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The commissionning agenda

If the Health Bill goes to plan, the future of funding in the NHS lies with the CCGs and their commissioning boards at group area level and practice managers for individual practices – there will of course be some cross-over with PMs who also represent at board level. PCTs are now involving CCGs in NHS contracting, with a view to transferring functions in full by April 2013 (when the PCT will be completely abolished). But transferring of functions is happening now, with more advanced CCGs already powering forward and implementing strategy for commissioning. This year will see a high shift in funds transferred to CCGs with plans and outlines already in place. This is why it is important to begin discussions with CCGs now, and be in the minds of commissioning boards who will overlook budget transferring. Commissioning Success is leading the way to provide that communication path. With the implementation of commissioning in the NHS, the former PCTs will eventually slide away to be replaced by Clinical Commissioning Groups (CCG). The listening exercise earlier the year resulted in the changes to the levels of responsibility being placed at the CCG (then known as GP consortia) – at present a £60bn budget for primary, secondary and acute care will rest with the board members of the CCG, who will work under their respective commissioning board.

What is Commissioning Success?

e published Practice Business as the first monthly magazine of its kind for the health sector more than seven years ago and stands firm as a champion of anyone in a business, financial or management role in health. Commissioning Success, brought to you by the Practice Business team, is a magazine that supports individuals involved with the new commissioning agenda. The CCG agenda and the future of NHS funding means an increased opportunity for healthcare service providers and suppliers – a more fragmented point of influence, with more local knowledge, equates to a much bigger opportunity – the only challenge is finding a route to the decision-maker audience. That’s where Commissioning Success comes in.

We guarantee a captive audience for your marketing message. We have a dedicated team of health journalists in-house. Their focus is always on the best content for the CCG board audience. Coupled with our excellent specialist contirbutor list, the Commissioning Success editorial content is bang on remit and of great interest to the reader. Our strapline, ‘supporting excellence in healthcare’, drives everything that makes us unique and leading in this sector. We feature a host of editorial content to help decision-makers involved with CCGs choose the right options to ensure they do best by their patient population. From case studies to in-depth sector analyses, quick tips to news, Commissioning Success has all the information to help make those decisions,

whether they be financial, managerial or strategic in nature. The face of healthcare in the UK is changing, and will continue to change, Commissioning Success will walk the path with its readers, offering insight, support and information along the way, helping them to be at the very top of their game. At Commissioning Success, we ensure our on-target and meaningful editorial delivers a captive audience to our advertising partners. Associating with our publication in front of our captive audience will be crucial in delivering your marketing message to the commissioning groups. This means your marketing spend works harder by not only hitting the relevant people, but ensuring it’s placed within a framework that is extremely effective.

There is a difference between knowing who you need to reach and reaching them effectively

Commissioning Success UPDATE NEWS

UPDATE NEWS

NEWS The two operations directors of the NHS Commissioning Board Authority’s national leadership team have been named. Ann Sutton, currently chief executive of Kent and Medway PCT cluster, has been made director of NHS commissioning (corporate) and will be responsible for devising and overseeing the national framework for the NHS Commissioning Board’s direct commissioning responsibilities,. including specialised services, primary care, public health, healthcare for military personnel and their families and for offenders. While Lyn Simpson, currently NHS director of operations in the Department of Health, has been appointed director of NHS operations and delivery (corporate) responsible for NHS planning and performance, assurance of delivery by CCGs and national lead for NHS emergency preparedness, resilience and response. Ian Dalton, chief operating officer and deputy chief executive of the NHS Commissioning Board Authority, commented: “These two posts will provide the strategic leadership and oversight to ensure that we have a strong, innovative and patientfocused commissioning system that improves outcomes, tackles inequalities and supports the NHS in England to be the best it can be.”

North • Cheshire, Warrington and Wirral: Moira Dumma • Merseyside: Clare Duggan • Greater Manchester: Mike Burrows

• South Yorkshire and Bassetlaw: Andy Buck • North Yorkshire and Humber: Chris Long • Durham, Darlington and Tees: Cameron Ward. Midlands and East • Essex: Andrew Pike • Hertfordshire and the South Midlands: Jane Halpin • Leicestershire and Lincolnshire: David Sharp • Derbyshire and Nottinghamshire: Derek Bray • Shropshire and Staffordshire: Graham Urwin • Birmingham and the Black Country: Wendy Saviour. • London • London: Simon Weldon

Significant savings were made at Mid Essex Hospital Services NHS Trust by clinical and non-clinical teams working together to reduce procurement costs in the areas of reconstructive and trauma orthopaedics. Over £300,000 was saved in three months on hip products alone, with the final savings across all categories, including upper and lower limb, trauma and pulse lavage, forecast to be £500,000, representing a 28% saving.

National award for NHS Nottingham City CCG

Macclesfield GPs receive faster A&E updates

South of England • Surrey and Sussex: Amanda Fadero • Wessex: Debbie Fleming • Devon, Cornwall and Isles of Scilly: Ann James.

NHS Nottingham City Clinical Commissioning Group (CCG) was named BMJ Clinical Commissioning Team of the Year. Dame Barbara Hakin, national MD of commissioning development at the Department of Health, sat on the awards panel and said of the judging process: “We, as judges, were unanimous in our decision that the winners should be Nottingham City. They showed strong leadership, great organisational development and were really looking at an enormous number of areas where they could effect change. But most of all, what stood out for us was that they were already making changes and delivering better outcomes.”

East Cheshire NHS Trust’s A&E department can now collate and send clinical patient information to GPs electronically for all patients that attend the department. This development complements the eDischarge Notification Forms (eDNF) to GPs – a system that has helped them achieve an 84% compliance for meeting the NHS 24-hour communications delivery target. Patient information is input into Extramed (the operational management and coding system for all A&E attendances) this automatically generates a discharge letter, which is then stored and delivered electronically to GP practices across Cheshire, streamlined by Medisec Trust eDelivery software. Customer service delivery manager Debi Lees said: “Patients visiting their surgery after being discharged from our A&E Department the previous day can now rest assured their GP will be fully up-to-speed with their condition and any emergency treatment they may have received. This marks another significant step in our continuing drive to improve patient care.”

