Practice Business July 12 by Intelligent Media Solutions

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july 2012

MAKING PROVISIONS

GP retirement is on the up. Is your practice prepared?

A UNITED FRONT

How federating helps smaller practices survive

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Editor’s letter EXECUTIVE EDITOR www.roylilley.co.uk MANAGING EDITOR julia.dennison@intelligentmedia.co.uk ASSISTANT EDITOR carrie.service@intelligentmedia.co.uk REPORTER george.carey@intelligentmedia.co.uk CLINICAL EDITOR dr paul lamden ACCOUNT MANAGER george.petrou@intelligentmedia.co.uk PUBLISHER vicki.baloch@intelligentmedia.co.uk DESIGNER sarah.chivers@intelligentmedia.co.uk PRODUCTION/DESIGN peter.hope-parry@intelligentmedia.co.uk CIRCULATION MANAGER natalia.johnston@intelligentmedia.co.uk

A little more conversation, a little more action Never has there been a more important time for GP practices to keep up a stoic front. Despite a number of changes to the health system in this country, drastically affecting how health professionals do their jobs, the patient voice is getting louder and louder. And they can vote with their feet. With the ability to rate practices out of 10, patients hold the power, which means that every single interaction matters. Every single phone call, consultation or waiting room experience could result in a review through NHS Choices, or even word of mouth, which could cause patient customers – because that’s what they are – to move on. Therefore, despite all the hubbub around preparing for the CQC, it’s not just the inspectorate that demands your attention, it’s the person on the street. It doesn’t help that practices are on a back foot. With the negative publicity around quality of care and privatisation of the NHS, readers of the national newspapers – who are, let’s not forget, all patients – are losing faith in the system and need to be reminded of why we’re all here. As I write this, we are days away from the doctors’ strike. This is all well and good, and I think it’s important for clinicians to exercise their desire to take industrial action, however, what is important is that the hows, whys and wherefores are communicated to patients. As with so much of this upheaval, much can be forgiven, excused or even understood with a little more conversation. In this issue, we cover a number of different topics in general practice – from GP retirement (p12) to rolling out the 111 non-emergency number (p18) and how practices working together have found success under the new commissioning agenda (p22). Finally, we end on a blog post from Ann Boyle on why having a laugh at work could be at the expense of your patient relations (p38). So here’s to a great summer. Hope you do manage to have a laugh or two, even if it is behind closed doors.

editor

Contents sector 06 news Top news for practice managers this month 08 executive editor comment The latest from controversial columnist Roy Lilley

PRIMARY PROVIDER 10 12 16

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

legal Making provisions Succession planning for the increase in GP retirement

social media Don’t get caught in the web How to approach social networking safely when reaching out to patients

18 111 The magic number The impact of the 111 programme on GP practices

PEOPLE 22 case study Strength in numbers A look at how federating has helped smaller

practices survive and thrive

26 case study Back to the future How one practice saves time and money by modernising

its back-office processes

MANAGEMENT 32 advice Diabetes in crisis What practice managers can do to alleviate the

burden of the long-term condition on the health service

34 clinical QOF This month: Smoking cessation 36 legal Private property? A look at NHS Property Services Limited

Work/life 38 diary Practice blogger Ann Boyle on why sometimes it’s good to keep schtum

sector

Patients happy with GP experience Despite findings of a survey released by the King’s Fund last month citing that public satisfaction with the NHS is at a record low, a survey commissioned by the Department of Health and carried out by Ipsos-MORI revealed that NHS patients are mostly happy with the service they receive from their GP. The findings included that: • • • •

88% of patients rate their overall experience of their GP practice as good 79% of patients rate their overall experience of making an appointment as good 93% of patients have at least some level of confidence and trust in the last GP they saw 81% of patients are satisfied with their surgery opening hours.

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The majority of patients who responded to the survey were also satisfied with out-of-hours GP services, with 71% of patients describing their experiences as good. However, 14% of patients rated the service as poor. In terms of trust, 82% of patients reported that they have at least some level of confidence and trust in out-of-hours clinicians.

news

july 2012 | practicebusiness.co.uk

Small practices join forces to fight closure Four surgeries in Lancashire are going to tender as one single entitiy and a single provider will be sought to take them over in a bid to avoid closure under the changes to the NHS. Two of the practices – the Eagle Medical Practice in Accrington and the Horsfield Practice in Colne, run by the NHS East Lancashire – have joined together to avoid closure once the PCT is phased out early next year. The Brierfield Practice and Pendle Valley Mill Practice in Nelson will also join the conglomerate, bringing the total number of patients to 7,000. If the tender as a group is unsuccessful, the four surgeries may be forced to close. Pendle councillor Graham Waugh told the Lancashire Telegraph: “I would think the four surgeries would be more attractive as one as a business, but I am not convinced that it is the best thing for the patients or the surgeries.”

Are you a perfect 10?

Government data on GP practices in England will be published for the first time. Patients will be able to benchmark their surgery on things like how convenient it is to get an appointment; waiting and opening times; and communication. The system rates each practice out of ten based on data from the GP Patient Survey. Health Minister Lord Howe said: “As we set out in our Information Strategy, we want to make it easier for patients to find the best NHS care for them. Giving patients more information about their local NHS is a big part of our commitment to transparency and using data to drive improvements.” The scores will be available on the NHS Choices website where people will also be able to find a surgery with experience treating specific conditions. Patient organisations have welcomed these proposals as a significant move to improve patient experience in primary care.

SECTOR | news

clinical news Practices will not be paid for extra work during the Olympics NHS London says its GP practices should be prepared to deliver a “business-as-usual” service during the Olympic and Paralympic Games (27 July - 9 September), the demand for which the SHA believes will be similar to a “mild winter”, with activity for non-elective and urgent care rising by five to ten per cent. The SHA says it estimates low numbers of extra patients during the games, however, former Greenwich LMC chairman Dr Rob Hughes believes his area could expect at least a 10% increase and any extra work would remain unfunded. “In Greenwich they are calling it ‘business not as usual’,” he told GP Online. “There is no funding for this extra work. There are not local enhanced services for it.” Dr Hughes believes the main problem will be getting staff to practices. “Locally, most people will have to walk to work,” he said. London practices have been told to report to their PCT to assure them they are ‘Games ready’. NHS London has provided a checklist for practices to ensure they have made provisions for staffing, supply and home visits. The SHA said practices should decide whether visitors be treated as temporary residents or just provided with immediate necessary care. Information is being sent to all visitors to the Olympic Games regarding the use of local health services.

