Practice Business by Intelligent Media Solutions

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The changing health sector Patients are living longer; there are more and better treatments available; but the health budget is finite. The solution: deliver more care within primary care Services delivered close to home, by the people patients know and trust:  delivers better patient experience and better health outcomes  and it’s much better value for taxpayers – the two key drivers of government policy. For the practice, delivering more services is financially rewarding, but it all needs to be managed, and practise managers are the people in place to do this.

GP Commissioning The Government is committed to establishing radical changes to the NHS to ensure it better meets the needs of patients at a local level. In July 2010, it published the whitepaper ‘Equity and Excellence: Liberating the NHS’, concluding that GPs were best suited to make decisions on behalf of their patients and paving the way to GP-led commissioning. Pathfinder CCGs formed, and quickly covered nearly 90% of the patient population in England. Their boards included GPs, practice managers practice nurses and latterly, secondary clinicians. It is becoming increasingly clear that practice managers are stepping up to take on the management support role in these groups.

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The evolving role

Practice managers are the professionals to influence when it comes to selecting, specifying or purchasing decisions in the practice. The Government has publicly linked the success of its own health agenda to the development of a successful primary care sector and for primary care to really prosper, a tier of great practice managers is essential.

of the practice manager

In recent years, the practice manager’s role has extended way beyond its traditional responsibilities. Going forward, the scope of the role is set to increase further and it is vital they receive focused attention. Are you serious about practice managers? The Government is… During the last GMS/PMS health chapter, a core theme and outcome was GPs positively delegating all practice-wide management issues to the practice manager. For the current chapter, practice managers were widely consulted in developing the policy for the white paper: ‘Equity and Excellence: Liberating the NHS’. And now, CCG boards typically include two or three practice managers – as since GPs generally have little management experience, it is practice managers that are stepping up to take on the management support role.

A study into the practice manager’s responsibility for managing the income and expenditure within a practice indicated that: Practice managers are responsible for managing 68.6% of all income and 97.9% of all costs

Changing the way practice managers do business Our goal is to totally support practice managers in their role with strategic, managementfocused content If it doesnâ&#x20AC;&#x2122;t help practice managers to be more effective, it doesnâ&#x20AC;&#x2122;t make it into the magazine or onto the website

We think that to be useful, information needs filtering, context and, most importantly, practical guidance on how best to use it. Like many professionals, practice managers can be too busy to do all that, so we do it for them and deliver it in a format they understand; because we do all that for them, they read what we deliver. Informative, focused, relevant A management focus

Our editorial content is based on a clear understanding of the health sector, primary care and, in particular, the way practices and practice management are evolving. We respond with appropriate, focused editorial to support and stimulate the reader in all aspects of their job. Tailored to suit

We deliver across a range of media, so practice managers can choose how they want to receive our content, whether it be:  daily through our websites, blogs and social media feeds  weekly through our email newsletters and alerts  monthly in Practice Business magazine.  or throughout the year with our conference media partner arrangements.

Who is holding the purse strings? As an advertiser, you can rest assured knowing your marketing budget is going straight to the decision-maker

The practice manager has significant responsibility for directly selecting, specifying and purchasing a wide range of products and services. They are also the custodian of the GP’s time and a gatekeeper to practice access Which products and services? Practices are independent businesses contracted to the NHS and so maximising the value received in return for their spend is vital, including:  general products and services that all businesses have in common  clinical products and services specific to practices.  and pharmaceuticals – supply for prescribing practices and prescriptions for all practices. The practice manager is the most important point of influence when it comes to selecting, specifying or purchasing in the practice.

We may be able to help you keep in touch The health sector is extremely fragmented, which makes it difficult to communicate with. We can’t solve that issue but we can guarantee you the eyes and ears of practice managers nationwide. Practice Business addresses practice managers with intelligent editorial, relevant to the decisions they make on a daily basis, and because it’s targeted and relevant to them, they read it.

our strategy what makes us

We want you to keep coming back So our approach is different. We really understand our readers and their market; our highly targeted, original, and useful content engages them; which means weâ&#x20AC;&#x2122;re perfectly positioned to help you engage with them.

Our role is to facilitate good engagement with the key purchasing audience within the primary care sector. They’re extremely busy people with varied roles, and it’s difficult for suppliers to get their messages through to them without a strong marketing vehicle

so whaT makes ours a sTronG markeTinG vehicle? our people

We have a great team of talented and innovative individuals, who know how to go that extra mile and deliver mould-breaking marketing solutions. You’re in good hands! our ediTorial

Our team of in-house journalists understand our readers intimately and deliver valuable need-to-know content that specifically meets their needs, in a way that best suits them. This means our readership is loyal and fully engaged with our magazines and websites, and in turn, we know them and what they want. value To you, The adverTiser

We keep the percentage of advertising pages below 30%. We believe it’s the right balance to keep our readers engaged, and give our clients’ advertising content space to shine. There are also ways for suppliers to get involved editorially, for example through case studies or offering expert opinion, but it is always at the discretion of our editorial team. Our main objective is to ensure our pages are read thoroughly, which in turn guarantees that your marketing message is being seen and absorbed. our desiGn & producTion

All our products feature strong, easily recognisable design that reflects and enhances the editorial quality, ensures they stand out from the crowd, and encourages the reader to pick them up and read them. our sales approach

Our view is that a true partnership will always benefit both parties. We care about building strong relationships with our clients; really understanding their businesses and their marketing objectives; and then finding the most effective ways to meet them. We are specialists, and we have way more to offer than simply space on a page. Our publications provide a strategic, effective and proven marketing channel for our clients - a true media solution.

While others talk – we deliver.

Approved Partners

We could never do it alone Our partnership with these individuals and organisations enhances our direct link to practice managers, offering further insight into the areas that interest them. Our main priority is to deliver relevant, interesting and valuable content to our readers and our partnerships help us to achieve that.

NAPC “The National Association of Primary Care is delighted to have formed an approved partnership with Practice Business. We are confident that its management focused editorial strategy is perfect to help the practice manager cope with the many and varied demands of primary care.”

Roy Lilley An independent health policy analyst, writer, broadcaster and commentator on health and social issues. He also provides consultancy to NHS organisations and the companies providing products and services to the health service.

Maggie Marum

NHS Alliance “The NHS Alliance brings together GP consortia, PCTs, clinicians and managers in primary care. We are an independent nonpolitical organisation proud to be at the forefront of clinically-led commissioning. We’re delighted to be working with Practice Business.”

Chris Hanney

IHM Dr 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 advisor to the Parliamentary Health Select Committee.

“IHM’s focus is continuous professional development, but we recognise that it will take a varied agenda, delivered by a wide range of organisations, to make a real difference. That’s why the IHM is delighted to be involved with Practice Business. We believe that management focused editorial, delivered through testimonials, is a great way to help practice managers achieve their own goals.”

