the practice to move, the practice went on the lookout for a new location.
Work in progress
fast facts Practice Creech Medical Centre Patients 3,226 Partners 2 Nurses 2 Additional clinical staff 7 Practice staff 7
After struggling to find an existing building that would facilitate the centre’s needs, the team decided to purchase an area of land about half-a-mile away from the old practice and build the new centre from scratch. The practice had initially approached a surgery investment firm, which had gone so far as to secure an architect when Dr Balder had a change of heart. “The plans were quite far along; we had planning permission,” she says of the plan to use the firm. “Then I decided I wanted to buy instead of lease because a lease is something that ties you in for a long time, and I was a bit nervous about that.” But in order to purchase the land and build on it, the practice needed capital funding. For this, Dr Balder approached her banking partner, Lloyds TSB Commercial, which, a few business plans later, provided the £1.7m loan needed for the project. Once the money was secured, building work began in October 2011. The partners and their team had say in the architecture and build of the new structure, as did the PCT, which funds the repayment of the loan. “There are lots of general rules about what you’re supposed to have – like a nice big reception, and so many consulting rooms, nurses’ rooms and a staff room upstairs,” Dr Balder explains of the new build. Once a plan for the layout was set, her and her partner “tweaked it and fiddled with it” until they were entirely confident that the building would suit the needs of their patients. Soon, building work was underway. All went smoothly enough for the project to be completed ahead of the centre’s official launch in September of this year. The endresult is a modern practice that is entirely fit for purpose. The new building boasts four large consultant rooms, multiple nurses’ rooms and a conference room. It has the capacity to cater for up to double the amount of patients currently on roll at Creech. It also includes space for a midwife, physio, dietician, chiropodist and health visitors. “We have a whole group of health visitors upstairs, where we only used to have one,” Dr Balder explains. The newly opened surgery has space for an onsite pharmacy as well as treatment rooms for a
december 2012 31
people
case study
people
case study
We’re just a nice little surgery that now can become a nice big surgery number of new services and facilities. To take full advantage of its new site, the practice plans to launch more services and is considering renting rooms out to other healthcare providers. “We don’t want to rent to anyone, of course,” Dr Balder is quick to add.
A stellar result All told, the partners and their team feel proud of what they have achieved. “Creech Medical Centre has come a long way since it first opened as a small practice,” says Dr Balder. “All the partners and staff have worked tirelessly to grow it to the position we are in now and the relocation is a crucial step in ensuring that we offer the best possible service to our patients.” For her, the larger premises means the practice not only has bigger space to work in, but staff are able to operate more efficiently. There’s now plenty of parking too, which has undoubtedly contributed to the fact that the patients are happy with the new set-up. “They like the new centre; they’re quite pleased with it,” says Dr Balder, adding that, lucky for Creech Medical Centre, none of its patients felt the need to move practices during the upheaval. Dr Balder has high hopes for getting her already increasing patient list that little bit closer to the 6,000 mark. “We are growing a
32 december 2012
little bit more, we hope and think,” she says. “It’s a bit early to tell, of course, because we’ve only been here three months.” Reassuringly, in this short period, she has already noticed a slight uptake in patient registrations, which is exactly what the practice had hoped would happen when it decided to start afresh. More practically, the new building also puts the practice in good stead for CQC. “I think we should be fine,” says Dr Balder of the inspection process. When it comes to preparing for CQC, she’s fairly sceptical: “It’s not going to make us a better surgery or a better practice; it’s just a hoop we have to jump through.” She also has no plans to take part in commissioning, if she can help it, as she believes it’s important for her to focus on where she’s needed. “The doctors who do that have to cut back on their hours,” she says of commissioning, “nobody can do that alongside their job.” As this doctor celebrates ten years as partner, she looks forward to the next decade with more confidence. “We’re just a nice little surgery that now can become a nice big surgery,” she says. “We want to grow and have more patients,” she continues. “Depending on how well that goes then we can get another doctor in that would be great. Otherwise, I don’t want to do any other particular medical things. I just want to be a GP.”