“”

They said… “It would constitute a breach of contract if they only provide urgent care and in a worst-case scenario, it could lead to the end of the contract” Lynne Abbess, of Hempsons Solicitors, on the GP strike last month

fact 1,000,000

Fatter nations could learn from the Japanese Growing obesity levels could have the same impact on global resources as an increase in population of one billion people, according to a recent study by the London School of Hygiene and Tropical medicine, which said the world’s population is carrying around approximately 15 million tonnes of excess weight. However, there is a huge variances between nations. Although there are evidently links between poverty and being underweight, the research also found that countries that are prosperous don’t necessarily have an obesity problem – citing Japan as a prime example. The USA is responsible for a third of the world’s obesity, with countries including Ethiopia, and Vietnam being the other extreme.

Get the latest news in your inbox Want to be bang-up-to-date on your health sector news? Subscribe to the free PB Weekly e-newsletter and receive the latest practice manager news and views straight to your inbox. To sign up, email subscriptions@intelligentmedia.co.uk with the subject line “PB Weekly” or visit PracticeBusiness.co.uk.

diary 19 September

NHS INFORMATICS: DELIVERING A SUCCESSFUL INFORMATION REVOLUTION The Barbican, London

The new NHS 111 non-emergency number has dealt with over one million calls since its introduction in August 2010, with 10 areas around the country running the service. Nearly all (92%) of callers were satisﬁed with the service they received. The DH has agreed a six-month delay in the full roll-out of the 111 number.

4-6 October

THE RCGP ANNUAL PRIMARY CARE CONFERENCE Glasgow

practicebusiness.co.uk | july 2012

SECTOR | comment

Roy Lilley Roy Lilley is executive editor of Practice Business. He is an independent health and policy analyst, writer and broadcaster and commentator on health and social issues.

Buggins off!

With the doctors’ strike – sorry, industrial action – been and gone, Roy Lilley asks: is it worth the fallout? Can you remember what you were doing 30 years ago? I can’t, but I can tell you MTV played its first music video, the Falkland’s War was raging and Elvis left the building for the last time. It was also when the doctors last went on strike. The British Medical Association said separate ballots of six branches of its 130,000-strong membership, including GPs and hospital consultants, had produced an overall majority in favour of action. The rights and the wrongs of strike are buried in the arcane calculations that surround the negotiations between the BMA and the Department of Health. Or, put another way; the British Machiavellian Army and the Department of the Hard-ofhearing. Both sides are blaming the other. It is true the BMA thought it had sorted out its pension palaver with an agreement in 2008, with a ‘cap and share’ deal; future contributions capped and additional costs shared. In comes the coalition, the economy in tatters and all bets are off. It is true the doc’s pension is still worth dying for, the Government’s fear is that they won’t die early enough and the scheme will run out of money. So, we have a day of industrial action. Not a strike apparently (according to the BMA, anyway). If your test or operation was cancelled it would have felt like a strike. By the time you read this we will know how the day of inaction passed. The real issue is what happens next? Andrew Lansley, secretary of state, made it clear – days before the action – that he wouldn’t change his mind and the Collation was rock-solid in its resolve. What happens now? Another day of action? Two days of action? Three? A complete walk out? Down stethoscopes and scalpels? How about chaining themselves to the railings outside Downing Street, or throwing themselves in front of the Queen’s horse at Royal Ascot? This is a short-sighted strategy that has led the GPs into a cul-de-sac of public disapprobation. They can only reverse out covered in ignominy. BMA leader Hamish Meldrum has got them into this mess. The good thing is he has done his time as BMA leaders and elections are due for a new one. All the betting is a hospital consultant will take over. They tend to rotate GP, hospital doctor in a sort of Buggins’s turn. Let’s hope, whoever it is, (and it will be a ‘he’ as there is no woman candidate) will take advantage of the clean-sheet and try a more fruitful approach. Withdrawing from CCG preparations would kill off Lansley’s political ambitions but be invisible to the public. Oh, and in case you are racking your brains; the first music video played on MTV was ‘Video Killed the Radio Star’ by the Buggles. Let’s hope Buggins doesn’t kill off the doctors!

This is a short-sighted strategy that has led the GPs into a cul-de-sac of public disapprobation. They can only reverse out covered in ignominy

july 2012 | practicebusiness.co.uk

It has now been announced that Dr Mark Porter will be succeeding Dr Hamish Meldrum as head of the BMA.

primary provider

Electronic healthcare to reach ‘tipping point’, says white paper Unless action is taken to ensure better patient privacy in the NHS, the future of electronic healthcare is at risk – and so are the reputations of providers, managers and clinicians. These were the words of a security white paper published last month by a leading organisation in patient privacy. The report, ‘Make or Break – Digital Healthcare and Privacy Reach the Tipping Point’, draws on publisher FairWarning’s experience working with 800 hospitals and 2,500 clinics in Europe and North America. In the wake of recent data breaches, it looks at why patient privacy must be protected and how clinical organisations can safeguard it. It aims to provide a blueprint for NHS data security. “Electronic healthcare is among the most important advances of our times,” commented Kurt Long, CEO and founder of FairWarning.

Delivering commissioning in practice

GPs to work with drug companies

july 2012 | practicebusiness.co.uk

GPs are to be encouraged to work with pharmaceuticals companies when commissioning services and designing care pathways, Pulse reports. The government-backed initiative is hoped to help create better partnerships between suppliers and commissioners. A guide to joint working agreements has been written up by the Association of the British Pharmaceutical Industry (ABPI) and the DH. The guidance document lays out a week by week plan for forming a partnership, from idea generation to project completion. Critics of the plans have said that conflicts of interest could occur and GPs could find themselves with unmanageable workloads. A spokesperson from the ABPI told Pulse: “We would encourage CCGs to engage with local pharmaceutical representatives and highlight areas where patients could benefit from combining the skills and resource of the NHS and pharmaceutical industry.” A DH spokesperson said this was part of an initiative “to promote joint working between the NHS and industry”.

“Given the rapid and dramatic changes, it is vital for healthcare leaders to make sure they also become leaders in privacy protection.” He says privacy and security should form “the bedrock” of NHS healthcare, but the public’s “loss in confidence” could stand in the way. “The loss in confidence in electronic healthcare could undermine the drive to deliver many initiatives such as those outlined in the Information Strategy,” he said. “We have reached a ‘tipping point’ where privacy and security needs to be high up the NHS agenda and our paper outlines for board members, IT specialists, clinicians and patients, as to how this can be achieved.”

Has No decision without me been left behind?

Following the publication of the consultation paper ‘Liberating the NHS: No decision about me, without me’, the NHS Alliance is calling on the Government to show commitment to shared decision-making in healthcare. The NHS Alliance’s Patient and Public Involvement Group believes instead of exploring shared decision-making, the consultation paper focuses almost exclusively on mechanisms to ensure patients’ choice of providers, a relevant but, they believe, small part of the process. Co-lead Dr Brian Fisher said: “Shared decision-making is a process that brings clinicians and patients together to select tests, treatments, management or support packages, based on clinical evidence and patients’ informed preferences. It improves outcomes and lowers health service costs. Ignoring this vital intimate work in the patient consultation threatens to exclude shared decisionmaking from NHS focus. This is bad for patients, clinicians, or the NHS.”