Sue Hodgetts

AMSPAR Roger Hymas Roger Hymas is chief executive of Healthcare Commissioning Services. He has been CEO of BUPA’s insurance division; founding director of Health Dialog in Boston, USA; a strategic adviser to Humana and Hampshire PCT’s director of commissioning.

“Is a professional membership and awarding body which provides a range of professional qualifications that sit both inside and outside the National Qualifications Framework. It also offers members advice, support, and guidelines. AMSPAR is delighted to be working with Practice Business for the benefit of managers in primary care.”

Tom Brownlie

practice business Health Secretary Andrew Lansley has announced that 97% of the population of England will be covered by shadow commissioning groups. In his speech to the NHS Confederation’s annual conference in Manchester last month, the secretary of state for health announced the fifth cohort of pathfinders – GPs and front-line clinicians who have come forward to lead the way in commissioning. In total, 257 groups of GP practices from across the country, covering around 97% of the population (around 50 million people), have now come forward so they can directly commission services for their local patients. Lansley said: “GPs know their local population best and they should have the power to improve care for patients. The fact that 257 pathfinder groups now do this for around 97% of the country is not only great news for patients but for the entire NHS, as front-line clinicians step forward to modernise services.”

The selected groups represent GPs and other health and care professionals who have demonstrated readiness to start taking on commissioning responsibilities. These emerging clinical commissioning groups are working together with patients, other NHS colleagues and local authorities to help manage local budgets and design services for their patients. Pathfinders will become part of a national Pathfinder Learning Network and will be supported by the National Clinical Commissioning Network, the National Leadership Council and national primary care bodies.

The NHS Alliance and NAPC have published a paper explaining how commissioning will help to tackle the three major challenges facing the NHS in England over the next five years. ‘Clinical commissioning: securing better outcomes for the NHS and its patients’ outlines the role of commissioning in improving the health of the population; reducing health inequalities, and delivering better services to patients while achieving ambitious efficiency savings. Dr Michael Dixon, chairman of the NHS Alliance, said: “This discussion is extremely important. Clinicians are in the best position to lead through the changes that will make the NHS not only sustainable, but also able to deliver better care for our patients. “By working to overcome the barriers between the NHS and social care, [clinical commissioners] will be able to provide patients with better, seamless and more accessible care,” he added. NAPC chair Dr Johnny Marshall added that clinical commissioners must accept a collective responsibility to deliver the best possible health outcomes for their populations. “Whatever uncertainty there is yet to come, clinical commissioners must seize this opportunity to lead the NHS in doing what is right for our patients, their carers, their families and the public,” he said. “We must not let ourselves be deflected from that.”

A more efficient system

commissioning in context

The NHS Alliance has published a document to help practice managers tackle a range of management challenges relating to clinical commissioning work. ‘Liberating Practice Management: How to create a thriving practice in challenging times’ offers case studies as well as practical advice and tools to help PMs realise the opportunities commissioning provides to improve patient care and manage NHS resources more effectively.

Topics covered include managing practice finances during difficult times, engaging with the local community, achieving excellent customer services and developing quality systems. Caroline Kerby, co-lead of the NHS Alliance’s Practice Management Network, welcomed the report. She said: “During the health care reforms, practice managers will be pivotal in looking after their teams and making sure they are supported in developing the skills and abilities required.”

PATIENTS COMPARE THE MARKET

The government is planning to publish comparative performance data on GP practices as part of its information revolution, including information on clinical outcomes and staff satisfaction. The proposals, revealed last month, are part of the government’s larger plan for increased transparency in the public sector. GPC chairman Dr Laurence Buckman said that while greater transparency could improve clinical standards, “simplistic” league tables taken out of context could make it “impossible for people to interpret the information appropriately”. The plan is for GP data to be published online by December, which would allow members of the public to compare practices on prescribing data, staff satisfaction and comparative clinical outcomes. The RCGP says it will help the government to come up with appropriate indicators. Reports point to NHS Choices as the channel of choice for publishing the data, as it already lists practices and lets patients review services. Buckman commented: “Comparing the clinical outcomes of GP practices would need to be done in Key Facts a way that is fair and compares like with like – rates  GP data is set to be published and outcomes for chronic bronchitis, for example, online by December, most likely can differ markedly depending on the lifestyle and on the NHS Choices website even the occupations of the local population.  Topics open for comparison to “While greater transparency is a good thing, include things like prescribing it must be both appropriate and meaningful data, staff satisfaction and and that generally means context is important. comparative clinical outcomes Information concerning health treatment and  Critics worry this “simplistic” outcomes should also always form part of the approach to data could be taken out of context by patients. discussion that a patient has with their doctor as part of their overall care.”

“In terms of administration, EMIS Web is overwhelmingly superior.”

Joy Baker This month we speak to Joy Baker, practice manager at the Marden Medical Practice in Shropshire about the benefits of EMIS Web.

STAYING LOCAL

‘Pivotal’ PMs supported in commissioning challenges

A DH report, ‘Healthy Lives, Healthy People: Update and Way Forward’, outlines how public health in local communities will be emphasised under commissioning. Highlights include:  Clarifying the new leadership role for local authorities and their directors of public health, across health improvement, health protection and population health advice to the NHS  Proposals for commissioning public health services  Establishing a new integrated public health service, Public Health England, to drive improvements in health and protect against health threats  Public Health England will be an executive agency of the Department of Health, to provide greater operational independence within a structure that is clearly accountable to the Health Secretary  Clear principles for emergency preparedness, resilience and response. www.emis-online.com

A busy urban practice in Shropshire is realising the benefits of EMIS Web for staff and patients after being among the first practices to switch to the new system last November. Joy Baker, practice manager at the Marden Medical Practice, which serves 6,700 patients, said the administration side of EMIS Web was “overwhelmingly superior” and had the potential to deliver important clinical safety benefits. “Data searches are easier to put together and the results are more accurate and easier to understand. Practice staff have found the system easy to pick up.” Using Concept Manager, Joy’s team has just finished adding comprehensive drug alerts to the system, which she believes will improve patient safety, help GPs in keeping their knowledge up-to-date and cut down on repeat visits to the surgery. “Now that we have instant alerts popping up on the records, patients won’t have to come in several times to have blood taken for different tests,” she says. “We will be able to roll several tests into one, making the process much more efficient and safer.” Reception staff also appreciate the new appointment booking for EMIS Web, which makes it easier to plan a week’s appointments, add extra sessions and put together individualised templates for the GPs. Joy added: “Staff found EMIS Web easy to pick up and now, after more than six months using it, everyone is proactively looking for ways of developing the tools on offer to make sure it can do exactly what they want.”