management
GPES
business intelligence and management sense for practice managers
S AY I N G Y E S TO GPES
GP patient records offer the most complete picture of a patient’s health. Soon the General Practice Extraction Service (GPES) will be coming to every practice in England to ensure these records can be used safely and securely to support improvements in care. The Health and Social Care Information Centre explains what it will mean for practice managers
34 december 2012
N
ine out of ten patient contacts with the NHS take place within primary care. Yet, despite the wealth of information practices hold, relatively little of it is available centrally to support initiatives for improving patient care. That’s because different practices use different GP computer systems, each with their own technical structure and means of recording patient data. Up till now that has created an almost insurmountable barrier to creating a standardised picture of patient care. However, all that is about to change. The Health and Social Care Information Centre’s General Practice Extraction Service (GPES) is currently being incorporated into the GP clinical system of every practice in England by the practice’s system provider. When up and running, it will provide
General Practitioners.” One of the first beneficiaries of GPES will be the Learning Disabilities Observatory (LDO), which is running a project to provide better information on the health outcomes of people with learning disabilities. One of their first goals is to use data from GPES to ensure more people with learning disabilities take up invitations to be screened for bowel, breast and cervical cancers. “GPES is the most exciting data prospect for a decade,” said professor of public mental health at the University of Durham and LDO co-director Gyles Glover. “It will give us an opportunity to use the huge wealth of information currently sitting in the electronic filing cabinets of every GP practice in the country to help deliver real improvements in care for people with
a centralised data query and extraction service that will remove the complex scheduling processes now in place and reduce the burden on practice staff. The first major role for GPES will be as part of the new process for providing payments to GPs and clinical commissioning groups. This will see GPES extract the Quality and Outcomes Framework data needed to support payments to GPs from April 2013 (although GPES won’t be responsible for calculating or making the payments). “GPs and practice managers have been involved every step of the way during our development of GPES,” says Health and Social Care Information Centre (HSCIC) chief executive Tim Straughan. “Their involvement has been absolutely crucial and very much shaped how the service will run. “We know that patient confidentiality is a prime concern and practices’ commitment to safeguarding that has been a driving principle behind the information governance arrangements we have in place. “Practice representatives sit on the independent advisory group that vets all applications to have data extracted by GPES. We have also designed the system so that practices can opt in and out of extracts as they see fit.
learning disabilities. “We don’t want to know about individual patients. Instead we need to know how many people on GPs’ registers have a learning disability so that we can analyse their care needs. “Our initial focus will be on uptake of vital screening checks. We will analyse how many patients with a learning disability are taking up the offer of a check and compare that nationally. “This will enable us to pinpoint places where people with a learning disability are not accessing these checks, so that local practices can review the way they deliver these services to ensure they meet the needs of a group of patients who may not be able to respond if a practice gets in touch with them by letter.” Practice manager Steve Humphreys says that practices will be able to incorporate GPES into their day to day routine easily. Humphreys, who works for The Garden City Practice in Welwyn Garden City, was part of an advisory group set up to help the HSCIC develop aspects of the way GPES will appear on practices’ computer screens. “Practices need to understand that only information to support health improvements will be extracted by, GPES,” he says. “In practical terms, extractions should
“All this is in clear recognition of GPs’ role as data controllers for their patients’ medical records and we’re delighted that GPES has received the backing of the ethics committees of the British Medical Association and the Royal College of
take no more than a couple of minutes and I think that with the right reassurances, practices will be happy to be part of it.” For more information, go to www.ic.nhs.uk/gpes
GPES facts 1.
GPES is coming soon to all general practices in England and these practices need to be ready to go live in April 2013.
2.
GPES will be part of the service that replaces QMAS and will extract Quality and Outcomes Framework (QOF) data from April 2013.
3.
Your system supplier will work with you to integrate GPES with your practice’s IT system so you should have no difficulty sending your QOF – or any other – returns.
4.
GPES will also be used to extract patient-level data (both anonymised and patient identifiable) for other purposes too – but only when they fulfil stringent information governance criteria and will support better health.
5.
GPES’s rigorous information governance processes have been approved by National Information Governance Board and the Medical Ethics Committees of both the British Medical Association and the Royal College of GPs.
6.
GPES has been set up to support GPs in their role as data controllers, enabling them to opt in or out of extracts.
7.
Before it goes live, practices will be able to download an information governance pack that contains all the documents needed to comply with the Data Protection Act when your practice uses GPES.
8.
Induction materials will be available online from February 2012 to help you familiarise yourself with the system before it goes live.
9.
Your practice will need to update its Smartcard to the spine by contacting the registration authority within your local primary care trust.