Patients to choose where to go for tests New proposals published last month outline how patients will be able to choose where they receive essential tests from April, instead of having to go to the nearest available option. They will make these decisions in partnership with their doctor, who can help advise them on which choice would be most appropriate. Alongside more choice, an important change will be made to the system that GPs and patients use to choose a hospital for their treatment – Choose and Book – by including detailed waiting time information on the system. These new plans are outlined in the ‘Liberating the NHS: No decisions about me, without me’ paper, which details how the DH hopes to make more choice available to patients throughout the health service over the next few years. Health Secretary Andrew Lansley said: “Our NHS reforms are all about making life easier for patients. We will make medical tests work for you, not the system, by allowing you to choose where it will be most convenient for you to go. “By giving you information about how long it will take for you to wait to be treated you will be able to choose the hospital that best meets your needs. “No two people are the same, and that’s why our plans will offer patients more personalised care, ensuring that ‘no decision about me is made without me’.”

Practice Business has launched a new commissioning magazine

While we will still cover commissioning-related topics from a primary care provider point of view, practice managers heavily involved in clinical commissioning will want to refer to our new bimonthly commissioning magazine that launched last month, called Commissioning Success. It will be targeted at decision-makers and participants in commissioning, from board members to commissioning support units and supporting groups. Because of our background in practice management, the magazine will focus on the management and strategy behind effective commissioning, as well as keep readers up to date with all they need to know in terms of news and updates. If you’re interested in receiving a free copy, please email your details to subscriptions@intelligentmedia.co.uk with the subject line “Commissioning Success”.

PROVISION | legal

Due to the additional work arising from GP-led commissioning and CQC registration, many GPs are considering leaving the profession. Healthcare lawyer KATHARINE MELLOR gives her advice on how to plan for partner retirement in a new era of the NHS

MAKING A SUCCESS OF SUCCESSION GPs are leaving the profession in increasing numbers as their working landscape changes. The uncertainty surrounding reforms like the Health and Social Care Act 2012 and regulatory pressures by the Care Quality Commission are making many practitioners rethink their career. The subsequent surge in retirement means that succession planning is an issue many practices are likely to face sooner rather than later. Forward planning is crucial to ensuring a smooth transition and to avoid the threat of the partnership dissolving when a contractor GP retires. With adequate preparation, the retirement of an individual need not cause any disruption to the running of a practice. With that in mind, here is some advice for GP practices.

FIRST STEPS It is important to understand that many of the requirements necessary to deal with a retirement depend upon individual factors, such as the contract the practice holds with the primary care trust, and how many GPs are in the practice partnership to begin with.

july 2012 | practicebusiness.co.uk

The first step will be to agree a realistic leaving date and ensure that there is sufficient time before the GP leaves to allow for the handover of all workloads and to deal with all arrangements regarding asset transfers and notifications.

SOLE-PRACTITIONERS Sole-practitioners wishing to retire will need to recruit a replacement partner(s) if the practice is to continue. It’s advisable to take time to find the right person, and once the suitable recruit is found, to make sure the contractual agreement works for all parties involved. This goes for all practices where a new partner is taking over the duties of a retiring partner. Of course, it may not always be possible for a solepractitioner to find the right partner(s) to take over, or they may simply intend to close the practice once they retire. In such cases, they will usually have to give three months’ notice to the PCT to terminate the practice contract. It should be noted, however, that not all Alternative Provider Medical Services (APMS) contracts will allow the contractor to terminate the contract.

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PROVISION | legal

GOING YOUR SEPARATE WAYS The partnership agreement will usually set out the terms on which a partner may leave. However, not all practices have agreements in place, and in such cases, the partners will have to negotiate the retirement terms and set them out in a deed of retirement. If they don’t, there is a risk that the partnership could be dissolved following the retirement.

MAKING IT OFFICIAL The practice contract must be transferred to the remaining partners if it is to continue following the retirement of a partner. The process involved will depend upon the contract in place. A General Medical Services (GMS) contract, between the PCT and the practice, can be handed over between any partners eligible to hold the contract, as long as the notice requirements are followed precisely. However, Personal Medical Services (PMS) contracts, held between the PCT and each individual partner in the agreement, require PCT consent for any change to the partnership. It’s unlikely that a PCT would refuse a variation in the agreement, but consent is discretionary. In reality, a PCT would only reject a change if the adjustments to the partnership could negatively impact on the practice’s ability to deliver services.

resolve the disagreement. It’s helpful if mechanisms to allow for this are written into the partnership agreement. The practice premises, if owned, are often the most valuable asset in a partnership, and can be complex assets to transfer. There will usually be an agreement in place as to whether partners have the right to retain an interest following retirement. If a retiring partner has a right to retain an interest in any partnership property, a lease should be put in place documenting the terms of the partnership’s occupation of the premises. If the partner instead decides he wishes to sell his interest to the continuing partners, the value of his stake will have to be agreed. Practice agreements will usually provide provisions for the

Not all practices have agreements. In such cases, partners have to negotiate retirement terms. If they don’t, the partnership could be dissolved

PASSING ON THE ASSETS Depending upon the terms of the partnership agreement, the practice assets may need to be transferred to the continuing partners upon a retirement. In these circumstances, the assets may need to be valued. Assets other than the premises are usually transferred at the book value from the last set of accounts, adjusted to the leaving date of the retiring partner. Occasionally, disputes may arise regarding valuations, and in such cases an independent accountant should be called in to

july 2012 | practicebusiness.co.uk

methodology to be used to derive a valuation. In cases where there are no valuation principles in place, the partners will have to negotiate and agree a value for the purpose of transferring the premises. In circumstances where no value can be agreed, the retiring partner may have to remain an owner. Financial advice should always also be sought on arrangements regarding transfer, as there will be tax considerations to take into account. If the premises is occupied under lease, the situation is slightly more straightforward, but there are still some important considerations. If the retiring partner was party to the original lease

agreement, arrangements should be made to assign the lease to the remaining partners. The retiring partner should also seek to be released from any obligations the lease held them to.

I’M SURE YOU’D RETIRED… Of course, a GP may not be planning to leave permanently at all, but instead take ‘24-hour retirement’. This is a mechanism that triggers the start of a GP’s pension under the NHS pension scheme, and involves the GP retiring for a short period before returning to the practice as a partner or in a salaried capacity. The practice should have a written agreement between the partners setting out the provisions for 24-hour retirement, and should also make arrangements for the practice contract to continue in the partner’s temporary absence. It is also important to ensure that provisions are put in place to re-admit the GP on their return. Practices will also have to comply with the requirements of the NHS pension scheme regulations and follow the relevant procedures regarding the practice’s contract with the PCT.