BIT OF BACKGROUND There will be 27 local area teams with staff working from a number of office bases across their geographical area. All local area teams will have the same core functions around CCG development and assurance, emergency planning, resilience and response, quality and safety, configuration, system oversight and partnerships and stakeholder engagement, with the senior leadership of the local area team participating as a full partner on health and wellbeing boards.

more involved A Family Doctor Association survey of 100 commissioning GPs showed that GPs want to be consulted at every stage of commissioning in a genuine two-way dialogue with CCGs. The study also found there to be a wish for democracy and genuine representation of practices and protected time for doctors to increase their involvement. Over 50% of GPs questioned felt able to influence their CCG’s decision making, but one in eight (13%) felt unable to do so and felt disempowered. There was also a clear desire for a fresh start. National chairman Dr Peter Swinyard said: ”The message to CCGs is clear. Talk with your member practices and listen to them.”

Poor hospital data threatens commissioning Hospitals in England are not supplying accurate patient data to the wider NHS, which could undermine GP commissioning, a report published by the NHS Information Centre claims. The report found that up to a fifth of data returns by hospitals and councils contained errors in patient records and cited the ‘reorganisation and reconfiguration of services’ as a factor leading to poor returns. On average, hospital trusts made errors in seven per cent of all data submissions, likely to have affected millions of patients’ data.

04 | SEPT/OCT 2012

Data management and technology plays a huge part in successful clinician-led commissioning. Here we look at innovations in managing information and IT that will help a CCG succeed at delivering care to its local population – whether it be procuring better machines for clinics or improving the back-office system used across your member practices.

IN ACTION CASE STUDY

DIARY 16-17 October Four Nations, One Challenge – Improving Patient Outcomes Manchester Central FMLMconference.com

SEND IN YOUR STORIES

We are always looking for local commissioning news. If you have a story to share, email editor@intelligentmedia.co.uk.

IN ACTION CASE STUDY

Clinical commissioning groups in the southwest have found strength in numbers. POLLY ELLISON looks at how federating has helped their smaller practices survive

he GP federation model adopted by Somerset Clinical Commissioning Group, although still evolving, must be one of the most successful approaches to commissioning being carried out around the country. A nominated GP from each federation sits on the CCG board, ensuring that each federation has equal representation, in the well-organised over-arching structure of the CCG. The key to the CCG’s success is in its recognition that the nine GP federations in Somerset differ from each other geographically, and that they have very different patient populations. In order to tackle this, each federation has adopted a different way in which they operate; a different working style and their aspirations vary tremendously from federation to federation. Recognising this, and supporting it, by allowing the appropriate management funds to flow through to local level, the CCG has empowered its GPs to become actively part of the commissioning process. One example of this is the South Somerset Healthcare Federation. The federation is made up of 17 practices serving 108,000 patients across a region from Langport to Yeovil, through to Wincanton. As Len Chapman, treasurer of South Somerset Healthcare Federation, explained: “What we have developed is a federation of the South Somerset practices, with our focus on the commissioning agenda, with a view to interacting with the Somerset CCG in order to do that.” Aiming to provide effective, coordinated commissioning and healthcare provision via existing and new services, the group is used to working together, having originally been a co-op providing out-of-hours services and part of

THE C O L L A B O R ATO R S

WyvernHealth, delivering practice-based commissioning. Those involved have a wide range of skills and local knowledge. They are also establishing close working relationships with other stakeholders in the area, such as Yeovil District Hospital Foundation Trust, Somerset NHS, Somerset County Council and Somerset Partnership. POWER TO THE PM The federation currently has a monthly evening meeting for GPs and practice managers plus a monthly steering group meeting to facilitate the implementation of agreed work plans. They are proposing a change to regular meetings of a smaller GPand practice manager-led working group, bi-monthly federation evening meetings and task groups as required for specific subjects. The federation holds educational workshops, such as a recent reablement programme, which gives the group more information on the new reablement service and telehealth and provides it with an opportunity to learn more about the aims of the joint NHS/local authority programme. Another development has been to assign practices to one of three working sub-groups to cover important areas of work, such as paediatric emergency admissions, zero- and short-length-of-stay admission, as well as identifying local commissioning priorities. The close working of the GPs with their practice managers is the key to success, as practice managers are involved in all that is going on. In some areas of the country, practice managers would not necessarily know who the GPs on the CCG board were, never mind being involved in working with them and assisting with the development of services. Tapping into the expertise of practice managers is so important as they form the essential link

SEPT/OCT 2012 | 17

COMMUNITY CARE SHARING SERVICES

SHARE ALIKE

Sharing services between practices sounds like a practical way of ensuring patients have access to a range of treatments in their local area. So why aren’t we seeing more CCGs implementing the idea? CARRIE SERVICE investigates

haring services should be easy and effective. In theory, a GP who is trained to provide a specific treatment should be able to provide this to anyone within the local community who needs it. It should be as simple as a couple of clicks on a mouse and a taxi to take the patient to the nearest provider. However, for one reason or another, this has not been the case for many. I spoke to David Thorne, chief executive of Newcastle West Clinical Commissioning Group, about the challenges involved in sharing services.