10. Practices will need to give patients information about GPES. An online pack with materials to help you do this will be available before GPES goes live.
december 2012 35
management
GPES
management
premises
MANAGING ASBESTOS Asbestos could be present in any building that was built or refurbished before the year 2000, therefore management of the substance should be something that every practice manager working in a 90s building or older should be aware of. PRACTICE BUSINESS provides a rundown of what is involved
First things first In the first instance, a survey should be carried out to determine whether or not your practice actually does contain asbestos. If you’ve recently taken over at a new practice or have changed premises, this is probably wise, especially if you are likely to be the nominated duty holder. The Health and Safety Executive, which provides a wealth of information on the management and identification of asbestos, says: “People responsible for maintenance of non-domestic premises have a ‘duty to manage’ the asbestos in them, and should provide you with information on where any asbestos is in the building and what condition it is in.” So if that person is you, be sure to check how the issue has been managed before you arrived. If there is insufficient information available and you suspect asbestos may be present you should have the area surveyed and representative samples of the material analysed – especially if you are planning on carrying out building work. Alternatively, you can assume that any material you need to disturb does contain asbestos and take the appropriate precautions for the highest risk situation.
The dutyholder Every public building containing asbestos should be assigned a dutyholder – the person who has the ‘duty to manage’ any asbestos present. This person is not required to organise removal of the asbestos (in fact, this is not recommended as it would do more harm than good in most cases). The duty holder (according to regulation four of the Control of Asbestos Regulations 2006) is required to: n take reasonable steps to find out if there are materials containing asbestos in non-domestic premises, and if so, its amount, where it is and what condition it is in n presume materials contain asbestos unless there is strong evidence that they do not
36 december 2012
n make, and keep up-to-date, a record of the location and condition of the asbestos containing materials – or materials which are presumed to contain asbestos n assess the risk of anyone being exposed to fibres from the materials identified n prepare a plan that sets out in detail how the risks from these materials will be managed n take the necessary steps to put the plan into action n periodically review and monitor the plan and the arrangements to act on it so that the plan remains relevant and up-to-date n and provide information on the location and condition of the asbestos materials to anyone who is liable to work on or disturb them. Asbestos regulations are enforced by the local authorities and the Health and Safety Executive. With this in mind, it is important that anybody planning to complete work on the premises who could come into contact with asbestos is properly trained and has documentation to prove that this is the case. If you are unsure whether or not asbestos is something your surgery should be concerned about, it is worth visiting HSE.gov.uk for more information and advice.
If there is insufficient information available and you suspect asbestos may be present you should have the area surveyed
ua ce lif y
C us on q “P uo to ta BS ti n U g da ct B6 r e ” f to er y q en
PracticeBusiness november 2012
2012 s december PracticeBusines | issue 87
Practice solutions business rs inspiring e manage tic ac pr for
inspiring bu siness solut ions for practic e managers
| issue 87 dec 2012
november 201 2
The road to long-term health
LTCs | PraCTiCe Pr | ComPeTiTion
itions
cond e | pay and
ice incom nals | pRact
FoReign natio
t to Reaching ou s the outsider
Practice
are you doing enough to tackle chronic conditio ns?
it tices when ired of prac What is requ ing foreign nationals at tre comes to
Subscribe now receive months free
ost self a bown, what Give your are do
e profits se When practic offer to inrea es can you extra servic e? om inc
Don’t sell yo
iness is an Practice Bus ner with... approved part
Promoting you
urself shor
r services to the
ComPetition
CCG
Clause how to stand a chance against corporate prim ary providers
t
Practice Busin ess is an approved partn er with...
ade y, there’s no a pay upGr rk for less pa wo se With more ask for a rai for pMs to better time
As more care moves into the community, general practice faces a time of great opportunity and much challenge: increased competition, greater accountability and a need for strategic, top-quality business management. Practice Business supports practice managers with information-packed articles, the latest news analysis, best practice interviews and easy to read guides to all aspects of your role. All this can be yours free for six months - how’s that for best value?
020 7288 6833 subscriptions@intelligentmedia.co.uk @ www.practicebusiness.co.uk/subscribe/
*TERMS & CONDITIONS In order to qualify for a free subscription, the recipient must be a first time subscriber and be a finance, practice and/or business manager with purchasing authority at surgeries and practices in the UK or Ireland. For those who do not qualify log on to our website to subscibe for half price. For details or to subscribe contact Natalia Johnston on subscriptions@intelligentmedia.co.uk, +44 (0)20 7288 6833 or visit www.practicebusiness.co.uk/subscribe/
management
HR
The hidden cost of sick leave Increasing numbers of employees are on long-term sick leave caused by stress. Practice budgets can bear the brunt of it since managers may have to pay for temp staff or overtime. Employment lawyer MADELEINE THOMSON looks at the issue
W
ith the Christmas holiday season upon us, there is financial pain ahead for those employing individuals on long-term sick leave. Thanks to European law, employees in the United Kingdom can now save up holiday leave entitlement accruing to them while on sick leave and take it when they are well enough to return to work. They can also claim to carry over this holiday leave to the following
38 december 2012
holiday year for a reasonable time thought, following European cases, to be about three months. If the employee’s employment terminates during sick leave, they will be entitled to payment in lieu of holiday. So, if an employee has been on sick leave for a year and has a holiday allowance of six weeks per year, when they return to work the following year, they may be entitled to 12 weeks holiday leave.