BREAKING THE NEWS There are other parties to consider when a practice goes through a major shakeup like the retirement of a partner. The practice should notify its patients, suppliers, and the various authorities with whom the practice is registered. Employees should also be notified in writing, explaining that their terms and conditions will remain unchanged.

THE DOCTOR WILL SEE YOU NOW The retirement of a GP can be quite an upheaval for a practice. However, as long as the practice partners are prepared in advance, the change need not be anything to worry about. With that in mind, it’s advisable to ensure partnership agreements adequately deal with arrangements when partners retire, to ease the process when it happens. Katharine Mellor is a partner at DWF

Spreading the word

provision | social media

The standard rule applies that if you don’t want to say it in public, don’t say it through social media july 2012 | practicebusiness.co.uk

Those who haven’t been living in a cave in recent years will have at least some knowledge of social media. George Carey discovers how it could help your practice

With 50% of the UK now using Facebook and the increasing prevalence of Twitter in everyday life, it should be of no surprise that some people in healthcare are trying to demonstrate the help that social media could provide for practices and patients alike. So what are the benefits and potential pitfalls of adding social media to your practice’s arsenal? One of the biggest challenges is how to use social media without breaching confidentiality rules and regulations, since 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 to communicate. He believes that confidentiality is not under as much threat from social media as some would like to 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 primary care practices do so much more than treat people and there is a duty to inform your 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 it’s potential pitfalls. While these pages are as vulnerable to trolling – perpetual posting of abusive messages – and other internet abuses, it doesn’t use any confidential information and therefore poses no 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.”

provision | 111

It is hoped that NHS 111 will provide a better, more efficient alternative to NHS Direct, guiding patients towards the correct services and reducing GP workload. But, with huge reductions in clinical staff involved, how efficient can it really be? Carrie Service reports

The future’s calling NHS 111 has promised to revolutionise the way non-emergency health issues are handled by efficiently triaging patient calls using a tried and tested system. The hope is that lessons learned since the launch of NHS Direct in 1998 can be applied to create a more efficient version of the programme, making better use of clinicians’ time and providing an alternative to A&E for patients needing clinical advice out of hours.

Do efficiencies mean redundancies? Unison, the public services trade union, claims that the introduction of NHS 111 could see huge redundancies for nurses who are currently working with NHS Direct when the service changes over. At the moment, 75% of call handlers for the service are nurses. NHS County Durham and Darlington (the

july 2012 | practicebusiness.co.uk

first contract to be awarded to NHS 111) are reported to be cutting the numbers of nurses employed in comparison to NHS Direct by at least 50% ─ from 54 nurses to 25. The reasoning given by the DH for this move is to make better use of clinicians’ time, rather than using fully trained nurses to answer calls that could be easily dealt with by a trained call handler. These call handlers will take the same six-week training course as 999 call handlers, and will use a system specially designed by doctors, nurses and IT specialists. Every shift will have experienced nurses present so that if clinical support is required they can be on-hand. In more serious cases, calls will be transferred through to a doctor or another clinician. This all suggests that the 111 programme could have a significant and positive impact on the primary care workload,

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CALL: 020 7288 6833 EMAIL: subscriptions@intelligentmedia.co.uk WEB: 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/

provision | 111

however, the NHS Alliance claims this isn’t necessarily the case. The organisation carried out a survey of members of the Clinical Commissioning Federation and Urgent Care Network earlier this year. Fifty-one people responded to the survey – which the alliance recognised was “not a representative sample” but is at least, a “straw poll” of some of the clinicians who will be responsible for commissioning the service. Only two per cent of respondents agreed that workload would be reduced by the introduction of NHS 111. The report claimed it could in fact have the opposite effect as nonclinical workers triaging calls are at risk of scheduling unnecessary doctor’s visits. The RCN agreed with this, saying: “We are extremely concerned that the loss of clinical expertise that allows people to self care at home will result in thousands of people taking unnecessary and expensive trips to hospital in ambulances and attending their GP practices.” The responses of the NHS Alliance survey may not have been be a representative sample, however the combined professional opinion of the British Medical Association, the Royal College of Nurses and the NHS

july 2012 | practicebusiness.co.uk

confederation that the launch of NHS 111 should be stalled cannot be ignored.

Improving clinical engagement For NHS 111 to be successful there needs to be a restoration of confidence in the system and some reassurance that it will achieve its aims; after all, if the clinicians don’t believe in it, how can they expect patients to? NHS Alliance has made its views clear and laid out recommendations to clinical leaders for how they believe engagement can be improved. Its key recommendation was that CCGs should be allowed to “pause” or slow down the process of implementation if they feel they are not fully prepared on a local level. And it turns out, the DH has listened. As I write this article, the Department has announced that they will be allowing CCGs to apply to delay the launch of NHS 111 in their area for up to six months. This, it is hoped, will allow CCGs the time to become more involved in the delivery of the service and will help increase clinical engagement. Dr Jean Challiner, chief medical officer at Clinical Solutions, believes the key to successful delivery that allows full clinical engagement lies in integrating the right technology; a real challenge for commissioners: “Technology can efficiently and costeffectively support call handlers step by step through their part of the triage process,” says Challiner. She describes 111 as an “ambitious endeavour”, creating challenges for providers around unit pricing,

For NHS 111 to be successful there needs to be a restoration of confidence in the system interoperability and patient demand management. “These challenges create a large issue around risk, deployment and managing the demand, but the right technology partner can reduce the risk through partnership and innovative technology.” Another huge test for NHS 111 may well be its ability to cope with the scalability requirements of the service, she adds. Ultimately it is the patients who will decide whether or not NHS 111 is truly successful. With the service having received its first million calls this month via the pilots – irrefutably a ‘representative sample’ – the 92% patient satisfaction rate speaks for itself.