PRACTICALLY IMPOSSIBLE Newcastle West is a small but extremely proactive CCG for one of the most deprived inner city populations in the country. Thorne explains that although the group is well engaged they have still not managed to get around some of the practical issues that prevent practices from sharing services. One service that Thorne believes does have the potential to be shared is contraceptive implant fitting. Some patients may prefer to be fitted by a female GP and the CCG recognised the potential for the service to be made available to patients from outside practices where a female GP wasn’t

available. With this in mind, Newcastle West trained up around 30 of their female GPs in hope of allowing patients from practices in surrounding areas to use the service. However, the project didn’t achieve the level of success that Thorne believes it could have, and has now fallen by the wayside. When I ask why, he explains that there are practical issues that may seem trivial, but have a profound impact on the success of this sort of project: “The practical difficulties you always get with things like this are the clinical IT systems that practices have. We’ve only got 18 practices, but we’ve got four different systems and they don’t talk

to each other.” Not having a universal IT system across the CCG meant that medical notes could not be easily shared, creating a clumsy process that in theory should have been pretty straightforward. There was also the issue of payment and who should be acknowledged for having provided the service. “It’s always the same things that come up about systems, permission, and contractual issues around payment,” reflects Thorne. “It’s just the sheer complexity of the NHS and the arcane nature of the system. Can you get a £25 payment for putting that contraceptive implant in, even though it wasn’t your patient?” Another drawback that has made many wary of referring patients to a different practice is the danger of losing them altogether – do practices really want to risk sending their patients off to a GP that they might prefer? “That is a concern [of many],” says Thorne. “But in our practices it isn’t.” He puts this down to good teamwork and collaboration across the group. An issue that he believes does warrant some concern, however, is

transport: “Because most of our patients don’t own cars and they are on very low incomes, there are practical difficulties about how you get someone from one place to another. In theory, there’s no problem at all, we’ll get some kind of small contract with a taxi company to take people back and forth.” In practice though, this never quite came off, but Thorne stresses it is something that will have to be addressed for services to be successfully shared in deprived areas.

“Everybody knows what we want to do, but not how to do it” THE FUTURE Despite not seeing much success with it so far, Thorne does believe there is a bright future in sharing services; commissioners just need more time to tackle some of the practical issues involved. With authorisation taking up a great deal of time over the past six months, there has been little left over to spend on planning

26 | SEPT/OCT 2012

INFORMATION TECHNOLOGY DIGITAL COMMUNICATION

The myriad communication possibilities opened up by the power of the internet offer a cost-effective and relatively simple way for commissioning groups to release information and gain feedback from the patient population. GEORGE CAREY finds out what options are available

D I G I TA L D I S S E M I N AT I O N

rom surveys to digital services and social networking, there are now more ways than ever to inform and keep in touch with your patient population. While some elderly patients may have resisted the move to disperse more information through digital channels, this method is constantly increasing in popularity and will only do so at a faster rate in years to come. So what are the best ways to harness the internet to enable your commissioning group to benefit its patients? SURVEYS Surveys in healthcare are nothing new but the digital age has made them significantly easier to carry out. The entire process has been streamlined and the difference in costs is huge, with no paper or expensive postage to consider. Making patients aware of the surveys is now simple through email and the increased feeling of anonymity can result in a higher rate of survey completion and entirely uninhibited answers from those who do choose to participate. Collating the data has been simplified as well, with software

30 | SEPT/OCT 2012

new projects. “We’re frustrated,” he tells me. “We were making more progress on clinical projects last year than we probably are now. And we’re a very active group – although we’re small we have forty clinical commissioning projects going on at the moment.” As well as relaunching the contraceptive implant shared service, there are other projects that Thorne is hoping to see develop nicely after the storm has settled, including a new nursebased ENT service for syringing ears. This would work in the same way, with nurses based in peripheral sites so that if the practice nurse isn’t available that day, the patient can be referred elsewhere. What commissioners need now, says Thorne, is some success stories so that they can follow suit: “Everybody knows what we want to do, but not how to do it. It’s getting the right people together, going through it and cracking all of these permission issues and transactional-type boundary issues, and then using that in a way that you can replicate as a template for other specialties.”

SEPT/OCT 2012 | 27

INFORMATION TECHNOLOGY DIGITAL COMMUNICATION

MANAGING COMMISSIONING This section focuses on the logistics behind delivering better commissioning. It aims to help readers see through their commissioning plans succinctly and successfully. It focuses on budgetary issues, and ensuring CCGs make the most of the Government’s per patient management allowance. It also touches upon how to get the member practices of your CCG involved in commissioning and contribute their support.

Patients who are denied approved drugs by their local health trust should take legal action, Sir Michael Rawlins, chair of the National Institute for Clinical Excellence (NICE) wrote in the HSJ. He said “numerous trusts” were unlawfully denying patients drugs approved by NICE or were employing “delaying tactics” to save money and that this should not be tolerated. He gave the example of patients with retinal vein occlusion who would benefit from dexamethasone intravitreal implants, but many trusts have been refusing the treatment for financial reasons. There is also sometimes dispute between the PCTs and hospitals on who should pay for the treatment – often at the expense of the patient’s sight. Sir Michael called on campaign groups like RNIB to seek judicial overview to ensure rightful provision of the treatment. He also called on clinicians to “whistle-blow” on trusts failing to provide the drugs and treatments patients are legally entitled to.

SEPT/OCT 2012 | 05

COMMUNITY CARE

INFORMATION AND TECHNOLOGY

TRUSTS DENYING TREATMENT ARE BREAKING THE LAW

“New parents receive regular emails and text messages containing relevant and timely NHS -approved advice as their pregnancy develops”

available to analyse and interpret the information supplied at the click of a button and present it clearly and attractively in a range of different formats. It can then be distributed among all members of a commissioning group with ease to aid a discussion of the results. DIGITAL SERVICES The NHS has embraced the chance to enrich patients lives with digital services and a great example of this is the NHS Information for Parents service, launched in May. It gives new parents information and advice they can trust, covering a wide range of issues related to staying healthy in pregnancy, preparing for birth and looking after their baby. By signing up to the service, parents-to-be and new parents receive regular emails and text messages containing relevant and timely NHS-approved advice as their pregnancy develops and as their child grows. Links to videos showing midwives demonstrating practical advice such as bathing babies, and parents discussing issues that affected them and how they supported each other, will also be sent at appropriate times.