ADVERTORIAL
CQC REGISTRATION
how dbg can help
ANDY SLOAN Andy Sloan is sales director at dbg and is responsible for increasing the value of the dbg membership base through the introduction of new and innovative products. With a passion for marketing and sales, he has a wealth of experience working for membership organisations, and is also registered with the Institute of Direct Marketing.
Special Offer If you take a CPD training session or risk assessment before the 31st December you can purchase dbg membership for a reduced price of £50.00 + VAT (saving £280.00)*
*Annual membership is usually priced at £330 + VAT, offer is first year only
As of July 2012, NHS GP practices across England have been required to begin the process of CQC registration, with inspections expected to commence from April 2013. With so many regulations for GP practices to consider, and so many different ‘boxes to tick’ it can be hard for practice managers to keep on top of absolutely everything. In many cases when CQC inspectors find a failing, the lack of compliance is normally as a result of lack of understanding on the part of the practice, and not on any grounds of wilful neglect. This is why it’s so important that as a practice team you fully understand the regulations and how they specifically apply to your practice. Without careful planning and thought, it can be all too easy to miss something out, only to have CQC inspectors pick up on it on inspection day. Ask yourself, for example: Do you have full records of staff induction training and additional refresher training on all pieces of equipment in your practice? Do you have a suitable infection control policy for your waiting areas? Do you have a full set of up-to-date practice policies and written procedures? At dbg we can help you address all these questions and more besides, as we work together with you to bring your practice into full CQC compliance. We have over 20 years’ experience working alongside healthcare practices and are ideally placed to meet your practice’s compliance needs. As well as providing membership services to GP practices, we also work closely with dental practices as well. Because dentistry has been under CQC jurisdiction for over three years now, we have built up an incredible amount of experience that we can bring to GP practices, giving you the tools you need to pass your CQC inspection with flying colours.
At dbg, our members’ interests are at the heart of everything we do. Our friendly and experienced team work to provide an excellent level of service and support wherever and whenever you need it, and we will always go out of our way to accommodate your needs. In the world of CQC compliance, we offer a whole wealth of experience, drawn from years of helping practices meet their regulatory requirements. With dbg you can be sure your practice is in good hands. Following on from your self-assessment, you may wish to work with us further via a full on-site practice assessment to ensure that your responses are accurate and evidence can be validated for a formal inspection. Our expert team can then help you with any areas highlighted and provide a full analysis of any areas where there are gaps in your compliance. The assessment is designed to demonstrate to your practice team, your patients and the regulatory bodies that you are proactively working towards maintaining your obligations and compliance with the ‘Essential Standards of Quality and Safety’, as well as highlighting any potential issues that you will need to manage. At dbg, our members’ interests are at the heart of everything we do. Our friendly and experienced team work to provide an excellent level of service and support wherever and whenever you need it, and we will always go out of our way to accommodate your needs. In the world of CQC compliance, we offer a whole wealth of experience, drawn from many years of helping practices meet their regulatory requirements. With dbg you can be sure your practice is in good hands. Together, we can help make your practice perfect. For more information, call dbg on 01606 861 950 or visit www.thedbg.co.uk
management
HR
Stress fractures One of the major causes of sick leave is stress. Stress triggers are on the rise and just reading the news can be stressful at a time when few have confidence in their job security. Money troubles at home place domestic relationships under pressure. Anxiety and tensions heightened outside work can disable the ability to concentrate and cope with the normal demands of the workplace. Once an individual is diagnosed with depression, the employer is legally obliged under employment and health and safety laws to take steps to reduce normal work pressures and to offer support. Employers carry a financial and moral burden. If full pay is continued for a time after an employee goes on sick leave, it is often a difficult decision to curtail that arrangement, particularly when the employee is known to be depressed or anxious about money worries. Another cost is the hiring of temps or locums to cover sick leave. It is common for work colleagues to be asked to take on the additional burden of covering for their fellow worker and this can in turn cause colleagues to be stressed or unhappy about workload. There is also an issue of trust. Employees on long-term sick leave may neglect to apply for holiday leave if they are taking holiday while off sick, perhaps taking the view that a trip abroad is therapy for their illness and not really holiday. If it comes to the attention of the employer that the employee has gone to Spain for a fortnight and not applied for holiday, this can affect trust and cause the employer the administrative burden of an investigation if the employee disputes that the travel amounted to holiday. Where the illness qualifies as a ‘disability’ under the Equality Act 2010, the employer is normally obliged to obtain a medical opinion to identify what reasonable adjustments the employer should be considering making, to support that person so that they can continue or return to work.