one-to-ones with the people making a difference

people

The collaborators

july 2012 | practicebusiness.co.uk

PEOPLE | case study

Clinical commissioning groups in the southwest have found strength in numbers. POLLY ELLISON looks at how federating has helped smaller practices survive The 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. A nominated GP from each federation sits on the CCG board, ensuring that each federation has equal representation. 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; style in which they work 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 Wyvern Health, 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 holds monthly evening meetings for GPs and practice managers, plus a monthly steering group meeting for practice managers to implement agreed work plans. They are proposing a switch to regular meetings of smaller GP- and practice managerled working groups, bi-monthly federation evening meetings and/or task groups for specific subjects. The federation also holds educational workshops. For example, a recent reablement programme gave the group information on the new related service, telehealth and an opportunity to learn more about the aims of a joint NHS/local authority programme. Another recent 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 key to success. In some areas of the country, practice managers would not necessarily know who the GPs on the CCG board were, never mind working with them to develop services. Tapping into the expertise of practice managers is so important as they form the essential link between GPs and practice staff and their wealth of expertise should not be allowed to go to waste. Somerset CCG has clearly recognised this and is benefitting hugely from this management resource. PROJECTS IN ACTION A variety of PCT projects to improve patient services have already been supported by the federation. One example is the putting in place of an urgent care GP pilot at Yeovil District Hospital (YDH), where a GP and practice manager have created and delivered a service to provide GP expertise to patients in the emergency admissions unit. The aim is to help identify people whose healthcare could be managed in the community. A small group of local GPs deliver the service with the support of healthcare assistants Monday to Friday between 1.30 and 6.30pm and an experienced GP works with the on-call medical team. There is also a facility to manage DVT patients where there is a problem with the timing of blood collections. The aim is to provide safe, good quality care for patients while reducing the workload of the DGH. During the shift, the GP receives all requests for medical admission. One of the good ideas in this scheme is that in order to support a rural community, a dedicated transport service has been set up to

practicebusiness.co.uk | july 2012

PEOPLE | case study

bring people in quickly, so that they can have the appropriate assessments and tests. Patients can also be returned home promptly in the early evening, if it is agreed that they are safe to be managed at home. A recent audit on this service highlighted the fact that 38% of patients have been discharged from YDH the same day. Twenty per cent of patients have been transferred out of YDH where prior to the service being set up, they would have spent at least one night in the hospital. There is now a plan to implement increased ambulatory care for patients where they can be seen, assessed and discharged the same day. An effective link to primary care will be crucial to this. CARING FOR THE COMMUNITY On a smaller scale, but no less important for the elderly, is a toenail cutting service that has been set up in five locations. It is advertised widely across the practices but it is hoped that eventually more practices will decide to host a service so services are available across South Somerset. The federation is also helping to facilitate the centralisation of leg ulcer services by September, which were previously provided by individual practices. The federation has also done excellent work for the region’s carers, distributing South Somerset Healthcare Federation Carers’ Champion Resource Packs to support the carers in their work. These initiatives are examples of what each federation is doing locally. Dr Helen Kingston, the CCG GP delegate from East Mendip Federation is equally enthusiastic about the process as Dr Chapman is, seeing federations as ideal ways of taking commissioning forward across the county. Although the process is an evolving one, the results are positive. Dr Kingston is a partner at the Frome Medical Practice, which also has a branch in Warminster. This has meant that she

Left to right: Le Chapman, treasurer of South Somerset Healthcare Federation and Dr Helen Kingston, CCG GP delegate, East Mendip Federation july 2012 | practicebusiness.co.uk

has a wealth of expertise not only in Somerset but also in Wiltshire and continues to work across both health communities as joint chair of the West Wiltshire, Yatton Keynall and Devizes Clinical Commissioning Group as well as the Somerset Clinical Commissioning Group. Such expertise and exchanges of information are invaluable to the CCGs in their evolution. The solid, step-by-step approach of the federations will undoubtedly prove to be beneficial to the local engagement of GPs. One of the most important aspects of the federation work is not just GP engagement, however, but the engagement and utilisation of the expertise of the practice managers within the federations. In some areas of the country practice managers have little or no information on their CCGs. In Somerset the practice managers’ very active role in the commissioning process will make all the difference.

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

people | case study

Practice for the future In this era of efficiency, practices have to bring their admin into the 21st century. Dave Mills, patient services and IT manager at Dr Anscombe & Partners, Donnington Healthcentre, Oxford, describes how his practice saved time and money by modernising

In the modern NHS it seems that all the major primary care headlines are very much focused on the end result of all of our endeavours – the patient experience. How to improve clinical care, how to make sure there are enough appointments for the patients, how to bring the private sector theories on ‘customer’ service and apply them to the modern day GP surgery. All of these goals are all very right and proper. But every house has to be built on strong supporting foundations, and in our surgery we had started to find that the workload involved in many of our supporting back-office processes was quickly spiralling in the wrong direction and taking time away from patient care.

july 2012 | practicebusiness.co.uk

people | case study

In the beginning Our crunch point came when the pigeon holes in our admin room were full to bursting with paperwork and we simply couldn’t fit everything in to the doctors’ trays each day. We knew we had to make some fundamental changes to the way the whole surgery dealt with paperwork and the traditional comfort of actually seeing a piece of information written down on paper in front of you. Thus began our on-going journey to tackle all areas of the practice to make the back office processes more efficient and paper light with the use of strategically placed IT systems. Looking at the piles of paperwork arriving by post each day there was an obvious place to start. As easy as 1, 2, 3 At the same time as we had begun to notice a problem, our PCT was offering practices in the county the option to have a document management software installed. The theory being that it would replace the rather basic scanning solution in our clinical system, and allow us to send the 600 or so patient documents per week around the business electronically and with an audit trail. Needless to say we did not take a lot of convincing to sign up. After an initial bedding in period to get used to the Docman system, it provided a quick solution to our overflowing pigeon holes. The doctors got their patients documents the moment they were scanned, and they could forward them to the admin team to book appointments, read code diagnoses, whatever their heart so desired. The software did initially have one drawback which was rectified by the company: While the system was easy to use when you knew how, the interface did look a little overly complex for those who are not naturally drawn to the world of Windows, Google, and Wikipedia; shortly after we had installed an updated interface. The new interface is more streamlined and easier for most users to get to grips with. When we switched it on pretty much everybody was able to use it without any training. There are a number of ways we have customised our document management processes: • Templates: We use templates, so that when a document is scanned the member of staff can click on a template name and the document will automatically be sent to the correct person. For example ‘registered GP’ will send the item to july 2012 | practicebusiness.co.uk

Fact box Practice Dr Anscombe & Partners, Donnington Healthcentre, Oxford Patients 13,500 Partners and staff Nine partners, 12 doctors in total, 25 admin staff

the patient’s doctor without the need for staff to look up who that is. We also set a template up for all reports and forms to be sent to the practice administrator. Many of these were chargeable, but if sent straight to a GP often ended up being completed and sent off with no invoice. The administrator was able to do this before sending them on to the GP, generating the practice a sizeable increase in income. • Short cuts: We gave programmed them to complete several steps in one mouse click. The upshot being that 95% of the documents a GP receives are processed with a single click, and they can be sent to the correct person with a uniform explanation of what is needed to be done with the document. We have set up unique sets of short cuts for each department, and documents are now passed around in the blink of an eye.

