practice manager networking event, 14 dec

#GPforwardview#GPforwardview

www.england.nhs.uk/gp

[email protected]

Welcome

#GPforwardview#GPforwardviewbit.ly/161213birmingham

Download today’s

presentations

Welcome

#GPforwardview

WelcomeWelcome and housekeepingContext settingYour priorities and questions

Running the practiceThe importance of sharingManaging workload in the practiceShare challenges & solutions

Professional developmentLeading primary care into the future - lessons so farOpportunities for sharing and developmentYour personal developmentNext steps

#GPforwardview

#GPforwardview

Who’s here?General Practice Development Team• Sue Pritchard• Sandra McGregor• Patricia Dolor• Robert VarnamSustainable Improvement Team• Christine McDermott• Sheinaz StansfieldPatient Online Team• James Blanchard

Practice Management Network• Steve Williams

Practice Index• James Dillon

#GPforwardview

pollev.com/gpfv


Dr Robert VarnamHead of general practice development

@robertvarnam

Whyare we here?

#GPforwardview

So why are people talking about change? It’s partly about the pressure we’re under right now, and partly about the huge opportunity to do something better. And, for once, the same changes that would help with one are also necessary for the other. Pressure Opportunity

#GPforwardview

Pressures on general practice

↑ population

↑ consultations

↑ complexity

↑ costs

↓ relative funding

↓ relative workforce

#GPforwardview

At the heart of the case for change is not the workload of practices – important though that is – it is the needs of patients, and they way they are changing. When the NHS was founded, its purpose was fairly simple. Every now and then, people got ill. When they did, they consulted their doctor. If it was a straightforward problem, they would give a prescription, the person would get better, return to work and, in a year or two, they might need the doctor again. If it was less straightforward, they would be referred to a clever doctor – who would give a prescription or cut out the offending part. The patient would then get better, return to work, and, in a year or two, they might become ill again.

That accounted for the majority of the anticipated work of the NHS. And, for some patients, that’s still the kind of care that’s needed.

However, a growing proportion of our work is fundamentally different. This now seminal chart illustrates the central fact underlying the quantitative and qualitative change in the work of primary care. It illustrates the rise in multimorbidity with age. As people get older, they have more simultaneous longterm conditions. So that, by the age of 75, for example, at least a third of people are living with four or more LTCs. And, as our demography changes, the proportion of older people increases. Dealing with longterm conditions already accounts for over half of work in primary care. It is set to increase.

And, crucially, this represents a qualitative change in the nature of work. These are not people who visit the GP every year or two to get cured of their problem. These are people with problems that we cannot cure – they are living with multiple issues which will not go away, and they visit the GP six, seven, eight or more times a year. At least. Furthermore, the more simultaneous problems someone has, or the greater their frailty, the less helpful it is to pass their care to a doctor specialising in one part of the body. These people need treating as people, not diseases.

So the population of people who need what only primary care can offer has grown, the amount of time they need has grown – and both are set to continue growing. This is the chief case for change in primary care, the pressure of patients’ needs.

This is not a blip requiring a short-term correction to the priorities of the NHS. It is a fundamental shift which requires every developed nation on earth to turn away from what Muir Gray has termed the ‘century of the hospital’, and place the emphasis where the population’s need is.

Based on: The Lancet doi: 10.1016/S0140-6736(12)60240-2

#GPforwardviewwww.england.nhs.uk/gp

#GPforwardview

www.nhsalliance.org/making-time-in-general-practice/

#GPforwardview

Pressure of bureaucracy

#GPforwardview


2nd national bureaucracy audit

cfep.net/u6k


Improve access Improve longtermconditions

Work collaboratively

Release timeRelease time

#GPforwardview

So why are people talking about change? It’s partly about the pressure we’re under right now, and partly about the huge opportunity to do something better. And, for once, the same changes that would help with one are also necessary for the other. Pressure Opportunity

#GPforwardview

What are the biggest challenges in running the practice productively?

What would you most like to learn from colleagues today?

Your priorities

The importance of sharing ~The GP Forward View and Practice Manager Development Programme

Welcome!

https://www.bing.com/images/search?q=nhs+logo&id=6333044668293B57AD5E287428E298BB6E7FB02F&FORM=IQFRBA

• Practice manager development• Practice managers are a vital resource in the NHS, playing a key role

in maintaining a quality service and in redesigning care for the future. Yet they are also one of the most neglected parts of the workforce, receiving relatively little formal training or ongoing development. Many practice managers report feeling overburdened and isolated in their role, and it is often noted that the most efficient ways of working are slow to spread between practices.