Keeping to budget The current economic troubles mean employers should be looking to make their contractual terms and employment policies as recession-proof as possible. Policies that may have been sustainable in boom times may be impracticable now. If the employer pays over and above statutory sick leave, can they afford to do this and, if so, have they retained the ability to stop
40 december 2012
such payments? Does the sick pay policy set out how any discretion is exercised and, once exercised, the circumstances in which the discretion to pay sick pay will be reviewed and stopped and on what notice to the employee? Does the employer restrict the ability to carry over holiday from one year to the other and, for those on sick leave, is the ability to carry over restricted to the minimum holiday allowance permitted under statute, rather than any enhanced holiday allowance under the contract? If the employer operates a bonus scheme, is the entitlement to bonus moderated if the employee is on sick leave for a lengthy period of time? Are employers engaging in home visits? These are valuable to monitor the progress of the employee and to signal to the employee that they are of value so that a relationship of trust is maintained, conducive to honest discussions about the employee’s recovery and the likelihood of returning to work within a reasonable time taking into account the needs of the business. The employer should also consult regularly with their employees covering for sick colleagues to ensure that
they are not over burdened. The UK government is concerned about the way in which the European Court of Justice has interpreted the holiday entitlement of those on sick leave, and there is a conflict between the Working Time Directive and the UK’s Working Time Regulations. This is currently under review. Most employers though will wish to avoid legal disputes with employees about the interpretation of the conflict between UK and European law. Instead it is more pragmatic to communicate clearly with employees about the economic pressures that the employer is experiencing, what the employer can and cannot afford to do if an employee goes on sick leave and to maintain a regular and candid dialogue with the employee during sick leave. This must be done whilst ensuring that employment contracts and policies are able to withstand the current vagaries of European law and enable the employer to make decisions that are fair both to the employee and the stability of the employer’s business. Madeleine Thomson is head of employment law at Hamlins LLP
management
medicine for managers
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.
Seeing red In a regular series, DR PAUL LAMBDEN provides easy-to-read skill-ups on key clinical areas. This month: scarlet fever
I
n most period dramas, someone inevitably suffers from scarlet fever and, after a tempestuous course, more often than not, dies. It used to be a very serious infection but has become less severe over recent decades. Indeed the term ‘scarletina’, which was originally used interchangeably with ‘scarlet fever’, has now come to be used to describe the more recent milder form of the disease when it occurs. The infection is caused by a bacterium called streptococcus (for the more nerdy, it is actually a group A Streptococcus pyogenes). The bacterium produces an erythrogenic toxin (‘erythro’ means red), which makes the skin go flush. The bacterium attacks the throat and produces a number of other symptoms, including the characteristic red rash, headache, high fever, vomiting and swollen cervical (neck) lymph glands. The disease is most common in three- to 10-year-old children and is spread by aerosol (coughing and sneezing) and direct contact. Cases are more frequent in late winter.
42 december 2012
The appearance of the tongue and the rash usually betrays the diagnosis. Initially the tongue appears pale with red spots, which give it a strawberry appearance, although after a few days the whole tongue becomes red. The rash is fine and red and starts on the neck and upper chest. It later spreads more widely to involve the abdomen and the skin folds, appearing worse in the groins and the axillae. The rash characteristically feels like fine sandpaper. The temperature subsides after three to four days, the sore throat lasts the better part of a week and the rash fades after four to six days and may be accompanied by peeling of the skin, mainly on the hands and feet. The diagnosis is usually made from the history and examination. The rash is typical of the infection but some people are not sensitive to the toxin and do not develop the rash. In such circumstances, the bacterium may be identified from a throat swab. Treatment of the infection is with penicillin or, if the patient is allergic to penicillin, with erythromycin
medicine for managers
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or clindamycin. The temperature and sore throat can be treated with paracetamol or ibuprofen and the sufferer should be cooled to enable them to feel more comfortable. The recovery is usually complete within seven to ten days. Occasionally complications may occur and the patient may develop an ear infection, tonsillar abscess (quinsy) or a sinus infection. Less frequently pneumonia may occur and rarely meningitis. Of historical interest is the Dick test and vaccine. The test, developed in the 1920s by Gladys and George Dick, involved the injection of a culture of the toxin into susceptible patients. The result was a circle of red and swollen skin within 24 hours of the injection. Non-reactors were considered to be immune to scarlet fever. A vaccine was prepared from horse serum and was used to protect against the infection with some success until its use was overtaken by penicillin in the late 1940s. The test and the vaccine are not used these days. It is hard to believe how serious the disease actually was. It killed the composer Johann Strauss and it appears as a scourge in many novels and films. Its attenuation in the early 20th century was fortuitous and undoubtedly removed a childhood disease.