Sites Three (two of which belong to the practice and the third is a PCT-run building next door with district nurses, health visitors etc. who work with the practice and uses its computer network). Computer terminals 60 on the network, and around 80-90 regular users who are either employed by the practice or work in their buildings.

people | case study

Following on from the initial success of our document management system, we added an electronic document transfer module soon after. This automatically downloads all of our patients’ out-ofhours GP reports, and hospital discharge summaries straight into our system ready to be sent to the GP and attached to the patient record. Gone are the days when the receptionists had to sit and print out reports only to rescan them into a different program. We are now downloading up to 100 documents a day in this manner. Our staff continually have problems finding the correct documents on our network drive. The list of them is truly staggering and keeping on top of what is old and what is new is a herculean task with line upon line of folders and file names. A library module allows us to give documents tags which are searchable with a single click. We have started implementing this in reception initially with tags such as ‘minor ops forms’, ‘registration forms’, ‘patient forms’ etc. The results so far have been encouraging, with less time spent searching the proverbial haystack for that pesky referral form that you just know is ‘in there somewhere’. Next to the library are several mini back-office apps. These mostly take the shape of replacing a number of the old paper records that we have to keep. As we all start the relentless march towards CQC registration in 2013, these will be an invaluable tool to keep all our records in one easy to access and easy to update location. There are currently apps for accident logs, asset registers, death register, fridge temperature logs, significant events, practice feedback, and a register of births. Results Over the past four years the practice has seen an increase in incoming paperwork of 75%. Thanks to the changes we made we have been able to process this without any extra investment in staff admin time. Our GPs have found that they have made similar efficiency savings when dealing with their patients paperwork. When you consider that a full-time GP can receive up to 200 pages of patient documentation each week, they are each saving between one to two hours every week just from this single improvement. That’s the equivalent of up to a dozen patient appointments for each doctor. We have also seen numerous other time savings ranging from a receptionist saving half-an-hour a week searching for documents, far fewer mistakes as the systems reduce the possibility for human july 2012 | practicebusiness.co.uk

error significantly, and information is more readily available at people’s fingertips when they need it. Investigating and fixing human errors is always something that can drain valuable management time, especially in a large practice such as ours. We have noticed a reduction in time spent on this particular task of up to an hour a week. On top of the efficiency savings we have also generated extra revenue due to cutting out numerous charging errors from incorrect routing of reports that are not covered under the NHS. With the continual pressure on primary care budgets as well as other big projects such as CQC registration on the horizon, we couldn’t have coped without paying as much attention to the back of the business as well as the front.

Our staff continually have problems finding the correct documents on our network drive. The list of them is truly staggering and keeping on top of what is old and what is new is a herculean task with line upon line of folders

business intelligence and management sense for practice managers

management

A litmus test for the NHS?

Diabetes and diabetes-related illnesses, such as kidney failure, blindness, heart disease and stroke, cost the NHS billions of pounds a year. Could more be done on a practice level to help tackle this? Carrie Service reports The NHS spends a reported £9bn a year on managing diabetes, and things are only going to get worse as diabetes-related illnesses stretch resources to the limit. If the NHS wants to prevent history from repeating itself, it needs to learn from its mistakes – quite a challenge when clinicians are trying to address the current situation as it stands: “Diabetologists are still in the midst of trying to make improvements to services to look after their pre-existing patient population, let alone the gathering storm,” says Dr Paul Grant, director of communications at The Young Diabetologists Forum (YDF).

Investing in the future Grant believes the future of diabetes rests on how well the NHS invests in integrated care: “Patients with difficult-to-manage diabetes [should] see the right professional, be it a diabetes specialist nurse, GPwSI or diabetologist, at the right time, without inappropriate delays relating to worries about short term cost saving.” Making sure that patients have access to specialists may incur up-front costs, but has the potential to create savings in the future by helping to prevent the onset of diabetes-related illness. On a practice level, Grant recommends the use of a strong IT infrastructure, and staff with good data handling capabilities with a powerful enough database to capture all the requisite information about patients. This can then be shared between healthcare professionals to make the most of valuable information and share best practice: “Whatever form a diabetes service takes, it should be open to peer

july 2012 | practicebusiness.co.uk

review and ongoing assessment to make sure that patients are being managed effectively,” says Grant.

Help them help themselves Alan Eastwood, forum administrator for online forum DiabetesSupport.co.uk, believes the only way to tackle the disease is to be as proactive as possible in helping patients help themselves: “The single most effective and important thing that surgeries could do to enable patients to gain a good understanding of their diabetes and manage it well would be to provide the facility and education for self-management,” he says. “Diabetes is a very individual condition and people need to learn how their bodies react to and tolerate different foods, and the only way they can do this is to be able to monitor their reactions.” Making blood glucose test strips more readily available to patients so that they can see how well they are managing their diet is an effective way of doing this, but is something that seems to be approached with reluctance by many surgeries. “On countless occasions highly-motivated and capable members of our support forum have been refused this facility [this only applies to patients who are not on insulin or hypoglycaemic agents, as they would be prescribed strips] and have had to either self-fund or simply rely on periodic HbA1c tests which, if not good, will provide no clue as to where the problems may lie. In contrast, those who are able to self-monitor had shown great improvements – often resulting in reduction in medications and non-diabetic blood sugar levels.” So why aren’t practices making the most of this simple and effective

management | diabetes management

solution? “The argument against self-monitoring is cost,” explains Eastwood. “Yet complications from poor management cost the NHS considerably more. Diabetes is 99% managed by the individual, as it is a 24/7 disease. Without the proper tools and guidance to manage it well, complications are far more likely.” Sue Marshall, a Type 1 sufferer and founder of Desang, a provider of diabetes kitbags and other related accessories, agrees that strips are a good way of reducing future pressure on NHS budgets. She believes that if patients are proactive enough to use strips, they should be provided without question: “Access to strips is a basic way to improve health outcomes in those interested in their health enough to bother to use them. An interested patient should not be deterred in this, it is a trifling cost next to that of being hospitalised.”

The bigger picture As previously highlighted by Grant, GP practices are not only tasked with reducing future strain on the NHS caused by diabetes, but are also responsible for managing the ever growing current crisis. Encouraging patients to be proactive about conditions that are dealt with by other providers is one way of doing this: “GP surgeries should talk to

patients about their eye health,” advises Marshall. “Diabetes is the leading cause of blindness of people of a working age. In fact many High Street opticians do pick up signs of diabetic eye damage which can in some cases lead to a diagnosis of diabetes.”As with all conditions, it is vitally important to have as much information available within the surgery about diabetes and related illnesses as possible. There is a wealth of information available online for sufferers, but the GP surgery is a trusted source of support and advice and is well placed for providing information about help groups and the like. Imagine being in the position of a patient and ask yourself how accessible the information is to you. Do you know where to find leaflets and literature relating to the disease? Are there any support groups running in your area? Are there clear, easy to read, informative posters? Also, are you tackling all of the illnesses caused by diabetes, such as kidney failure, stroke, heart disease and blindness? Type 2 diabetes is stealing all the headlines at the moment, but it is important to consider Type 1 in your awareness campaign too. With a quarter of Type 1 diabetes cases in children going undiagnosed until they are admitted to A&E, raising awareness about the symptoms of this type of the disease is a matter of life and death.