PMs’ contract issues news

Contract law is the topic most frequently brought up by practice managers seeking employment law advice with a leading medical union. According to the MDDUS, 46% of calls to its inhouse employment law advisory team this year were regarding contractual issues affecting practice managers. MDDUS’s employment law adviser, Janice Sibbald explained: “Practice managers have become more financially aware in the current economic climate. As a result, almost half of the calls we received asking for employment law advice have been contractual.” Common issues include the employment of new staff on revised terms and conditions or guidance on contract interpretation, as well as issues surrounding maternity or sick pay. “One of the day-to-day challenges facing practice managers is getting the best out of staff,” continued Sibbald. “Whether it’s dealing with personality clashes within a practice or simply giving a practice manager guidance and practical tips on an issue of concern.”

SHA TRAIN SCHEME NHS South Central has created a new training course for GP practice managers – which it claims is the first of its kind in the country. Currently, practice managers can pursue qualifications such as the diploma in primary care and health management (DPCHM) from the AMSPAR, as well as the newly introduced IHM Accredited Manager Programme. However, the SHA argues there has never been a formalised training scheme for practice managers, which it sees as a “disparate group”, “pivotal” to leading primary care staff through the changes to the NHS and supporting CCGs. Maggie Woods, leadership development manager at NHS South Central, commented: “The role of practice manager is both challenging and varied. The scope of work can vary widely, but the independence of some GP practices leaves many managers feeling that they work in isolation and that the opportunities for development in all but the essential skills are limited this encouraged us to design this brand new course.”

SECTOR

Lansley challenged over manager cutbacks

They said…

fact

“The education of children and the treatment of the sick should not be treated as a commodity to be traded, as if healthcare and educations were chocolate bars or washing powder.”

You spent about a year at Newham. What sort of things did you get involved in with commissioning? It was early days for me on that side, so I don’t have a great deal of direct experience with commissioning. I worked mainly supporting the practices that came under Newham PCT.

Medical refrigeration Following the recent case of drugs tampering at a Cheshire hospital, practices are being urged to perform urgent security checks on their refrigeration devices and told to avoid using domestic fridges to store medical supplies. “As this case highlights, it is crucial that valuable drugs, vaccines and potentially dangerous substances are stored in professional medical fridges that come complete with an alarm and locks to restrict unauthorised access,” said Lucy Kinsella, medical marketing executive at Lec Medical.

So you moved over to manage this practice two years ago. What sort of things do you do? As well as the day-to-day running of the practice, I do a lot of consultancy work in other practices, helping them to get organised with different things. What does that involve? I go into a practice, look at their QOF points and their organisational skills, assess their HR policies and those sorts of things, and bring it all up to date. Then I develop an action plan and advise them on the sorts of things they need to be doing in three or six months, and up to two years’ time.

Patient choice NHS patients will have more freedom to choose any qualified provider for their healthcare from April 2012 when referred by their GP for selected services. These providers could be NHS providers, independent sector providers, or voluntary or third sector organisations. Suitable services include back pain, diagnostics and talk therapies.

Is that just in London? I get recommended, so it’s word of mouth and mainly in London and Hertfordshire and the surrounding area. I do that one day a week and I’m here at the practice four days a week. I’m spreading myself a bit thinly now, so I’m having to reign everything back a little, especially with the demands of CQC regulation and making sure the practice is at the standard it needs to be.

announcement of a free-market public sector that could see local health services going out of business without the government stepping in

Get the latest news in your inbox Want to be bang-upto-date on your health sector news? Sign up to the 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 www.practicebusiness.co.uk.

Fifth wave of pathfinders announced. In total, there are now 257 clinical commissioning groups across England, covering about 97% of the population (around 50 million people).

Still waters run deep practicebusiness.co.uk | august 2011

august 2011 | practicebusiness.co.uk

one to ones with the people who matter

commissioninG success

At Enfield’s Freezywater Primary Care Centre, improving systems and processes was essential for practice manager ANITA BOULTER to prepare for CQC regulation and commissioning, as she explained to ALLIE ANDERSON How did you come into practice management? I’ve been in this role for two years, but I’ve been a PM for 15 years. Before that, I had an interim role at Newham PCT in commissioning and did some work in the practice support unit there for about a year. I’ve been involved in practice management and PCT

work on and off for the last seven to eight years. Prior to that I was a PM in Waterloo, which is Lambeth PCT, and I also worked in City and Hackney PCT for a while. That’s a very innovative PCT and they’re frontrunners – one of the best PCTs I’ve worked in. I was really impressed with their foresight.

Do you think Freezywater is ready for the CQC changes? No, and I don’t think many are. Practices, in general, have been ticking away nicely. QOF came up and we dealt with it like we always do, by mucking in. But practices have to realise this is an open market and the government is trying to push us onto the same level playing field as private companies, and we have to be responsible for the day-to-day running of the practice including policies and procedures. Many practices aren’t geared up for that. What we’re seeing now is a great deal of PM posts coming up, where a partner retires and his wife, who was the PM, goes as well. So the practice has to put a new team in place, all because of this [CQC and commissioning] panic. Some PCTs in other London boroughs aren’t phased by it. They’re saying: “It’s just another one of these measures that we’re going to have to do, but it’ll fall by the wayside.” But we have to be clear that practices need to be accountable for everything they do. It may have another name but it’s something important that we have to do on a daily basis, and everyone must realise that.

about what I want to achieve for the practice, and recognise where I can get help. PMs in the past have basically done everything, but now it’s becoming overwhelming. There’s HR, health and safety, and all the day-to-day things you would normally do, but now you also have to write reports and action plans that never used to be required. Most PMs don’t have time to do all of that, because if you’ve got Joe Bloggs kicking off downstairs, you’re the one who has to go and deal with that, which knocks everything else out for the rest of your day. If you’d planned to focus on health and safety, for example, that gets sidelined if a problem arises in the practice. An automated support network is essential to make sure things get done – it’s taken a whole heap of work off me. What kinds of things will automation do for you and the practice? I’m looking to implement the whole lot – everything to do with risk assessment, health and safety and HR. I’m still managing it, but I’m doing it in a way that’s easier for me, using a process that doesn’t take forever. It also involves retraining a lot of the team, because again, they’ve spent years saying to themselves: “We don’t have to bother with that, we’re just a doctors’ practice.” But it’s more than that – we’re part of a community and we’re serving that community, and the feedback we’re getting from patients is that we need to provide a service they can access easily. One person trying to coordinate all of this places too much stress on that person. Many GPs think if

Fact Box Name: Anita Boulter Time in profession: 15 years Practice: Freezywater Primary Care Centre Patients: Circa 11,000 Clinical staff: Seven GPs including three partners, three part-time practice nurses and one HCA Non-clinical staff: Small team of admin and reception staff PCT: NHS Enfield

Do you have an action plan or a strategy? Yes, I need to automate as much as I can. I’m just one person and I can’t do everything. I’d love to be superwoman but I’m not, so I have to be realistic

Consortium: Enfield GP Consortium

july 2011 | practicebusiness.co.uk

practicebusiness.co.uk | july 2011

MANAGEMENT

secTor

business intelligence and management sense for practice managers

Considered news reporting and comment from our editors and regular contributors.

people in pracTice Our best practice management section - real interviews and other inclusions from real practice managers. It’s always better to hear it from one of your own kind.