Launched in March 2012, Commissioning Success is the only commissioning title specifically targeted at helping CCG board members, participants in commissioning, and all related health networks and shadow boards manage the NHS reforms successfully. It is a must-read for anyone interested in clinicallyled commissioning. Whether they’re on a the board of a clinical commissioning group, participating in commissioning, a provider or interested from the sidelines, Commissioning Success magazine will help them stay one step ahead of the Government’s plans to give clinicians power over £96bn of the NHS’s budget. Commissioning Success is a unique proposition. It’s a focused publication for a focused audience; a management agenda magazine, with relevant and useful information covering all aspects affecting commissioning. Editorial is never sold, it’s written for the audience and not the sector suppliers – we make no apologies for that – because the more people that read it, the more beneficial it is to everyone.

JANUARY / FEBRUARY 2014

Lessons learnt from the New Zealand earthquake

LOOK, NO HANDS!

The benefits of voice recognition software

REDUCING ABSENTEEISM Conquer a perennial bugbear

ISSUE 10

The Commissioners in Action section focuses on movers and shakers and forward-thinkers in the clinical commissioning sector. It includes interviews with commissioning leaders and inspirational CCG case studies. Readers will turn to this section for a look at how other people in the rest of the country are undertaking the commissioning task and learn by example.

Community Care features articles and case studies surrounding improved clinical pathways in the community, as well as moves towards better integrated care and any examples of a CCG that is undertaking a specific project or method to see their commissioning through in their local community. This section also features best-practice articles on improving patient engagement and outreach, alongside success stories on how CCGs are tackling conditions in their local area.

CLINICAL CORNER

A cross-functional commercial and clinical team was formed that reported directly to the clinical director, CFO and COO. Bill Martin, consultant orthopaedic surgeon and lead clinician on the procurement project, said: “The initial worry that financial pressures would lead us towards accepting substandard implants or major inventory changes has not been borne out, and it was reassuring to be involved in the process as a surgeon.” The work is part of a wider programme of procurement cost reduction, led by procurement consultancy Inverto. UK MD Richard McIntosh said: “The results clearly demonstrate the power of clinical engagement and what can be achieved when you combine specialist procurement expertise, clinical and commercial expertise and the backing of the trust board.”

GP practices COMMISSIONING BOARD: KEY DIRECTORS APPOINTED want to be

FIRST LOCAL AREA TEAM DIRECTORS The first round of appointments to the 25 local area team director posts has also been made as follows:

COMMISSIONERS IN ACTION

LOCAL NEWS

CLINICAL ENGAGEMENT DRIVES MAJOR SAVINGS AT ESSEX TRUST

ISSUE 10

COMMISSIONING SUCCESS IS A QUARTERLY MAGAZINE AIMED AT HELPING CLINICAL COMMISSIONERS GET THE BEST OUTCOMES NZ EARTHQUAKE | VOICE RECOGNITION | REDUCING ABSENTEEISM

This section features news, views, analysis and commentary surrounding the progress of clinically-led commissioning and the Health and Social Care Bill. Here we take an in-depth look at budget handovers, clinical commissioning group mergers and any news surrounding best practice in commissioning.

commissioningsuccess JAN/FEB 2014

COMMISSIONING UPDATE

SUPPORTING EXCELLENCE IN HEALTHCARE

FREQUENCY Quarterly

CIRCULATION 2,500 board members of CCGs 2,000 other individuals active within the CCG arena 500 NHS trust executives 200 PCT executives* *Contact us for the most up-to-date circulation figures

READERSHIP CCG board members, participants in commissioning, and all related health networks and shadow boards .

SOCIAL NETWORKING With 50% of the UK now using Facebook and the increasing prevalence of Twitter in everyday life, social networking can be an incredibly effective tool for commissioning groups to communicate with those whose care they are responsible for. One of the biggest challenges is using social media and other digital channels without breaching confidentiality rules and regulations, when you are potentially talking about people’s very private healthcare needs. Alex Talbott is digital communications officer for NHS London and founder of NHS Social Media (nhssm.org.uk), a blog designed to help NHS staff and those interested in healthcare and the web communicate. He believes that confidentiality is not under as much threat from social media as some would make out: “It’s something we’ve discussed a lot on the NHSSM blog and time and again people try to knock social media out of the comms toolbox because of confidentiality issues. Of course there are issues around that, but we shouldn’t just throw it out because of this one concern, there are too many positives that we can get out of it.” He goes on to explain: “The standard rule applies that if you don’t want to say it in public, don’t say it through social media.” It is important to bear in mind that CCGs do so much more than treat people and there is a duty to inform patients of vital public health messages. This is where social media is at its most useful. Already, initiatives such as NHS Smokefree are using a Facebook page as a place for people using the service to keep up to date with important information and discuss their experiences with other people trying to give up smoking. It’s these kinds of applications of social networking that use all of its strengths and avoid its potential pitfalls. While these pages can be vulnerable to trolling – perpetual posting of abusive messages – and other internet abuses, it doesn’t use any confidential information and therefore poses little threat to those using the service. Talbott concludes: “There needs to be an understanding that social media isn’t big and scary and only for big companies to mess around with. There is a possibility here for the NHS and other healthcare providers to increase the service offer that they currently have for patients.” It’s time to digitise your interaction with patients and ensure that you are getting full value from the huge range of communication tools available. Research carried out in June by NHS Local involving 328 people found that more than half of those questioned would be happy to Skype their GP. Proof if it were needed that these advances in communication will continue to diversify. The most progressive CCGs will grasp the chance with both hands.

ESTABLISHED March 2012 SEPT/OCT 2012 | 31

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BEHI ND

THROW OUT INSIDE FRONT COVER – THREE PAGES The inside front cover has the ability to out from the magazine into an eye-catching double-page spread where you get three pages of coverage to use for adverts, advertorials or a combination of the two. It’s very high impact and a great way to make a splash!

