NAGPC

NAGPCNational Association of GP Co-operatives

Represents & Supports GP Co-operatives&

Promotes Quality OOH Patient Care

www.nagpc.org.uk

Website Sponsored by

NAGPC

Dr Mark Reynolds MBE

NAGPC Chairman

Desired organisational characteristics

Directors liability

NAGPC

Last years NAGPC Conference

“At the Crossroads”

PIO - CIC - PICwas a popular option

PCT mergera safe house

NAGPC

Patient

PCO + PracticesCo-operative

OOH + ClinicalServices

Day Support

Enhanced Services

NursingTransport

A & E Pre

Triage?

NHSD WIC

Access

NAGPC

A Once in a Career Chance!!

ButHow can we make it happen?

Who can make it happen?

NAGPC

Whole System Approach

for a

Whole NHS Change

NAGPC

Key components

• Motivation• Caseload• GP Involvement• Skill Mix• Organisational

structure

• Integration• Leadership• Contracting• Beyond Short term

planning, risk sharing?• Directors liability

NAGPC

Making it Happen

• Unprecedented PCT co-operation

• Must have an authorised lead

• Must involve co-design

• Must trust expertise

• Can you do this?

• Does the StHA need to be much more involved?

NAGPC

Someone must have authority

to facilitate and create essential collaboration -

where it is not happening

NAGPC

Remember Date

X?

NAGPC

£££££

• Whole System

• Whole Budget

• Released GMS not enough in many areas

• Whole team thinking helps

NAGPC

Skill Mix- The New Teams

• No recognised “OOH” qualification

• Not enough- not yet

• Senior GPs must help build teams

• GPs “in team” will manage uncertainty

• Significant advantage to a team with experienced GP players

• Examples exist

NAGPC

Leadership

• Small empowered team

• Mandated by committees

• Chief Executive/Director Primary Care/Medical Director/General Manager

NAGPC

Beyond short term planning

• Must look to the future

• Staff need security

• NHS needs stability after change

• Integration will take time

• Initial structures must be flexible

• Joint sharing of financial and governance risk? – the payback for “open books”?

NAGPC

GP Recruitment

• A new relationship

• A new and rewarding job

• A new flexible contracting process

• BUT - must demonstrate commitment

• Maybe yearly contracts (at least?) with six monthly rolling renewal

• Significant career opportunity

NAGPC

Motivation

• Para GPs - minimum red tape

• GPs - conditions, involvement, pay

• Managers - security, conditions, creativity

• Staff - local knowledge and expertise

NAGPC

Integration

• Patient need first

• Coincidence of policy + need

• Careers to be made

• Chief Execs and SHAs - please!

• Leadership - influence or power?

• Intelligent patient journeys

• Whole system back-up

NAGPC

Organisational Structure

• Involve and motivate workers• Be NHS/public services motivated• Involve all relevant contributors• Be able to create change• Be stable• Be fast moving• Be liked by the public• Reflect developing skill mix• Be independent?

NAGPC

GP Involvement- Managerial

• Please use those who know how

• Complex relationships and clinical consequences

• Very separate, until now

• Clinical/managerial expertise - Leaders!

• Will manage the risk of work transfer to acute sector

NAGPC

GP Involvement & Caseload

• 40-60% of OOH Pts presenting to nurse fronted co-ops need a GP (a working estimate)

• No GPs would result in a major increase in patients to A and E

• Cost ?

NAGPC

Contracting

• What level of detail?– Organisational– Financial

• Look at what has worked

• Is PCT process motivating ?

NAGPC

Directors Liability

• Essentially;

“ ..Will I be personally liable for the medical consequences of a lack of doctors?”

But there must be negligence for there to be liability

NAGPC

Directors Liability

mitigated by

• Managerial approach

• Rota planning

• Sharing the problem, scale, partnerships

• Opt out planning

NAGPC

Managerial Approaches

• Assess caseload

• Match to clinicians

• Robust rota

• Horizon planning

NAGPC

Rota Planning- for management

• Commitment- one year ?• Include “bad shifts” if necessary• Three month planned, nine months hours ?• Renewed six monthly on a roll over basis• BUT- for clinical owners• Flexible• Enjoyable• Team approach• Properly paid• Influence on style, content, workload

NAGPC

Rota Problem Foreseen

• Share problem with the whole system

• Back to PCT

• Whole system reset

• Skill mix deployment

• Alter terms and conditions

NAGPC

Opt Out Planning

• Structure

• Establish PCT and SHA criteria

• Phased ?– Financial – Organisational

• Advanced clinician planning

NAGPC

Summary

GP directors must not be responsible for the

consequences of a national problem outside

their control.

This approach decreases liability.

How is this issue dealt with in a mutual structure?

NAGPC

NAGPC

Huge new role in sharing good practice and innovation

• Structures, practical assistance and troubleshooting• Implementing REC, assisting the wider vision• GP Contracting process and best practice• Skill mix integration and education• Political representation and lobbying• Day service development practicalities, best practice and

support

N.A. of Urgent Primary Care?

NAGPC

Summary• Finance, think whole budget• GPs are needed• Skill mix - yes but don’t hold your breath• Motivation - involvement and conditions• New organisational structures, a choice• Rota and opt out planning• Integration• Directors liability

NAGPC

A Once in a Career Chance!!

“New Integrated service shatters A&E waits!”

“Streamlined service saved my sister!”

Now to choose a structure that delivers

NAGPC

NAGPCNational Association of GP Co-operatives

Represents & Supports GP Co-operatives&

Promotes Quality OOH Patient Care

www.nagpc.org.uk

Website Sponsored by