Every GP practice in the UK should have a team of obesity specialists in place, urges leading obesity specialist, Professor Tony Leeds of Central Middlesex Hospital on the BBC’s website. Obesity costs the NHS around £4.2bn annually and the wider economy £16bn, and he says practices having obesity clinics would help reduce the number of hospital referrals as a result of obesity. “Britain’s front-line obesity management could be done in primary care if adequate resources were provided,” he wrote.

Tessa Jowell, shadow cabinet office minister, on David Cameron’s

august 2011 | practicebusiness.co.uk

A comprehensive section dedicated to this crucial, health-sector-changing topic. It will fundamentally affect the way healthcare is delivered and is always in and around the front pages.

PEOPLE | interview

Obesity

Health Secretary Andrew Lansley’s plans to cut healthcare administration by 33% and management costs by 45% by 2015 are being by challenged by the NHS Confederation and the King’s Fund, who are collaborating to develop indicators to measure the benefit managers have on clinical outcomes. The organisations have voiced concerns that a reduction in management could harm patients and therefore seek to measure the value added by management in tangible terms, the HSJ reports. To do so, the two organisations plan to publish a paper in spring of next year, setting out the contributions made by managers, along with the indicators that could be used to measure their value. Research uncovered by the HSJ, and commissioned by the Department of Health to be published this summer, has already found a correlation between better management, higher staff engagement and good patient outcomes. The study, by Aston University, indicates that better management leads to higher staff engagement, which leads to staff being more committed to their job, able to work better with colleagues and therefore less likely to make errors in their patient care.

“”

| news

clinical news

PEOPLE

LEADING THE WAY

COMMISSIONING TICKS BOXES

your monthly industry lowdown

COMMISSIONING

Visit the Commissioning Success blog at PracticeBusiness.co.uk/CS and stay up-to-date with all the NHS reform news and commentary affecting practice managers. EMPOWERING PRACTICE MANAGERS IN CONSORTIA

Welcome to Commissioning, a new section to Practice Business where we aim to cover the latest news in the new world of GP commissioning to better prepare managers and primary care professionals forming GP consortia

SECTOR

PRACTICE INSIGHT

MANAGEMENT | diabetes

A youth movement The recent National Diabetes Audit presented a damning report on the state of diabetes care for younger patients in primary care. JULIA DENNISON looks at what this says and what practices can do to up their game The NHS could be facing a diabetes time bomb. Shocking evidence published this summer in the shape of the 2010 National Diabetes Audit revealed a major problem: GP practices are not doing enough to treat the hundreds of thousands of young people with diabetes, and as a result the health service could suffer. Nearly 300,000 children and young adults with diabetes have high-risk, and 144,000 dangerously highrisk blood sugar levels that will lead to high levels of severe and disabling complications like kidney failure, limb amputation and stroke - and they are the ones who are less likely than older or elderly adults to receive the basic checks required to monitor their condition from their GP. This has led to concerns that a whole generation with diabetes will only require more substantial hospital care in a few years’ time. It’s up to practices to act now to ensure their services are adequate before it’s too late.

THE SITUATION AT HAND Only 42% of 24- to 54-year-olds receive all nine recommended basic care processes with their GP annually, such as blood pressure, blood sugar and foot checks, compared with 54% of adults aged 55 and over, according to the diabetes report. Overall, the percentage of patients receiving every process is improving each year, but two thirds of Type 1 patients and almost half of Type 2 patients still do not receive all nine. Dr Bob Young, lead clinician on the audit and consultant diabetologist and clinical lead for the National Diabetes Information Service, said at the

inpatient admissions fell by 40% almost immediately. If rolled out, the pilot could save the NHS in Cambridgeshire around £5m a year. Extrapolated up for the rest of England, that’s an annual saving of £400m.

WHAT CAN PRACTICES DO? While each practice should have a named clinical lead for diabetes, practice managers can also play a part in improving diabetes care at their practice. Patient care for diabetes involves both organised reviews within designated diabetes clinics, often run by a practice nurse, and day-to-day care patients. Back office systems should facilitate practices to call in the people with increased risk of developing diabetes, for example those with insulin resistance, so they can be offered preventative support. People with diabetes should have annual health checks and practices should ensure they attend them. For those who are not yet diagnosed, Steve Dunn, CEO of Williams Medical Supplies, says more point-ofcare testing is needed. “In the UK there are 2.8 million people diagnosed with diabetes, but more worryingly

A safe pair of hands “Our streamlined system has clinical safety checks embedded at every stage. Nothing is done without speaking to the patient and, if need be, the GP”

PRACTICES MAKE PERFECT

Phil Day Clinical pharmacist Pharmacy2U

delivering health august 2011 | practicebusiness.co.uk

Younger people make up a quarter of those with diabetes yet have the highest risks of potentially preventable complications SCRIPT FILE

time of the report that the results “ring alarm bells”, showing that “younger people make up a quarter of all those with diabetes yet have the highest risks of potentially preventable complications”. “If these risks could be reduced much future disability and shortened life expectancy could be prevented.”

Primary care plays a pivotal role in ensuring that people with diabetes receive effective diabetes care. This is recognised by the inclusion of clinical indicators for diabetes in the Quality and Outcomes Framework (QOF), including two new 2011/12 indicators on foot examination to improve diabetes-related foot care and to improve patients’ outcomes. As a result, many patients with diabetes are now managed solely or mainly in primary care. The proposed healthcare reforms are putting practices, which have frequent contact with patients with long-term conditions like diabetes, in the driving seat. GPs will be the ones who can prevent unnecessary referrals to hospital through commissioning services on a local level. Speaking on the 63rd birthday of the NHS, Health Secretary Andrew Lansley referenced the work frontline staff in his own constituency of Cambridge have done to improve care for diabetes patients. He talked about how doctors from Addenbrooke’s Hospital took the initiative to work with local GPs and invest in community care to improve glucose control in diabetics and to help improve self-management. As a result,

there are approximately 850,000 people who have the condition but don’t know it,” he says. “With better diagnostics, practices can make a big difference to this statistic.” Dunn urges practice managers to look for costeffective diabetes solutions that will improve patient care and cut down on repeat visits and did-not-attends. “This means looking again at the whole range, from equipment through to disposable items such as testing strips,” he says. As with anything, a good service is paramount – and with obesity prevalent among younger patients and diabetes on the increase, there is no time like the present to improve your practice’s service.