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THROW OUT IN CORE OF MAGAZINE – FOUR PAGES 38

work/life

This follows the same principle as the fold-out front cover but is placed in the core of the magazine and rolls out to the right. It starts with a double page spread (DPS) in the magazine followed by a double-sided page folding out from the magazine. Very effective when used as a reply mechanism or promotional offer.

VENDOR PROFILES Designed to fit with the style and feel of the magazine, a vendor profile looks like a Commissioning Success feature but it is paid for, so it is your space to use as a platform to communicate strategic messages about your organisation or perhaps the details of a new campaign or promotion. It’s a great way to make our readers sit up and take notice.

You train them up and you mak welfare is at the heart of what t at it is then you have usually go

Change is good With so much happening in healthcare, it’s important to have your practice team on board. Jonathan hills seeks some good advice on how to motivate your team, put changes in place and assert your authority as practice manager and within the CCG

vendor profile | pelican

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vendor profile | pelican

In quality

we trust

management | legal Pelican Feminine Healthcare is a name GP practices trust. Practice Business finds

out more about the company and just what makes it such a trustworthy name in the world of disposable feminine health supplies as the nhs cuts start to take hold, your practice

Pelican Feminine Healthcare Limited underwent a rebranding; separating from the stoma care side of the business, and further emphasising its speciality in gynaecological and obstetric products. Pelican has also embarked on an ambitious development plan intended to transform its spacious premises in Cardiff to a state-of-the-art manufacturing and distribution centre and shares a joint research and development facility, based in Northern Ireland, with its sister company, committed to bringing innovative, quality products to market for the benefit of its customers.

ProduCts you Can trust Pelican’s primary care customers are particularly loyal to its gynaecological products. One of Pelican’s most popular and well-known products is its PELIspec disposable vaginal speculum, which is the leading product of its kind with 70% market share and is available on NHS contracts. Pelican’s newest addition to the PELIspec range is the PELIspec with Light Source, which uses an attached light source to visualise the cervix, ensuring maximum visibility for the professional to carry out any gynaecological procedure. The PELIspec with Light Source was mainly created using feedback from nurses and doctors, who complained of awkwardness when using separate, unwieldy light devices and, in some cases, the inability to see the cervix, which resulted in expensive hospital referrals. Ensuring everything runs smoothly is imperative when patients undergo what can be such a sensitive procedure, but it can save money too. The ability for a clinician to see what they’re doing can cut down on time, reduce the need to have another person in the room and also reduce repeat referrals.

vendor profile | pelican

of its products, and a dedicated customer services team, helps to explain why some of Pelican’s customers have been buying from them for all 18 years it’s been in business. Particularly for practice managers who are not doing the actual clinical procedures but are buying the products, having the support of a company they can trust is priceless. So while going for a smear test is probably last on the list of pleasant experiences for female patients, high quality products from companies like Pelican are there to ensure it’s as comfortable and efficient a procedure as possible, which not only helps the patients but the practice too.

For practice managers who are not doing the actual clinical procedures but are

will be money coming inbuying to the practice, then you are going to the products, having the support of aresources.” company they can trust is priceless forced into finding more innovative means by which to have to pool your keep an effective patient service running with growing Wright believes his staff have an altruistic approach costs and a reducing budget. like in any business, to dealing with patients, and therefore is something this will result in you needing to find more and more that can be used when reasoning with staff about taking innovate ways to cut spending and reduce costs. over roles and financial changes within the practice. it is a time to be pragmatic and learn new skills to “i think it is seeing what appeals to staff,” he ensure that your practice does not suffer as a result; standing bycontinues. “What motivates them to come in and do their values you will need to ensure that your staff are flexible and the work? Most, even 90%, of staff are very patient accommodating, ready for a challenge and prepared centered so they are very much dealing with the public Contact details to move into areas of responsibility that they might be and like speaking to them. in fact, most of them would thus far unfamiliar with. rather speak to them than do a lot of paperwork, and some practices particularly might have certain staff practice managers should think about this when remembers who are extremely proficient at the job they allocating roles in the practice. ordinarily perform, but when asked to move into a new “You train them up and you make sure that patient arena might become apathetic or reluctant to excel. welfare is at the heart of what they do, and as long at it Michael Wright, practice manager at Whyburn is then you have usually got their buy-in,” he added. Medical Practice thinks that practices working the integration of technology will also have a together will be key in tackling the implementation of profound effect on the running of your practice, the CCGs. and you and your staff will have to be prepared to “one of the main things, and one of the learn how to use it – and with the introduction of 38 39 things which is really going to come out of all the the CCGs the role of technology looks to become work/life | change management commissioning going on now, is working together,” more prominent. he says. Wright that use of the same back office You train them up and states you make sure the that patient welfare is at the heart of what they do, and as long “there are going to be times in your locality system is vital in the smooth running of a practice, and at it is then you have usually got their buy-in when you can share some of the back office functions. especially between consortium members: “one of the there is going to be pressure and there is talk of a problems at the moment is that there are a lot of it new contract, so if that means there is going to be less systems out there – if you have an it system, everyone

A negative impact

Pelican Feminine Healthcare

MANAGEMENT | service redesign

02920 747400

gill.sims@pelicanhealthcare.co.uk www.pelicanfh.co.uk

Quality has always been a priority for buyers of healthcare products. Purchasing high-calibre clinical supplies is instrumental to the health and wellbeing of patients and with the onset of increased patient choice of GP practice, never has this been more important. A debate at the BMA’s annual conference last month further reiterated the importance of the subject when it called on the NHS to take a firmer stance on procuring products from trustworthy sources. One company that has always prided itself on the trustworthiness and reliability of its products is Pelican Healthcare. Under the mission statement ‘quality, service, trust, innovation and value’, Pelican has a loyal fan-base of GPs, nurses and practice managers who are confident in the fact its disposable medical products will not let them or the patient down. Pelican started life in 1994 and from the outset manufactured disposable products for stoma care and feminine healthcare. The following year, the company

acquired Nightingale Limited which has since become the Pelican Home Delivery Service that supplies its stoma customers and serves all parts of the UK. In 2007, the company was bought by TG Eakin Limited, a world-renowned producer of specialist medical adhesives and wound care products, and is now part of the Eakin Group of companies. Its stoma care products are now available in the UK under the Pelican brand with an increasing number of international customers served by Eakin under the Eakin brand. This year Eakin went on to further acquire Clinical Innovations Europe Limited, which extensively added to Pelican’s obstetric and gynaecological product range. One of the more popular products brought on board was the Kiwi Vacuum Delivery System, essentially a single-use ventouse that works with an integral hand-held pump. Since the acquisition, the feminine health division of Pelican Healthcare has become its own entity.