Without the proper tools and guidance to manage it well, complications are far more likely practicebusiness.co.uk | july 2012

management | qof

Paul Lambden Dr Paul Lambden is a practicing GP and qualified dentist. He has been a GP for over 30 years, with over 20 in practice. He has previously worked as chief executive for an NHS district, LMC secretary and special adviser to the Parliamentary Health Select Committee

Smoking cessation

General practice plays a large part in the smoking cessation programme. It is recognised in the QOF, with 73 points available for meeting smoking targets. So, Paul Lambden asks, why do so many people still smoke?

Smoking represents the biggest single challenge for international healthcare. It threatens the NHS in its present form july 2012 | practicebusiness.co.uk

Earlier this week I was consulting with a mother and her child, a boy of nine. “I am worried about him,” she said. “He is smoking too much.” It transpired that he was smoking between eight and ten cigarettes a day. She asked me what I was going to do about it. She and her husband both smoke. I struggled with the consultation on many levels: why did the woman expect the NHS to sort out what should have been a parental control problem; where was he getting the money from; and why on earth were both parents still smoking? As I spoke to the boy he adopted a look of resignation. He treated the consultation as something he had to get through so he could go and have a fag. I have huge admiration for those people working tirelessly to help people stop smoking in the face of such apathy and, frankly, stupidity. The NHS, ASH and the media work so hard to stop people smoking and yet the problem is still considerable. About a fifth of the adult population smoke and two-thirds of them started before they were 18. Smoking causes serious levels of morbidity and that morbidity, which can affect almost every organ in the body, costs the NHS getting on for £3bn a year. Nearly 80% of the cost of a packet of cigarettes is tax so at least they contribute financially to the treatment of their own illness. Perhaps the most frightening statistic is that 86% of deaths from lung cancer, 80% of deaths from bronchitis and emphysema and nearly 20% of deaths from heart disease are caused by smoking. Around a third of all cancer deaths are associated with smoking. Smoking is the main cause of preventable morbidity and premature death, leading to an estimated annual average of 86,500 deaths between 1998 and 2002 in England alone and over 100,000 in the UK as a whole. This is all hardly surprising when it is considered that cigarette smoke contains over 4,000 chemicals, the most dangerous of which are tar components, nicotine and carbon monoxide. The ten million people who smoke do so in the face of increasing constraint. Advertising has been banned for some years and displaying tobacco products in large shops has recently been introduced. Cigarettes cannot be sold

Indicator

Points Payment Stages

On-going Management SMOKING 5. The percentage of patients with any, or any combination, of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses whose notes record smoking status in the preceding 15 months.

50-90%

SMOKING 6. The percentage of patients with any or any combination of the conditions as described above who smoke and whose notes contain a record of an offer of support and treatment within the preceding 15 months.

50-90%

SMOKING 7. The percentage of patients aged 15 and over whose notes record smoking status in the preceding 27 months

50-90%

SMOKING 8. The percentage of patients aged 15 and over who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 27 months.

40-90%

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to anyone under the age of 18. Smoking is now prohibited by law in almost all enclosed public places throughout the UK with only a few exceptions. General practice plays a significant part in the smoking cessation programme with many practice team members operating clinics, and the habit is now high on the agenda of most doctors during consultations. The importance is recognised in the QOF and 73 points are available for meeting all the smoking targets. The indicators and the achievable points emphasise the thrust towards identifying the vulnerable population and encouraging them to seek the support and treatment necessary to stop smoking. The range of diseases and disorders identified within the target groups is broad. The amount of evidence demonstrating the association between smoking and specific disease morbidity is variable and so, for instance, there is no direct link between smoking and increased blood pressure but the association between smoking and heart disease is strong with much evidence. Because of the clear association between hypertension and heart disease it is therefore appropriate to include hypertension in the target group. Smoking can be traced back five centuries before Christ to religious rituals and progressively became a global phenomenon. The exclusive use of mind-altering drugs gradually gave way to a mixed use of drugs and tobacco since the seventeenth century and now over a billion people smoke tobacco and drugs worldwide. It therefore probably represents the biggest single challenge for international healthcare. Britain is at the forefront of the assault on the habit and it is vital for the NHS to succeed because smoking and obesity together threaten the viability of the NHS in its present form. There is also the little matter of smoking reducing life expectancy by an average of seven to eight years. So to all those people who work so hard, face such difficult challenges and have had so much success, thank you and keep calm and carry on.

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MANAGEMENT | legal

LTD

Many GP properties are owned by PCTs and when PCTs are abolished next year, these will be owned and managed by the new NHS Property Services company. BEN WILLIS looks at the legal issues this could stir up Many GP practices occupy surgery premises owned by PCTs. In a large number of cases, the basis of occupation is not documented. There is no lease in place, no obligation to pay rent and property outgoings are dealt with on an internal counting basis. When PCTS are abolished next year, existing GP surgery premises owned by PCTs will vest in a new NHS Property Services company, which has been set up to own and manage large parts of the NHS property estate. PCTs are now required to properly establish and document the occupation of GPs and put leases in place. While on the face of it, this should be a simple exercise, a whole host of potential issues arise and we would strongly advise GP practices asked to sign a lease to take property and legal advice. The following issues are key: 1. The rent level you will be expected to pay and whether this will be â&#x20AC;&#x2DC;reimbursedâ&#x20AC;&#x2122; by the PCT and, indeed, its successor body. 2. The basis upon which your rent can be reviewed and how frequently. 3. The length of lease term you are expected to sign. A lease is a contract and cannot be unilaterally terminated by either party unless it incorporates specific break clauses. 4. Repair obligations to be imposed. If you are expected to take a full repairing obligation, this can include an obligation to put premises not in repair into a full state of repair and decoration.

5. Whether the lease restricts the use of the property to NHS use only, which could limit plans for the future operation of the practice. 6. Whether the existing building is fully compliant with the requirements of statute (asbestos, disability access, fire risk etc.) With one eye on CQC requirements and a likely obligation in the lease to ensure that premises are compliant, be careful that you are not inheriting an expensive liability. A survey might be a good idea. 7. On what basis the lease can be transferred. Leases can be onerous and place significant and expensive liabilities on a tenant. There will be legal costs incurred in negotiating a lease and (where necessary) registering the lease at the Land Registry. Whilst your existing occupation is not documented, do not underestimate your negotiating position. You may have the benefit of rights of security of tenure which would mean you are not under an obligation to sign a new lease either at all or in the form required by the PCT. Professional legal advice will assist you in ensuring that the lease offered is on terms that are right for your building and your practice.