NHS mail order pharmacy Pharmacy2U is trusted by 300 GP practices to manage repeat medication for patients who choose to use its time-saving home delivery service. It’s a responsible task, and the online pharmacy has developed a sophisticated system to ensure its service is safe and secure at every stage. For example, it can only request prescriptions for current medication and only on instruction by the patient. At the heart of the system is the company’s clinical pharmacist Phil Day, who checks many of the prescriptions received. REGULATED AND SECURE Pharmacy2U is regulated by the General Pharmaceutical Council, like other pharmacies, so practices can be sure it is working to the highest standards. “However, unlike most community pharmacies, our system makes extensive use of technology which improves clinical safety in a number of ways,” says Phil. “For example, many prescriptions that have been authorised by a GP

come directly to us as an electronic message.” This reduces the potential for error, as Pharmacy2U doesn’t need to re-input any information. “Our system also allows me to see the patient’s recent prescribing history, which is helpful when I’m checking the dosage and potential interactions,” comments Phil. Authorised prescriptions are picked by one of the pharmacy’s dispensing robots, which use barcodes to identify the medication – reducing the potential for human error. Specially trained members of the dispensary team do a final check before the packaged medication is sent to the patient. Three hundred GP practices currently use Pharmacy2U’s free prescription service, enabling patients to have their scripts dispensed without having to contact their GP directly or collect the paper prescription. Medicines are delivered free of charge to patients’ homes or workplaces. www.pharmacy2u.co.uk/practice

work life Water-cooler stuff…recognising that every practice manager has a life too!

WORK/LIFE | qualifications

quality management within the ever-changing context of health and social care (see box out). Assessment is conducted via a work-based reflective portfolio and, for the senior and executive candidate, a focused professional interview. The IHM has identified the need for four levels of Accredited Manager accreditations, to give managers at all stages of their careers an opportunity to access the programme. The levels are:

Accredit to the practice For practice managers eager to skill-up for the added task of commissioning, JULIA DENNISON provides an update on the latest qualifications available

advice for busy lives

Covering both clinical management and general management issues. For the practice manager, an ideal opportunity to learn something new and make a real change in the way you do your role.

WORK/LIFE

manaGemenT

As the practice management profession becomes more widely recognised, particularly with the onset of commissioning and registration for the Care Quality Commission, the list of professional qualifications available gets longer. As more responsibility falls on the shoulders of practice managers and many prepare to go above and beyond their daily duties to sit on the board of clinical commissioning groups, the forward-thinking practice manager will be looking to be as qualified as possible in preparation for the dawning of a new, general practice-led NHS.

QUALIFICATIONS The Association of Medical Secretaries, Practice Managers, Administrators and Receptionists (AMSPAR) works with City & Guilds to provide qualifications recognised by Ofqual for the sector. Particularly relevant is the level five Certificate/Diploma in Primary

july 2011 | practicebusiness.co.uk

Care and Health Management (DPCHM) (formerly known as DPCM); these are the only qualifications designed specifically for managers in general practice and the increasing demands of the primary care sector. The programme is open to existing managers and potential managers in a health or social care environment and core units cover topics relating to primary care including managing medical ethics and legal requirements, financial management, managing information and leading teams. Optional units, which will be particularly useful when preparing for the big-picture thinking needed for commissioning, include ‘Developing the manager as a critical thinker’, ‘Becoming an effective leader’, ‘Managing for efficiency and effectiveness’, and ‘Managing recruitment’. These units are provided by training company Syder and Young over two years – the first year as a certificate and the second year as an optional

Pictured | Newly qualified IHM Accredited Managers

diploma. Syder and Young offers a range of qualification programmes in primary care and one of the newest and most popular for practice managers is the four-day Institute of Leadership Management (ILM) Level 7 Award, which comprises two days on ‘Leadership in Practice’ and two days on ‘Developing a Reflective Leader’. As an independent professional body for managers working in the health and social care sectors, the Institute of Healthcare Management (IHM) also has a range of management courses including the Managing in Health and Social Care post graduate certificate and diploma, a vocational training scheme for practice managers, Milestones (bite size, flexible modules of learning), and Elements (an e-learning suite of self-study generic modules), which form the basis of accredited programmes delivered by other organisations.

ACCREDITED MANAGER PROGRAMME An important step in the augmentation of the practice management profession is the launch of the IHM Accredited Manager Programme, following a successful pilot and early adopter programmes involving 17 practice managers, many of whom have been featured in Practice Business, including Val Hempsey of Bridges Medical Practice, Alison Sample of Whickham Cottage Medical Centre, Sam Clark of East Barnwell Health Centre and Russell Vine of Hassengate Medical Centre. The programme is accredited by Middlesex University and has been developed by the IHM to provide a way of demonstrating a manager’s individual competence across 11 behaviours of

Front line managers – managers whose roles focus on a specific team or processes, within narrower parameters than the role of the middle manager Middle managers – managers whose roles are mainly operational in focus Senior – experienced managers who may be within three years of a board position, their role containing a mix of strategic and operational responsibilities Executive – board-level experience or aspiring board level, their role being predominantly strategic. Accredited Manager status is current for three years from the date of the award. Managers who wish to continue their status beyond that time must submit their statement of intention to renew submit to the IHM six months before the expiry date. On 12 April, the IHM held its first awards ceremony at Reynolds Porter Chamberlain’s offices in London and the awards were presented by Rob Smith, head of gateway at the Department of Health. Sample spoke of her personal development, and how she has explored a range of different and more effective ways of working since participating in the programme, and how this has been valued by her colleagues. With the onset of commissioning, acting as registered manager under the CQC, enhanced services and new QOF standards, the role of the practice manager will be in flux in the next few years. Now is your chance to stand out from the crowd, and often the best way of doing this is to ensure you’re as qualified for your profession as possible. Continuing professional development has never been more important for practice managers, agrees consultant Pauline Webdale, who is a fellow of AMSPAR. “The oft-quoted ‘bottom up’ change will only work with adept and highly skilled managers supporting and guiding partners to the right decisions for their patients and their practice – something most have always done, and now all will need to do,” she comments. “As Macbeth discovered a landscape on the move is not to be trusted, so managers must make sure they can see the wood for the trees.”

Eleven behaviours of quality management To become an IHM Accredited Manager, you must be able to demonstrate the following 11 behaviours: 1. Contextual leadership 2. Managing the political and stakeholder environment; working collaboratively 3. Delivering outputs 4. Putting safety first: managing risk 5. Managing resources effectively and efficiently (sustainability) 6. Building winning teams 7. Communication and relationship management 8. Improvement and innovation 9. Integrating equalities and diversity 10. Reflection 11. Governance. practicebusiness.co.uk | july 2011

besT pracTice manaGemenT Case studies, interviews and stories from real people – all examples of best practice, all bringing together the practice management community as a professional group with common goals, issues and interests.

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readership Practice managers within the UK’s GP practices. In our terms, a manager is someone genuinely empowered to make decisions on behalf of the practice, this includes office managers through to practice partners, and everyone in between.

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 itâ&#x20AC;&#x2122;s placed within a framework that is extremely effective.