Ensuring quality of product, particularly in the field of gynaecology, is so important to patient relations. One bad experience can put a patient off from returning to that practice or going for a future smear test altogether. With this in mind, Pelican also supports Jo’s Cervical Cancer Trust, by donating 5p to the cause from every box of speculums sold. Jo’s Trust offers information and support to help women understand the importance of cervical screening and encourage them to attend their smear test appointment. Pelican offers free delivery to its customers and is also the only company in its market to manufacture its products in the UK, which not only ensures a certain quality standard, but also reduces the risk of damage to the product en route. This, the reliability

july 2011 | practicebusiness.co.uk

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Is negative equity once again rearing its ugly head? OlIver POOl, an associate at veale Wasbrough vizards, asks the question, and discusses the implications for GPs owning surgery premises

Rising to the challenge

These can be horizontal, vertical, double- or single-page, running Change across the bottom or along the outside edge of the page. Banners is good can run in multiples of three, five, eight or just on their own, on consecutive pages or scattered throughout the magazine – a great Practical approaches to improvement in the NHS need alternative to standard page advertising for brand recognition. to be combined with strategic thinking, says MARK EATON

Recent concerns over the future values of commercial may be unwilling to participate if they are risking being october 2011 | practicebusiness.co.uk property raises the spectre of negative equity in surgery bought out for a loss in a few years’ time (the best idea With so much happening in healthcare, it’s important to have your practice team premises. There is no doubt that values have fallen, even for partners nearing retirement is not to participate on board. Jonathan hills seeks some when valuers take account of the fact that notional rent atyour all,team, but to allow the others to ‘get on with it’ and good advice on how to motivate put changes in place and assert your authority is paid when coming up with valuations.as Partners in indemnify them). practice manager and within the CCG the middle of careers should be in for long enough to Incoming partners may be reluctant about buying ‘ride out the blip’, but for incoming partners, and those into negative equity. We often hear incoming approaching retirement, it is important. partners asking why they should have to take In the last recession, it often came as a nasty over the share of a liability not of their own surprise to retiring partners who owned a share of the making. The answer is that partnership ‘comes surgery premises that they would be expected to buy as whole’ – if you want to be a partner you themselves out on retirement. But this is what happened have to accept the whole package and can’t in a number of cases, especially partnership the bits you don’t like –now the alternative Withwhere a £20bn challenge onreject the table for the NHS, is not the time to be deeds were silent on the issue, and especially where is toare finddone. a different or toachieve be a tinkering with the way things Thepartnership, NHS cannot this level of partners had been involved in costly new-builds, where salaried GP. improvement through buying cheaper paper clips or banning the purchase of the price of the development had exceeded the market At the same time, what cannot be achieved sticky tape. value. This situation may be rearing its head again. by the partnership deed is to bind incoming partners Just ‘working harder’ will only deliver incremental improvements in performance It is not uncommon for a partnership to ‘shield’ to buy in at a certain price unless they specifically andequity even by applying of ‘working smarter notincoming harder’partners will only pay off if what retiring partners from negative includingthe clichéagree to it, because of course you arethat working in the place.of the partnership provisions in the partnership deed provide on for is the right aren’tthing yet bound byfirst the terms Now is least the time for thinking differently about how andforwhere retiring partners to be bought out for at what they deed. Further, it may be permissible the services are contributed, or at least the delivered. previous acquisition cost. having partnership buy a retiring partner outevidence above This means to make to tough, but logical and based, choices management | legal This raises the issue of the goodwill rulesservices – paying above market locally. value, butIttomeans insist that an incoming about how are organised having to tell some people they the market value for surgery premises can beadeemed partner pays more than market value isservices much will be getting lot less money than previously and shifting between to be a transfer of goodwill, which is, of course, illegal. more likely to be a breach of the goodwill rules. organisations to ensure they are delivered both safely and productively. It means However, in practice these arrangements have not been The best way for this to be dealt with is to having to work with unproductive organisations to help them improve, but also called into question, as long as there is a clear presee the transaction as one in which partnership having the courage toany move the funding if they can’t or won’t rise to the challenge. again rearing its ugly head? OlIver POOl, existing agreement, and to dateIs negative there equity haveonce not been protects retiring partners from negative equity, rather an associate at veale Wasbrough vizards, asks the question, and The keys that will enable leaders at all levels in all organisations to rise prosecutions under the goodwill rules. than the incoming partnerand directly taking on the discusses the implications for GPs owning surgery premises to in thethechallenges unlockpartner’s improvements are going to case be found Including such provisions partnershipahead deed andoutgoing share of liability. In any it may in two strategically actions. will be particularly important for practicesimportant that are be worth checking the partnership deed to see if it deals contemplating new-builds – older partners in particular adequately these issues. The first action will be to create awith structure that enables teams and organisations advice for busy lives

