general practice improvement programme
Can general practice find the headspace to improve? Louise Johnston, Practice Manager, Unity Health, York Nick Downham, GPIP Team
Double aims of GPIP
Main Work Areas
GPIP Drivers (Practice Level) V2 5) Manage LTCs better
4) Reduce / smooth demand (the work we have to do, the need for appointments)
1) Create Headroom (help practices with everyday pressures and expectations)
3) Increase our capacity (the work we can do)
6) Reduce variation in LTC activity Consistency of Approach 7) Reduction in demand from high frequency patients
BLUE = PROCESS BLACK = OUTCOME
23) Chasing the Tail
8) Reduce wasted time from inefficient processes
11) Improve the management of high risk groups 12) Reduce variation in practice 13) Increase workplace organisation
14) Reduce meeting run over 15) Reduce email burden
19) Ensure staff availability does not hinder
GPIP as a whole
Chasing the Tail (only if adjusted to suit risk profiling) Consistency of Approach
Workplace Organisation
24) Effective Meetings and Email Effective Meetings and Email
16) Make equipment / forms easier to find 17) Make internal processes more efficient
9) Increase appointment capacity 10) Increase improvement capability and confidence
2) Remove stress causing issues
22) Consistency of Approach
20) Increase consulting clinician capacity 21) Ensure efficient access system
25) Workplace Organisation
Workplace Organisation
26) Workforce Planning
Chasing the Tail
GPIP ‘bolt on’
Co-Production Making GPIP bespoke for your exact context
York Based Practice 3 Surgeries – Including University of York Heath Centre
Louise Johnston – Practice Manager
York Based Practice Predicted List Size Increase 29000 27000 25000 23000 21000 19000 17000 15000 2010 2011 2012 2013 2014 2015 2016
Why did we look at Workforce Planning? •
Looks at ‘Capacity’ – or the amount of work we can do
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Spend a lot of time trying to sort out staff planning issues – rotas, sickness, holidays…. Firefighting these problems daily and weekly….
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An area we knew was a real headache and causing a lot of stress – lots of historical working practices…
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GPIP pointed us the fact that the root cause of much of these problems is how we look at our planning at high level – at a year level
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After all, you can have the best team in the world, but unless they are in the right place at the right time, then you have lost the game already….
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I chose to major on this area, as GPIP flexible – you don’t have to do every bit of it
Our Analysis ‘Pinch Points’ during the year
No. Sessions
Planned capacity in blue. Actual achieved capacity in pink
Weeks (previous year)
Quick analysis of the required and actual sessions for the whole year
Team Feedback
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Ratty
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Cannot face coming in
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Worn out
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Stressed
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Cannot carry on
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Risk
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Lucky it did not get
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Wearing
worse
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Dissatisfaction
Potential cost of planning problems GP Rota Problem • Practice Manager Time (1/2 day = £200.00) • GP Time (in meetings) (8 GPS x 1hr = £680) • Locum Cover (5 days x £680 = £3400) • Admin (2hrs x £12.5 = £25.00) £4305 Cost of a safety incident / poor service caused by staff overstretch… • Practice Manager Time • Partner Time • Legal Services • Reputation • Impact on FFT £Unthinkable
Observations Observations from the data gathering exercise (looking back at the previous year):
As we could only meet with the whole team for a short meeting, we prepared a list of observations to help provoke discussion and guide the meeting:
• In only one week in the past year did our actual hours match the planned hours we set out with. • Many of the points where we had the lowest levels of available resource happened at our busiest times (term time etc). • We loose approximately ¼ of our planned resource through natural processes such as holiday, training, meetings and sickness. • We require 2604 sessions to operate our practice(s). • We plan for 2652 sessions. • With the above natural losses, we only have 2121 sessions available. • These sessions are not smoothly, or appropriately available over the year (for example to match the peak periods). • With the planned new GP team members, the sessions will rise to 2588 sessions. • If we plan in our usual manner, we will still have periods of extreme pressure as these will present at the wrong parts of the year and be impacted by the pattern of planning losses to planned resource. • Our workload is due to increase through list size increases.
Ongoing working principles Ongoing working principles from the data gathering exercise.
Then the team put forward new working principles based on the analysis and observations (notice not ‘me’ putting the ideas forward!): We then operationalised these principles
To reduce stress, increase equity and meet demands without having to increase spend: • For equity we need a transparent and fair process for planning our rotas, training and holidays. • We need to plan our availability around the practice, not the practice plan around our availability. • We need to smooth out our holiday and training over the year. • We need to consider our staff planning as planning for one practice – not three. • We need to limit the numbers of staff who can be off at certain times. • We need to alternate who has first priority for booking in certain periods (to be equitable over an extended period of time) • We need a shorter holiday booking window so the practice can respond to changing priorities more rapidly.
In Summary This is not all about staff planning…. • It has demonstrated to us how to use data and improvement process to depersonalise and speed up decision making • It has demonstrated we can improve on our processes even further • Not an easy process, you do get support, but they don’t do it ‘for you’, they work with you • The coaches are considerate and do really ‘get’ general practice • The analysis is not too bad, it is just using existing data in a different way – and it can be done electronically or manually…..
The big picture The big picture behind the interventions: • Not just about the improvements from the specific interventions. • As • • •
a practice you are learning about: making decisions quickly, using data as a basis. learning how to manage resulting actions. learning how to de-personalise changes and improvements
• Bringing CCGs and practices together through development support. Not just the usual suspects, but a wider more representative group of practices and practice staff engaging with the CCG on its wider working.
Summary
• Designed to provide fast, flexible improvement • Help you with the here and now! • Demonstrate and build practice capability and confidence to carry on making improvements • Flexible approach that can be tailored to each CCG and to each practice • Exact approach for each CCG and practice is co-designed with practice and CCG staff – ending up with a bespoke approach that is exactly right for your context.
Summary Cont. • Delivered in a practical manner, Brief – Simulate – Do! No homework or huge workload…….. • Delivered little and often (typically 12 half days support sessions over three months) • Complimented with high quality workbooks so you have the background and reference of the techniques used – helps with knowledge transfer • Created using learning from other national large scale improvement programmes
www.gpip.co.uk