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

The magazine COMMISSIONING

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

the Commissioners in action section will focus on movers and shakers and forward-thinkers in the clinical-commissioning sector. It will include interviews with commissioning leaders, diary pages from commissioners and 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 Community Care will feature 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 will also feature best-practice articles on improving patient engagement and outreach, alongside success stories on how CCGs are tackling conditions in their local area.

EMPOWERING PRACTICE MANAGERS IN CONSORTIA

MARKS, SET, GO! Practices are not acting fast enough to set themselves up for commissioning, according to a leading health sector law firm. Speaking at the ‘Commissioning: The Era of Opportunity’ event in Newmarket last month, Ross Clark, partner at specialist solicitors’ Hempsons, urged GPs and practice managers to get organised now or risk being forced into consortia they don’t want to be part of. “Generally, I don’t think GPs are dealing with this quickly enough,” he told delegates. “It’s like a relay race – the consortium you’re going to be part of needs to be ready as soon as it gets that baton, not just to walk or drop it, but to sprint off. “Time will shift and I think you’ll be fully tasked by 2012. The government [isn’t] going to take their foot off the pedal.”

The NHS commissioning board must grant a consortium application if its constitution complies with requirements laid out in schedule two of the Health and Social Care Bill, which stipulates what the constitution must include and that the geographical area specified is appropriate. Clark urged practices to draw up a constitution as a priority so their consortium can begin making collective decisions and organising itself while in shadow form. “You need one now [to] get on with facing up to the fact that by 2012 they need to be running with that baton.”

Wikicommissioning

SCOTS KEEN TO COMMISSION

commissioning in context

commissioners in acTion

Practicebusiness.co.uk/cs

Welcome to Commissioning Success, a new section to Practice Business where we aim to cover the latest news in the new world of GP commissioning to better prepare managers and primary care professionals forming GP consortia

GPs called for greater involvement in decision making within the NHS at BMA Scotland’s annual conference last month. While making clear they did not wish to follow the route being taken in England, GPs in Scotland agreed that models of commissioning should be explored. This would allow them to take a greater role in shaping the care path of their patients. Dr Dean Marshall, chairman of the BMA’s Scottish general practitioners committee said: “We do not support the market-based reforms being pushed through in England, where the consequences for patients could be severe. But we do believe that an enhanced role for GPs in Scotland in making decisions about patient care could deliver very real benefits.”

A new website called ‘The Commissioning Community’ (www. commissioningcommunity.co.uk) has been launched by Practice Business columnist Roger Hymas to help raise the commissioning game in general practice. The website aims to bring together commissioning practices and techniques from across the NHS for consortia. PCT staff are also being invited to participate through an initiative called www. pctlegacy.co.uk, launching this month. Much of the reference material will be taken from individual PCT projects created under the World Class Commissioning Assurance programme, which ran from 2008 to 2010. PCTs are being asked to help identify their best work, which can be picked up by consortia and developed in the future in a wiki environment. The launch of the website focuses initially on the 2011/12 national contracts activity.

COMMISSIONING | analysis

Forget the Olympics, or 21/12/12, are you ready for 1/4/13 – commissioning’s day of reckoning? ROGER HYMAS reminds us that it’s 240 working days away

Roger Hymas Roger Hymas is a former MD of Bupa and director of commissioning for Hampshire PCT. He is the founder of the Commissioning Community website, www. commissioningcommunity. co.uk and a regular columnist on commissioning for Practice Business. You can reach him to clarify any issue at rogerhymas@btinternet.com

This is the year of the countdown clock. If you’re reading this on 14 February, it’s 164 days to the opening ceremony of the London Olympics. I’m pretty sure we’ll be reminded by the media as we hit every milestone: 200, 100, 50 and 30 days to go. But the other countdown in which we are all involved in is the run-up to the start of GP-led commissioning, scheduled for 1 April 2013. That’s 411 days away. Of course, it’s really much closer because I’m assuming that most commissioner weeks only have five days, not seven. Then there are bank holidays, Christmas, the New Year, Diamond Jubilee celebrations – all of which have to be deducted – plus four weeks’ annual leave, which means that there may be as few as 240 working days between now and 1.4.2013. Regular readers will know how much I witter on about how complicated commissioning is. Why I make this point is that it’s going to be a huge challenge for most CCGs to be in good enough shape to be effective commissioners by the due date. There is so much that has to be learned and implemented and for those involved – GPs and practices included – and on top there are the competing and familiar demands of the day job which just won’t go away. The other big issue is the shrinking resource to execute the commissioning challenge. If we go back two years ago to the halcyon days of PCT commissioning, you’d find that 250 people would have been employed in commissioning in each trust. Multiply 240 days by 250 people and you get close to 60,000 man days a year. Since then, PCTs and SHAs have been clustered and practically, but not quite, decimated. I’d guess headcount is around 40% of the numbers involved at their peak. This means that the 60,000 man days might now be no more than 36,000, about 7,000 per PCT cluster. Now it doesn’t stop there. The number of NHS administrative people actively involved in commissioning proper is destined to fall again. A critical milestone in the countdown process is the passing of the Health and Social Care Bill, which has to happen in the next 60 days or so before this session of Parliament ends. The passing of the act will be the starting gun for the inception of the NHS Commissioning Board and for the appointment of around 4,000 jobs at board headquarters and across the NHS in England. Most of these will be current PCT staff. It also means that if there are 100 CCGs by the year-end (and I’m betting it could be even fewer) there would be 40 NCB supervisors for each CCG. Perversely, this means that we could find ourselves with a headcount number that is greater than for individual CCG staffing. Think of it as a bit like the Navy having more admirals than ships. NCB people will have to fill their days with ‘useful’ work. Expect, then, that there will be lots of important authorisation questions that need to be answered by CCGs. The NCB will invoke good governance and due process, so I’m expecting that there will not be a lot of time for a great deal of real commissioning to get done in CCGs. Of course, it’s not the job of the NCB to do commissioning. Its job is to supervise the commissioning process, which is the job of the CCGs. All this means that there’s going to be significant disruption for CCGs just when they need lots of time in the run-up to taking over commissioning.

february 2012 | practicebusiness.co.uk

COMMISSIONING | case study

Swan song NHS Worcestershire brings end of life care out of anonymous hospitals and into the community. HELEN NORTHALL, CEO of PCC, explains how better commissioning can improve people’s lives until the very end