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as the nhs cuts start to take hold, your practice will be forced into finding more innovative means by which to keep an effective patient service running with growing costs and a reducing budget. like in any business, this will result in you needing to find more and more innovate ways to cut spending and reduce costs. it is a time to be pragmatic and learn new skills to ensure that your practice does not suffer as a result; you will need to ensure that your staff are flexible and accommodating, ready for a challenge and prepared to move into areas of responsibility that they might be thus far unfamiliar with. some practices particularly might have certain staff members who are extremely proficient at the job they ordinarily perform, but when asked to move into a new arena might become apathetic or reluctant to excel. Michael Wright, practice manager at Whyburn Medical Practice thinks that practices working together will be key in tackling the implementation of the CCGs. “one of the main things, and one of the things which is really going to come out of all the commissioning going on now, is working together,” he says. “there are going to be times in your locality when you can share some of the back office functions. there is going to be pressure and there is talk of a new contract, so if that means there is going to be less

money coming in to the practice, then you are going to have to pool your resources.” Wright believes his staff have an altruistic approach to dealing with patients, and therefore is something that can be used when reasoning with staff about taking over roles and financial changes within the practice. “i think it is seeing what appeals to staff,” he continues. “What motivates them to come in and do the work? Most, even 90%, of staff are very patient centered so they are very much dealing with the public and like speaking to them. in fact, most of them would rather speak to them than do a lot of paperwork, and practice managers should think about this when reallocating roles in the practice. “You train them up and you make sure that patient welfare is at the heart of what they do, and as long at it is then you have usually got their buy-in,” he added. the integration of technology will also have a profound effect on the running of your practice, and you and your staff will have to be prepared to learn how to use it – and with the introduction of the CCGs the role of technology looks to become more prominent. Wright states that the use of the same back office system is vital in the smooth running of a practice, and especially between consortium members: “one of the problems at the moment is that there are a lot of it systems out there – if you have an it system, everyone

should be able to use it, trained up and able to access your surgery regardless of what practice you belong to,” he said. Emphasising that practices need to be braced for the plunge, Webster argues that both personnel and financial steadiness are required for the transition if practices are to survive it. her advice on how the practice can ready itself for the financial implications of the transition is quite different, however while managing staff often reuires a tailored, individual approach, managing finances relies upon uniformity. whereas in managing staff importance in management should come with individualism, when it comes to finances, the greatest importance is upon uniformity. “it’s about adjusting roles within the practice because actually, certain elements of commissioning like scrutinising data and making sure everyone’s referral patterns and prescribing habits are the same, all takes time, so you have to adjust your workload accordingly – making sure the practice finances are robust enough, in case the worst happens and

october 2011 | practicebusiness.co.uk

Written and designed by the Commissioning Success editorial team,

practicebusiness.co.uk | october 2011

a vendor case study is an effective way to get company messages A negative impact and services in front of our readers. Featuring a commissioner in an interview style, it allows you to really promote your services in a meaningful and interesting way. Case studies are one of the best JARGON BUSTER Legal update sponsored by Veale Wasbrough Vizards Transformation read parts of our magazine, great for exposure. mapping Recent concerns over the future values of commercial property raises the spectre of negative equity in surgery premises. There is no doubt that values have fallen, even when valuers take account of the fact that notional rent is paid when coming up with valuations. Partners in the middle of careers should be in for long enough to ‘ride out the blip’, but for incoming partners, and those approaching retirement, it is important. In the last recession, it often came as a nasty surprise to retiring partners who owned a share of the surgery premises that they would be expected to buy themselves out on retirement. But this is what happened in a number of cases, especially where partnership deeds were silent on the issue, and especially where partners had been involved in costly new-builds, where the price of the development had exceeded the market

may be unwilling to participate if they are risking being bought out for a loss in a few years’ time (the best idea for partners nearing retirement is not to participate at all, but to allow the others to ‘get on with it’ and indemnify them). Incoming partners may be reluctant about buying into negative equity. We often hear incoming partners asking why they should have to take over the share of a liability not of their own making. The answer is that partnership ‘comes as whole’ – if you want to be a partner you have to accept the whole package and can’t reject the bits you don’t like – the alternative is to find a different partnership, or to be a salaried GP. At the same time, what cannot be achieved

provisions in the partnership deed that provide for retiring partners to be bought out for at least what they contributed, or at least the previous acquisition cost. This raises the issue of the goodwill rules – paying above the market value for surgery premises can be deemed to be a transfer of goodwill, which is, of course, illegal. However, in practice these arrangements have not been called into question, as long as there is a clear preexisting agreement, and to date there have not been any prosecutions under the goodwill rules. Including such provisions in the partnership deed will be particularly important for practices that are contemplating new-builds – older partners in particular

aren’t yet bound by the terms of the partnership deed. Further, it may be permissible for the partnership to buy a retiring partner out above market value, but to insist that an incoming partner pays more than market value is much more likely to be a breach of the goodwill rules. The best way for this to be dealt with is to see the transaction as one in which partnership protects retiring partners from negative equity, rather than the incoming partner directly taking on the outgoing partner’s share of liability. In any case it may be worth checking the partnership deed to see if it deals adequately with these issues.

to work together. This doesn’t mean a monthly meeting where the normal procedure is to send substitutes and where the energy levels start at mediocre levels and then go downhill. This means working together to create a clearly structured transformation map (see box out) that sets out the roadmap for local improvement by clarifying the local strategic objectives and the outcomes that need to be achieved to deliver each of them. The second action will be to create a structured, logical and pragmatic approach to implementation that will both deliver the roadmap and enable organisations to work together to realise the benefits. Legal update sponsored by Veale Wasbrough Vizards Answering the £20bn challenge will not only involve the delivery of organisational improvements such as shorter hospital stays, faster diagnostic turnaround times and fewer patient safety incidents. Changes will also have to be made in areas that need a different and often more collaborative approach such as providing care in new settings, improving end-to-end pathways and tackling the underlying issues that prevent the flow of information. MANAGEMENT redesign Rising| service to the challenge will need new types of thinking, something that can be delivered successfully by combining practical approaches to improvement, such as ‘lean’, with a strategic edge to it from such concepts as transformation mapping.

value. This situationto may be rearing its head again. contact by the partnership deed is to bind incoming For further information on legal issues relevant GPs, please Oliver Pool, anpartners associate at Veale Wasbrough Vizards It is not uncommon for a partnership to ‘shield’ to buy in at a certain price unless they specifically from negative equitythose by including advising agree to it, because who offers specialist legal advice to theretiring GPpartners sector and GPs,of course on incoming 0117partners 314 5429 or opool@vwv.co.uk

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Transformation mapping is a visual way of developing and linking strategy to implementation plans. Typically, this is achieved using a large diagram that depicts where an organisation wants or needs to be within a specific timescale, along with the associated implementation plans.