In most period dramas, someone suffers from scarlet fever and, after a tempestuous course, more often than not, dies
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2012
work/life
domestic abuse
Protect your patients:
advice for busy lives
IDENTIFYING DOMESTIC ABUSE
44 december 2012
According to the Crown Prosecution Service, nearly one million women experience domestic violence each year and two die every week as a result of it. What can GP practices do to tackle the issue and ensure that their patients don’t suffer in silence? CARRIE SERVICE investigates
D
omestic violence is on the increase – there has been a six per cent increase of reported cases in England and a seven per cent increase in Scotland since last year. A Kent newspaper recently reported that the county’s domestic abuse ‘one-stop-shops’, which offer support for victims, have seen an 18% increase in visits. Ashford experienced the highest increase, with a 125% rise from 75 visitors in 2010/2011 to 169 in 2011/2012. Some blame the recession for this increase, while others put it down to a rainy summer stopping couples going out. Whatever the reason, practices have a responsibility to look out for domestic abuse in their patients. But what are the signs and what should you do if you think you have identified a victim?
Spotting the signs Dr Sarah Jarvis, clinical consultant at Patient. co.uk, says knowing what domestic abuse looks like is just as important for staff as it is for GPs. “Victims of domestic abuse and their abusing partners may behave very differently in front of the GP than when they are waiting for their appointment,” she explains. “Abusive partners may insist on accompanying the patient to the consultation – less out of concern for the patient than from fear that their partner may speak out. In the consultation, they may appear to be solicitous towards the patient, while their guard is more likely to be down in the waiting room when they may not realise they are being watched.” Providing staff with training – from organisations like the IRIS (Identification and Referral to Improve Safety) programme – will help them spot the signs and provide them with the tools to take action.
Ask the experts Dianna Barran, chief executive of CAADA (Co-ordinated Action Against Domestic Abuse), recommends practices form strong links with local domestic abuse services. “Know who your local experts are,” she says, “don’t move outside your area of professional competence because there are typically experts in each area.” CAADA have recently collaborated with the Royal College of General Practitioners, the Department of Health, and the IRIS programme to produce a guideline document for GP practices on how to deal with domestic violence cases, called ‘Responding to Domestic Abuse: Guidance for General Practices’. Professor Gene Feder, RCGP domestic violence co-champion and project lead for IRIS, believes the document will provide practices with a much-needed point of reference. “Domestic violence is a public health concern and an RCGP clinical priority. GPs are increasingly aware of this, but many practices do not have clear care pathways for how to respond to victims,” he says. “Targeted at practice managers and clinicians, this guidance supports practices to respond appropriately and safely to women and men experiencing abuse.”
Appropriate action Although it is recommended that any suspicion of domestic abuse occurring with a patient should be reported to the GP, it should be noted that the GP should be a means of escalating the issue only. “The ideal situation is we want the GP dealing with the medical side of things, but identifying someone and referring them on to support via the appropriate services,” explains Barran. “They don’t want to get pulled into a longer-term support role – they don’t have time and nor is it their position to do that.” Ensuring you are aware of the support services available in your area and having direct contact with local representatives will prevent the GPs’ time being taken up with formalities, allowing the patient to receive the help they need as soon as possible. There may also be cases where there is a serious cause for concern and procedures should be in place to deal with these situations promptly. “There will be a small minority of cases which we would describe as high-risk,” explains Barran, “where somebody is being very seriously abused and they are at risk of serious physical and mental injury.” In these cases there are particular defined care pathways that should be referred to – and these are available in the CAADA’s guidance document.