Health services have an understandable focus on getting sick people better, but recent years have seen a drive to improve the care of dying people. NHS Worcestershire has put itself at the forefront of that drive, partly by signing up to the Marie Curie Delivering Choice (MCDC) Programme. One of the key indicators for improving end of life care (EoLC) is how many people are able to die in the setting of their choice. Although most people say they would prefer to die in a setting other than hospital – usually their own home – more than half of deaths still take place in hospital. Using the MCDC programme as a starting point, NHS Worcestershire has reduced acute admission costs by an estimated £400,000 in 18 months by introducing a range of initiatives covering primary care, community nursing, ambulance services and acute care.The percentage of deaths taking place in hospital has fallen from 45% to 42% as a result. Both the savings in acute care – which are reinvested in community services – and the improved record in meeting people’s wishes to die at home are particularly impressive. Felix Blaine, the local GP who has been one of two clinical champions for the initiative, says: “We really wanted to engage with primary care and that is why we came up with a local enhanced service specification. In the LES we are trying to enshrine standard good practice but also highlight new ways of doing things and change the culture.” The LES draws heavily on the national tool for EoLC in the community, the Gold Standards Framework. It includes a requirement for a lead GP from each practice to attend a full day’s training and for other GPs to undertake two one-hour modules developed by consultants in palliative medicine. The primary care initiative is credited with a three-fold increase in the numbers of patients on the palliative care register in 18 months. Being on the register appears to significantly increase the prospect of a patient dying in his or her preferred setting. Fewer than one in five patients on a register die in hospital. The registers help ensure that anyone involved in making decisions about an individual’s care is aware that they are nearing the end of life. It is an important factor in encouraging professionals, the individual and family to engage in advance care planning. Such advance planning can help professionals and carers respond to a deterioration in the individual’s condition in a way that respects their wishes and preferences. Too often the response

to such crises is an emergency admission to hospital. The project and local commissioners have targeted the high rates of emergency admissions out of hours that meant people were admitted to hospital to die. Regular meetings with clinical staff from the out-of-hours provider and district nursing teams, coordinated by the MCDC project team, identified how such admissions could be reduced and the education needs of OOH GPs. Every OOH GP completes an EoLC module developed by the palliative care team. The initiative has also created new posts or expanded roles and responsibilities, particularly for several specialist palliative care nurses and health care assistants. Nurse specialists in palliative care now provide a weekend service that is aimed at preventing emergency hospital admissions. The nurses have averaged around 100 contacts a month, assessing and supporting patients face-to-face but also advising clinicians. In response to demand from both clinicians and relatives, two health care assistants are available each night to support patients and families where planned care arrangements had suddenly become untenable. The Rapid Access to Trained Carers at the End of Life (RACE) service has cared for 60 patients in six months and is thought to have prevented at least 20 admissions – with overwhelmingly positive feedback from service users. Other steps include: n New forms filled in by GPs and held by the ambulance hub. These inform crews of any advance care plans or the preferences of any patient nearing the end of life. This information can influence whether the person is taken to hospital by ambulance – resulting in the form saving £74,000 in its first six months. n Supporting the local Dying Matters campaign to encourage more conversations – and therefore planning – about death and dying. n Improved anticipatory prescribing – including the use of justin-case boxes containing drugs that are kept in a patient’s home in case their needs change suddenly. An audit at six months showed 48 of 66 patients had accessed the drugs – saving £65,000 through admission avoidance, fewer calls to OOH pharmacies and hospice admissions. n Improved arrangements for dying patients being discharged from the acute trust. The memory of how a loved one dies stays with relatives and friends for many years. There is only one chance to get it right and health services are working together in Worcestershire to ensure that happens for a lot more families.

The memory of how a loved one dies stays with relatives and friends for many years. There is only one chance to get it right

» february 2012 | practicebusiness.co.uk

practicebusiness.co.uk | february 2012

COMMISSIONING | analysis

manaGinG commissioninG

COMMISSIONING | analysis

Roger Hymas Roger Hymas is a former MD of Bupa and director of commissioning for Hampshire PCT. He is the founder of the Commissioning Community website, commissioningcommunity. co.uk and a regular columnist on commissioning for Practice Business. You can reach him to clarify any issue at rogerhymas@ btinternet.com

Or why we need more of them

RogeR Hymas looks at whether the DH’s draft plans for commissioning do enough to help CCgs get statutory status and why we should be looking to america for inspiration

Honourable intentions

This section will focus on the logistics behind delivering better commissioning. It aims to help readers see-through their commissioning plans succinctly and successfully. It will focus on budgetary issues, and ensuring CCGs make the most of the Government’s £25 per patient management allowance. Here we will also feature interviews and advice from PCts and SHas invested in seeing the NHS succeed under the reforms. It will also touch upon how to get the member practices of your CCG to get involved in commissioning and contribute their support.

What is it they say about March – comes in like a lion and out like a lamb? What a load of crock! I was frenzied trying to get it all together for the end of March: QOF and financial year-end, incentive scheme evidence, enhanced services quarter and end-of-year and then, because we are part of a pathfinder, some bright spark decided to set up a programme for commissioning development where the PCT brains tell us what we will all have to do in the future (unless we employ them of course, there’s always that option). As that is fortnightly and more or less mandatory, particularly if you are on the board or simply a bog-standard PM who wants to know what’s happening, it takes a lot of time. Now I appreciate that someone has thought to do something to help us all out so we can hit the ground running, however I am still having a strop because everyone seems to want a piece of me. Attendances to all and sundry because I am on the board are multiplying at a rapid pace, I get emails everyday asking if I can help (and if it is one of my PM mates I always do). I have queues of pharma-type people wanting to understand it all (I never help them unless I am substantially paid an appropriate honorarium). However despite it all, we still find ways to help each other – one of my fellow PMs on the PM network steering group sent an email just days ago asking whether we could share what PMs were valued at in different parts of the country for commissioning work and did anyone have job descriptions or competencies of PMs on boards. Within 10 minutes she had all the information she needed. It was suggested she asked what competencies the GPs had to be on the board and to view their job roles. In my naivety I thought all boards had done that and had the evidence to support it, though maybe not?

informaTion and TechnoloGy Data management and technology will play 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.

A new start VAL HEMPSEY of the Practice Management Network survives the end of the financial year – just

april 2010 | practicebusiness.co.uk

The final countdown

commissioninG updaTe

december 2011 | practicebusiness.co.uk

We’re practically at the end of the year. How was it for you? Somehow, I’m feeling rather glum, but maybe it’s because I’m the eternal optimist, a glass-halffull kind of person, and I had high hopes that 2011 would be a breakthrough year, one that we’d always remember as the starting point of something really big and worthwhile happening for the NHS. But, here we are at the end of the year and my impression is that we spent the time not making any meaningful progress. It’s my job in Practice Business to look at the strategic aspects of commissioning – to anticipate how the 2010 white paper (doesn’t it seem so long ago and so full of promise?) would move through stages, become a bill, then an act and lead us to a fundamentally different brave new world of GP-led commissioning. But what I observe at present is commissioning falling between the cracks of the old PCT system, which is disintegrating, and the GP-led version, which is a long way off being properly formed. The consequence, and it’s a very dangerous one in my opinion, will be that, for some time yet, the controlling influence in the NHS will continue to be the acute trusts, which will have the largest, disproportionate influence over care design, delivery and finances. These are big businesses that need to keep growing their incomes; it’s not unreasonable for their senior management to be ambitious for their organisations. However, from the commissioner’s perspective, I don’t see how it’s possible to maintain cost control and improve care design if you don’t have adequate commissioning, contracting and performance management processes. If not, acutes stay in the dominant position and the real losers in this scenario will be the patients of community care and mental health organisations as the money is gobbled up by their sophisticated FT colleagues. I know I’ve been harsh on PCTs for their lack of rigour and professionalism in pursuing the commissioning agenda, but PCTs were getting better – a lot better – before the decimation and