Legal update sponsored by Veale Wasbrough Vizards VWV 2010 has particular experience in acting for GPs on surgery leases. month | practicebusiness.co.uk Contact Ben Willis on bwillis@vwv.co.uk or 0117 3145394 for a free initial consultation

PCT owned premises will vest in NHS Property Services Ltd, set up to own and manage the NHS estate

Ben Willis, partner

MEDICINES OPTIMISATION WITH FDB

THE CHALLENGE

THE SOLUTION

McKinsey’s 20091 report to the previous government identified changes in drug spending could deliver 10 to 15 per cent of the overall savings and indicated this might be achieved by reducing variation in prescribing practice and increasing the use of generics over branded products. In 2011 The King’s Fund ‘The quality of GP prescribing’2 report highlighted the need to address variation in prescribing practice variation and encourage adherence to best practice. Earlier in 2012 the GMC PRACtICe3 study into the prevalence and causes of prescribing errors in UK general practice revealed prescription drug errors for one in six people, with the elderly and young being almost twice as likely to experience an error. Bruce Guthrie’s recently published study in The Lancet4 found that the number of morbidities and the proportion of people with multimorbidity increased substantially with age so that by age 50 years, half of the population had at least one morbidity, and by age 65 years most were multi-morbid with physical and mental health comorbidities. In 2011 First Databank (FDB™) undertook extensive independent research to drill deeper into the current suite of clinical decision support available to understand: • why GPs reject the clinical decision support alerts available, • why GPs don’t always adhere to best practice, and • what extra support is required to assist the new CCGs and their component GP practices to achieve their saving targets? The research showed that currently available technology and tools did not specifically address the issue of deviation from best practice and most importantly none were clinically sensitive at a patient level – making recommendations without reference to current ‘problem’ and comorbidities or polypharmacy issues.

FDB has developed its new Medicines Optimisation solution specifically to help CCGs and GP practices manage their medications budgets and improve patient outcomes through better quality prescribing and adherence to best practice guidelines such as NICE. FDB’s Medicines Optimisation at the point of prescribing helps GPs and patients by providing

sales@fdbhealth.com References 1. ‘Achieving World Class Productivity in the NHS 2009/10 – 2013/14: Detailing the Size of the Opportunity’, McKinsey & Co, March 2009. 2. The Kings Fund – ‘The Quality of GP Prescribing’ A study by Dr Martin Duerden, Professor David Millson, Professor Anthony Avery and Dr Sharon Smart, 2009 3. ’Epidemiology of multi-morbidity and implications for healthcare, research, and medical education: a cross-sectional study’ Karen Barnett, Stewart W Mercer, Michael

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patient specific drug recommendations (with polypharmacy and comorbidities taken into account), • timely, evidence based best practice (prompts to follow relevant guidelines, with links to source documents), and • price comparisons for the drugs that are safe, in line with best practice for a specific patient. FDB’s Medicines Optimisation analytics provides a current view on prescribing behaviour across CCGs providing access to: •

population level analytics, which can be drilled down into the individual patient record to allow interventions, • best practice guidance – reducing prescribing variations, and • the information required to build condition specific formularies. These tools will free up Medicines Management team time for direct clinical care or local initiatives. The next generation of medicines related active clinical decision support is here now, complemented by unique patient level analytics capabilities. For more details on FDB’s Medicines Optimisation solutions email sales@fdbhealth.com or visit fdbhealth.co.uk

fdbhealth.co.uk Norbury, Graham Watt, Sally Wyke, Bruce Guthrie www.thelancet.com Published online May 10, 2012 DOI:10.1016/S0140-6736(12)60240-2 4. ‘Investigating the prevalence and causes of prescribing errors in general practice: The PRACtICe Study’, May 2012 Professor Tony Avery1, Professor Nick Barber2, Dr. Maisoon Ghaleb3, Professor Bryony Dean Franklin2,4, Dr. Sarah Armstrong5, Dr. Sarah Crowe1, Professor Soraya Dhillon3, Dr. Anette Freyer6, Dr Rachel Howard7, Dr. Cinzia Pezzolesi3, Mr. Brian Serumaga1, Glen Swanwick8, Olanrewaju Talabi1

Work/life | diary

Practice diary Ann Boyle Ann Boyle started working in the NHS just 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 BeyondtheReceptionDesk.wordpress.com

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

It’s all well and good having a laugh at work, but when it’s audible in the reception area, it can leave the wrong impression. General practice blogger Ann Boyle explains why receptionists should think before they speak I read an article recently with a woman stating that she had been humiliated by staff at her doctors’ surgery after they allegedly left a message on her answerphone mocking her looks. She said she could hear a group of woman in the background laughing at her. I do not know the full story – so therefore cannot judge – but I had a similar “complaint” against one of the surgeries I managed some years ago. I took a call from a woman claiming that when she phoned the surgery earlier that morning requesting a visit from the doctor for her sick husband the receptionist had laughed down the phone at her and she could hear laughter in the background, which she felt was directed at her. I took this complaint seriously but I could not believe that any of my receptionists would have done this. I promised the woman I would investigate and get back to her. I checked who had taken the call and was gobsmacked – it was not only one of our most senior receptionists, but one of the most professional receptionists we had. We went over the call. It happened that the woman was pretty rude when she asked if the patient was able to get to surgery. The receptionist said she did not retaliate. The receptionists said that once the woman had

said her husband was in no fit state to come the surgery she took the visit as she would normally. She denied that she had laughed and was quite upset by the allegation. I went down to discuss the incident with the rest of the team. As I walked into reception I was greeted by three girls laughing at a joke while someone was on the phone. Could this have happened earlier? I spoke to the girls – they all agreed that the receptionist had taken the call in a professional manner as she always did but confessed that “perhaps” they had been “chatting”. I phoned the woman back – I had to be careful how I handled the call as I did not want the woman to think I was calling her a liar. I asked if maybe she had misunderstood and perhaps had heard some background laughter. She disagreed, but I maintained that the receptionist would never had done that. I assured the woman that I would be speaking to the team and raising the issue and I promised her that we would look at our system and every effort would be put in place to ensure this would not happen again. I followed up the telephone conversation in a letter apologising for any upset she might have experienced. I enclosed a complaints form if she felt she needed to take the matter further – I am pleased to say she did not. What was learned from this experience is that reception needs to be kept quiet; laughter can be misunderstood and certain conversation could cause upset.

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