Victims of domestic abuse and their abusers may behave differently in front of the GP than when they are waiting
Dr Sarah Jarvis recommends practice staff look out for the following signs: n Does the patient you think might be a victim of abuse (usually, but not always, the female in a couple – men can be victims of abuse too) look anxious or on edge? Does she/he look instinctively to her partner when asked a question, as if in fear of giving the wrong answer? Does she/he apologise excessively for her/his behaviour? n Has a patient made an appointment for themselves, then arrived with their partner and allowed them to take the lead in checking in for the appointment? Abusive partners are often controlling of their partners. n Does the patient behave differently when their partner is around, seeming jumpy and on edge or reluctant to speak? n If the receptionist asks the patient if it is a medical emergency, do they look anxious and perhaps downplay their symptoms, suggesting they don’t need to see a doctor? n Does the patient show physical signs of abuse, such as bruising on the face, perhaps wearing dark glasses to hide it?
december 2012 45
work/life
domestic abuse
work/life
pay and conditions
Upping the stakes
Asking for a raise can be an awkward conversation in times of prosperity, but in this period of recession and cuts, it can seem like an insurmountable task. GEORGE CAREY takes the pain out of getting paid
I
n this tough economic climate, practices are, understandably, looking to keep costs down in every department and staffing costs are no exception. But It’s important to know that the hard work you put into your role as practice manager is appreciated and a huge part of that is being properly paid. Thinking that you deserve a pay rise and actually securing one are two very different things and approaching the partners for one can seem like an onerous task. If you go about it in the right way and prove your value to the practice, you can give yourself every chance of achieving a raise, so, how can you ensure that you give yourself the best chance?
46 december 2012
work/life
pay and conditions
Money can be a difficult thing to discuss in any situation, and the workplace is no different. Because of this, many people can become overly nervous at the prospect of approaching their employer for a raise, but if you enter negotiations with doubts in your mind, no matter how small, you are unlikely to come away with the desired result. A crucial part of going in to negotiations with the confidence you need, is knowing your worth in the practice. “Examine all aspects of your job and then do a little research to determine your value – both inside and outside the company,” says Dr Randall Hansen, founder of career development site Quintessential Careers. “Use a salary calculator or other salary sources and determine the salary range in your geographic area.” Another staunch advocate of ensuring that you have convinced yourself that you deserve a raise before approaching anyone else is stress specialist Helen Wingstedt. “It could be that they’ve actually been wanting a pay rise for years, even since their first job years ago, and now that they are in their forties, they don’t know how to go about it,” she says. “If that’s the situation, they’ll be in conflict with themselves and they’ve become reliant on their employer, so they’re not engaged proactively in the process, which creates negative stress.” Wingstedt’s approach to these sort of issues revolves around the concept of negative and positive stress; replacing the former with the latter by creating a strategy to achieve your goal. Key to this is breaking one big task down into lots of smaller, achievable, tasks; allowing you to dump stress every time a smaller goal is reached. Her advice in this case is to take a more proactive role and approach the problem a different way: “I tell people to ask themselves: ‘What do I need to do, to increase my pay?’ This puts you back in the driving seat, so you feel more in control.” She also thinks that some people’s anxieties around asking for more money could involve regression back to awkward childhood scenarios, which leave them feeling powerless. “They want more money, but don’t know how to put it to their boss,” Wingstedt explains. “The thought of asking for money takes their mind back to a situation, such as pocket money, when their parents controlled the purse strings and they had to justify their request. If people have negative experiences of that, they
48 december 2012
Examine all aspects of your job and do a little research to determine your value
bring it all forward and attach it to their current need for more money.” As hard as you will undoubtedly be working, there is always more that can be done and a new skill or the adoption of an additional regular task in the practice can be the type of thing that reminds your employer just how useful you are. Something as simple as taking a first aid course could make the difference, as knowing what to do in the initial seconds of an emergency, before a doctor arrives on the scene can prove a huge asset. Similarly, organising a patient engagement group is another duty that will not only show initiative but also gain the practice valuable extra QOF points, demonstrating a tangible benefit to the partners. Even if this approach isn’t instantly successful, going into discussions around salary with ideas will show that you are thinking about the practice as a whole and how you can help to improve it. If the initial reaction seems to be negative then suggesting a plan of action over, for example, a six-month period, will at least leave you with objectives to pursue in order to ensure you get the right result next time. Armed with renewed confidence in your abilities and ways of demonstrating your value to the practice, you should be in the best position possible to receive the reward your hard work deserves. Add in a few new skills and your plan for future months and you should be ready to enjoy yoyr new salary.
work/life
diary
Practice Business welcomes a different columnist each month to share their experiences and provide their view from the practice manager’s desk.
Practice Diary With the holidays on our doorstep, general practice blogger ANN BOYLE asks: How do you thank your staff?