clustering that has taken place in the past year. We now face a situation where, as we go into the 2012/13 commissioner/provider contracting season, we’ll be in a worse state of negotiating equilibrium than last year, in fact any year since 2006/07 when PCTs were invented. This will mean that powerful provider interest will largely maintain its grip in local healthcare ‘markets’. Let me give you just one small example. Last year’s DH contract guidance made a plea that GPs should be involved in the annual contracting process. This year, they have been told to lead it. I’d like to ask you: How many of you in GP practices and CCGs have been involved over the past couple of months in developing your local ‘commissioning intentions’ for 2012/13? These set out the local framework for the next NHS financial year, establish the commissioning priorities and start to lay down the rules of engagement ahead of the contracting round. They are also intended to get stakeholder feedback – information from the local authority, voluntary organisations, the public and patient groups – on what is good and bad in the local provider scene and how improved contracts, signed next March, can get the best out of the resources available. Putting commissioning intentions into the public domain is also a practical demonstration of the transparency that is a major feature of the 2010 white paper. I write this article at the beginning of November, but as I Googled “commissioning intentions 2012/13”, I didn’t find more than a handful of recent references to the subject. Arguably, there should have been a minimum of 51 – for all ‘clustered’ PCTs – and a maximum of 152, representing the original number of PCT organisations. If these programmes had been executed – and they are an essential part of any commissioner’s patient and public engagement programme – they should by now be within the view of the eagle eye of Google. There are, however, some examples of excellent commissioning intentions initiatives out there on the internet. Full marks go to Kingston – one of my favourite PCTs for a long time. The Kingston CCG got its commissioning intentions out as early as October. (Take a look at: http:// www.kingstonpct.nhs.uk/Downloads/KCC%20 papers/4%20October%202011/Att%20D%20-%20 KCC%20Commissioning%20Intentions%20-%20 working%20draft%20_2_.pdf.) I think the 21-page document is a beacon in what seems otherwise to be a very dark, empty commissioning landscape. Hats off

practicebusiness.co.uk | december 2011

commissioninG success is a bi-monThly maGaZine aimed aT helpinG clinical commissioners GeT The besT ouTcomes Launching in March 2012, Commissioning Success will be 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 will be a must-read for anyone interested in clinically-led commissioning. Whether they’re on a the board of a clinical commissioning group, participating in commissioning, a provider or interested from the side-lines, Commissioning Success magazine will help them stay one step ahead of the Government’s plans to give clinicians power over £60bn 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.

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So whether you’re on a the board of a clinical commissioning group, participating in commissioning, a provider or interested from the side-lines, stay one step ahead of the Government’s plans to give clinicians power over £60bn of the NHS’ budget. This magazine is aimed at GPs, practice managers, secondary healthcare clinicians and nurses – anyone who has an active role in commissioning. It will provide them with the must-have tips and tools to make a success of clinically-led commissioning.

Be one of the ﬁrst to sign up and receive a six-month subscription for free (worth £69.99) commissioningsuccess.com editor@intelligentmedia.co.uk BROUGHT TO YOU BY THE TEAM BEHIND

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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.

Designed to fit with the style and feel of the magazine, a vendor profile looks like a Practice Business 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.

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

26 27

vendor profile | pelican

In quality

You train them up and you m welfare is at the heart of wha at it is then you have usually

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

MANAGEMENT | service redesign

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 Pelican Feminine Healthcare is Pelican Healthcare. Under the mission statement ‘quality, service, trust, innovation and value’, 02920 747400 gill.sims@pelicanhealthcare.co.uk Pelican has a loyal fan-base of GPs, nurses and practice managers who are confident in the fact its www.pelicanfh.co.uk 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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practicebusiness.co.uk | july 2011

advice for busy lives

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 work/life

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 advice for busy lives

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

vendor case sTudies

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 Practice Business, a vendor case study is

practicebusiness.co.uk | october 2011

an effective way to get company messages and services in front of A negative impact our readers. Featuring an exemplary GP practice, it allows you to really promote your services in a meaningful and interesting way. Case studies are one of the best read parts of our magazine, great JARGON BUSTER Legal update sponsored by Veale Wasbrough Vizards Transformation 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

sponsorship

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.

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 Practice Business partner, it follows that we’re also endorsing their brand. Placed on very targeted editorial sections of the magazine, it’s a en extremely stategic and pretigious way to promote your brand. Something a bit different, a bespoke sponsorship position aligns you with the magazine’s message.

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 qu 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

Quality has always been a prio of healthcare products. Purcha clinical supplies is instrumenta and wellbeing of patients and w increased patient choice of GP this been more important. A de annual conference last month f the importance of the subject w NHS to take a firmer stance on from trustworthy sources. One company that has alw Contact details the trustworthiness and reliabi Pelican Feminine Healthcare is Pelican Healthcare. Under th ‘quality, service, trust, innovati 02920 747400 gill.sims@pelicanhealthcare.co.uk Pelican has a loyal fan-base of practice managers who are con www.pelicanfh.co.uk disposable medical products w patient down. Pelican started life in 1994 a manufactured disposable produ feminine healthcare. The followi

CASE STUDY july 2011 | practicebusiness.co.uk

Rising to the challenge

Mark Eaton is MD of Amnis

nhs but will thin acco team

BANNER ADVERT

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

opti prop she prac

Pelican Feminine Healthcare is a na out more about the company and ju the world of disposable feminine he

Mark Eaton is MD of Amnis

JARGON BUSTER Transformation mapping

and open aski prac ultim

we trus

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.

sudd men a pa the f

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Every week, we send out the PB Weekly news round-up email to our 8,500 email addresses that have signed up to receive it. Content often relates back to web news stories, but it can also point to editorial items in an up-coming issue. While email is an excellent method of driving response, it’s vitally important your message is conveyed in a way that ensures that its relevant and stands out in a crowded inbox. We have advertising opportunities in PB Weekly to help you ensure your message is delivered to and read by the decision-makers in practices who matter.

Practice Business is taking the lead when it comes to B2B publishing â&#x20AC;&#x201C; by continuously looking for ways to better engage with our readers. The way people communicate has evolved and more importantly this has shaped how people buy. to be effective in the marketplace, a company needs to be forward-looking and innovative. We offer a range of digital inclusions that, combined with our print offering, will drive engagement with decision-makers at schools, further build your brand and help generate a valuable response.

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