Advertisers have the opportunity to brand or sponsor a feature or section. We choose our sponsorship partners very carefully because as a valued Commissioning Success partner, it follows that we’re also endorsing their brand. Placed on very targeted editorial sections of the magazine it’s a en extrenmelyt stategic and pretigious way to promote your brand. Something a bit different, a bespoke sponsorship position aligns you with the magazine’s message.

suddenly you are not able to pay the wages,” she says, mentioning that this year her staff had to deal with a pay freeze for the first time in preparation for the future. her advice concerning the management of staff and how to handle personnel centres upon trust and openness. she upholds that being honest, including asking staff for their opinions on changes in the practice, leads to greater respect in her team, and ultimately, a better practice. “When you tell people why and give them the option to come back with concerns or alternative proposals they will respect the decision you make,” she says. “if people think you are just the boss in the practice, people will not go out of their way for you.” Whatever the future holds for practices in the nhs - and truthfully everyone may have an indication but no one actually knows the repercussions that will come with the introduction of the CCGs – one thing is certain, and that is it’s best to have a tight and accountable financial structure, and a solid practice team around you when you make the change.

For further information on legal issues relevant to GPs, please contact Oliver Pool, an associate at Veale Wasbrough Vizards who offers specialist legal advice to the GP sector and those advising GPs, on 0117 314 5429 or opool@vwv.co.uk

In qua should be able to use it, trained up and able to access your surgery regardless of what practice you belong to,” he said. Emphasising that practices need to be braced for the plunge, Webster argues that both personnel and financial steadiness are required for the transition if practices are to survive it. her advice on how the practice can ready itself for the financial implications of the transition is quite different, however while managing staff often reuires a tailored, individual approach, managing finances relies upon uniformity. whereas in managing staff importance in management should come with individualism, when it comes to finances, the greatest importance is upon uniformity. “it’s about adjusting roles within the practice because actually, certain elements of commissioning like scrutinising data and making sure everyone’s referral patterns and prescribing habits are the same, all takes time, so you have to adjust your workload accordingly – making sure the practice finances are robust enough, in case the worst happens and

VENDOR PROFILE

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Pelican Feminine Healthcare is a nam out more about the company and jus the world of disposable feminine hea

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Quality has always been a priorit of healthcare products. Purchasin clinical supplies is instrumental to and wellbeing of patients and wit increased patient choice of GP pr this been more important. A deba annual conference last month fur the importance of the subject wh NHS to take a firmer stance on p from trustworthy sources. One company that has always Contact details the trustworthiness and reliability Pelican Feminine Healthcare is Pelican Healthcare. Under the ‘quality, service, trust, innovation 02920 747400 gill.sims@pelicanhealthcare.co.uk Pelican has a loyal fan-base of GP practice managers who are confid www.pelicanfh.co.uk disposable medical products will patient down. Pelican started life in 1994 and manufactured disposable products feminine healthcare. The following

CASE STUDY july 2011 | practicebusiness.co.uk

Rising to the challenge

Mark Eaton is MD of Amnis

Practical approaches to improvement in the NHS need to be combined with strategic thinking, says MARK EATON

JARGON BUSTER Transformation mapping Transformation mapping is a visual way of developing and linking strategy to implementation plans. Typically, this is achieved using a large diagram that depicts where an organisation wants or needs to be within a specific timescale, along with the associated implementation plans.

With a £20bn challenge on the table for the NHS, now is not the time to be tinkering with the way things are done. The NHS cannot achieve this level of improvement through buying cheaper paper clips or banning the purchase of sticky tape. Just ‘working harder’ will only deliver incremental improvements in performance and even applying the cliché of ‘working smarter not harder’ will only pay off if what you are working on is the right thing in the first place. Now is the time for thinking differently about how and where services are delivered. This means having to make tough, but logical and evidence based, choices about how services are organised locally. It means having to tell some people they will be getting a lot less money than previously and shifting services between organisations to ensure they are delivered both safely and productively. It means having to work with unproductive organisations to help them improve, but also having the courage to move the funding if they can’t or won’t rise to the challenge. The keys that will enable leaders at all levels and in all organisations to rise to the challenges ahead and unlock improvements are going to be found in two strategically important actions. The first action will be to create a structure that enables teams and organisations to work together. This doesn’t mean a monthly meeting where the normal procedure is to send substitutes and where the energy levels start at mediocre levels and then go downhill. This means working together to create a clearly structured transformation map (see box out) that sets out the roadmap for local improvement by clarifying the local strategic objectives and the outcomes that need to be achieved to deliver each of them. The second action will be to create a structured, logical and pragmatic approach to implementation that will both deliver the roadmap and enable organisations to work together to realise the benefits. Answering the £20bn challenge will not only involve the delivery of organisational improvements such as shorter hospital stays, faster diagnostic turnaround times and fewer patient safety incidents. Changes will also have to be made in areas that need a different and often more collaborative approach such as providing care in new settings, improving end-to-end pathways and tackling the underlying issues that prevent the flow of information. Rising to the challenge will need new types of thinking, something that can be delivered successfully by combining practical approaches to improvement, such as ‘lean’, with a strategic edge to it from such concepts as transformation mapping. Mark Eaton is MD of Amnis

suddenl mention a pay fr the futu her and how opennes asking s practice ultimate “Wh option t proposa she says practice Wha nhs - a but no o will com thing is account team ar

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