ANN BOYLE is an anonymous blogger who started working in the NHS over 15 years ago as a receptionist and soon worked her way up to become manager for a large GP practice in the North. You can follow her blog at Beyondthe ReceptionDesk. wordpress.com
H
ow do you or your practice thank your staff? Do you tell them on a regular basis or keep it to once a year at Christmas? In my experience you will get far more from
people if they are shown thanks and appreciation and it doesn’t have to cost very much either. Here is how I used to say ‘thank you’ to my staff.
presents and work together on making sure it was a great shower. n If an older receptionist became a grandmother I would always send them a congratulations card. n If a member of staff was off on long-term sick I would always send them a get well card and tell them how much they were being missed.
Daily Basis
Yearly basis
n When I was leaving the surgery of an evening I would always take time to go into reception, ask if everything was ok before leaving and as I left always say: Thank you for all your help today.” n If I needed to go to one of the other surgeries to see one of the doctors or the surgery team leader I would always make a point of showing my face in reception – I always wanted to be approachable and let the receptionists know that I was always there for them. Again when I left to go back to my own office I would always thank everyone as I left.
n I would send a Christmas card to each individual member of staff thanking them for all their hard work throughout the year. To me this was very important to let each member of staff know how much I appreciated their hard work that year. n I would also get a personal present for each of the surgery team leaders at Christmas – just a small token but, again, to thank them for all their efforts over the year, and let’s face it I could not have done my job as well as I did without their support and hard work. n The practice would give the staff a Christmas party – usually in the form of a dinner dance – this really can keep morale going – and everyone was always on a high for a few days after – staff very much appreciated the practice doing this for them. n The practice would also give the staff gift vouchers every Christmas – again this was extremely kind of the partners to do this and again the staff always really appreciated this.
n At the end of any team meetings I would always thank everyone for coming.
One-off basis n When someone did something that stood out and was beyond their job description I’d get the staff partner to say ‘thank you’ in the form of a letter. This letter could then be put on their CV and used in their next appraisals (when again it could be brought up). This was not something that I did very often – so when a member of staff did receive a letter it was obvious that they had been praised for their good work. If the incident was appropriate and with the permission of the receptionist receiving the letter I would use the
If you would like to contribute to the diary page, please get in touch by emailing editor@ practicebusiness.co.uk
50 december 2012
incident in the next staff training. n If a receptionist was having a baby or getting married I would organise a baby shower and the receptionists would get together over lunchtime and have a good laugh. This was great for team work as they would organise the lunch, the
So, it does not have to cost a fortune to say thank you but it can be worth its weight in gold.
ua ce lif y
C us on q “P uo to ta BS ti n U g da ct B6 r e ” f to er y q en
PracticeBusiness november 2012
2012 s december PracticeBusines | issue 87
Practice solutions business rs inspiring e manage tic ac pr for
inspiring bu siness solut ions for practic e managers
| issue 87 dec 2012
november 201 2
The road to long-term health
LTCs | PraCTiCe Pr | ComPeTiTion
itions
cond e | pay and
ice incom nals | pRact
FoReign natio
t to Reaching ou s the outsider
Practice
are you doing enough to tackle chronic conditio ns?
it tices when ired of prac What is requ ing foreign nationals at tre comes to
Subscribe now receive months free
ost self a bown, what Give your are do
e profits se When practic offer to inrea es can you extra servic e? om inc
Don’t sell yo
iness is an Practice Bus ner with... approved part
Promoting you
urself shor
r services to the
ComPetition
CCG
Clause how to stand a chance against corporate prim ary providers
t
Practice Busin ess is an approved partn er with...
ade y, there’s no a pay upGr rk for less pa wo se With more ask for a rai for pMs to better time
As more care moves into the community, general practice faces a time of great opportunity and much challenge: increased competition, greater accountability and a need for strategic, top-quality business management. Practice Business supports practice managers with information-packed articles, the latest news analysis, best practice interviews and easy to read guides to all aspects of your role. All this can be yours free for six months - how’s that for best value?
020 7288 6833 subscriptions@intelligentmedia.co.uk @ www.practicebusiness.co.uk/subscribe/
*TERMS & CONDITIONS In order to qualify for a free subscription, the recipient must be a first time subscriber and be a finance, practice and/or business manager with purchasing authority at surgeries and practices in the UK or Ireland. For those who do not qualify log on to our website to subscibe for half price. For details or to subscribe contact Natalia Johnston on subscriptions@intelligentmedia.co.uk, +44 (0)20 7288 6833 or visit www.practicebusiness.co.uk/subscribe/