• NHS England 2016

General Practice – The increasing workload


• Practice manager development• We want to share our wide experience as business managers with our

colleagues in practice management and with others in the NHS. We want to promote excellence, provide practical support and identify examples of good practice. We will identify sources of expertise and encourage collaboration.

• We will champion the cause of practice management and the development of ever higher professional standards.

• Practice Management Network 2009

General Practice – The increasing workload


• Aligned to 7 health organisations

• 10 high impact actions champions

• 209 CCG lead opportunities• 7,500+ Practice Managers• 70,000+ Practice Staff

• The Practice Management Network (initially supported by the Department of Health)

• Over 4,100 registered managers• 14 steering group members• 4 regional representatives

General Practice – The importance of sharing


General Practice – The Way Forward10 High Impact Actions Champions

Active signposting - New consultation types -Reduce DNA’s -Develop the team -Productive work flows -Personal productivity -Partnership working – Use social prescribing –Support self care and

management -Build QI expertise -

2 x Co-chairs

NORTH

SOUTH

MIDLANDS AND EAST LONDON

209 CCG’s

BMA

NEW NHS ALLIANCE

IHM

RCGP

AMSPAR

NAPC

FAMILY DOCTORS ASSOCIATION


• Performance reviews• Other resources• The GP forward view• Leader or follower ?

• General Practice Today – The Challenges

• Who’s who in your practice• Practice policies• Practice benefits

General Practice – The importance of sharing


• Support for PM’s and a voice• Representing the profession, professional development and

primary care transformation• Support for PM’s in terms of brainstorming and problems• To ensure that PM’s are fully supported in their work and are

allowed to develop their skills

General Practice – What You Say

SUPPORT


• Understanding the main challenges faced in surgery.

• Supporting your team to manage workload and identifying where to delegate appropriate tasks

• How does this fit into the General Practice Forward View?

• What do the Five Year and General Practice Forward Views mean to my practice.

• How can I take part in the initiatives and access funding?

• Taking a leadership role in driving improvements in provision of primary care.

General Practice – The Challenges


General Practice – The Way Forward

In a survey of almost 2,000 people in Great Britain, the most commonly perceived barriers to seeing a GP were finding it difficult to get an appointment with a particular doctor (42 per cent), or at a convenient time (42 per cent), and disliking having to talk to GP receptionists about symptoms (40 percent).

11th October 2016



Receptionists 'put people off seeing doctor‘

11th October 2016 Patient: "They (receptionists) sometimes think they're the doctors"

Receptionists quizzing patients about why they need to see their GP could be putting some sick people off visiting their surgery, a survey suggests. Of almost 2,000 adults questioned for Cancer Research UK, four in 10 said they disliked having to discuss their ills with office staff in order to get an appointment.


General Practice – The Way ForwardThe PMn is in discussion with NHSE to determine how the funding of £6 million can be best utilised

AMSPAR already provide education and training with the Level 5 certificate/diploma in Primary Care Healthcare Management and offer professional membership

The NAPC with help from the PMn will be introducing an Advanced Practice Manager Programme – expected October 2017



Share your knowledge.It’s a way to achieve immortality.Dalai Lama(1357-1419, high lama of Tibetan Buddhism)

Let’s try it once without the parachute.

Image: Cartoonresource (Shutterstock)

http://soccerwidow.com/links/shutterstock/images/118312102.php


C’mon guys, we’ll find someone with the answers. Just keep looking.

Image: Cartoonresource (Shutterstock)

Sharing is sometimesmore demanding than giving.Mary Catherine Bateson(*1939, American writer and cultural anthropologist)

Scientia potentia est: Knowledge is Power.commonly attributed to Sir Francis Bacon(1561-1626, English philosopher, statesman, and scientist)

http://soccerwidow.com/links/shutterstock/images/118312096.php


Sharing is caring.Unknown


@robertvarnam

Managing workloadin the practice

Dr Robert VarnamHead of General Practice DevelopmentNHS England

@robertvarnam

#GPforwardview


#GPforwardview

Self-rating by GPs

5,128 consultations [email protected]

#GPforwardviewNationally [email protected]

#GPforwardviewTypical practice 6,700 patients [email protected]

#GPforwardviewTypical practice 6,700 patients

Free consultation audit

www.primarycarefoundation.co.uk/audit-tool.html

#GPforwardview

10 high impact actionsto release time for care

#GPforwardview

10 High Impact Actions to release time for care

Innovations from around England that release time for GPs to do more of what only they can do.

bit.ly/gpcapacityforum

#GPforwardview





#GPforwardview




Introduce new ways of working which enable staff to work smarter, not just harder. These can reduce wasted time, reduce queues, ensure more problems are dealt with first time and that uncomplicated follow-ups are less reliant on GPs consultations.Match capacity with demandAppointment systems and staff rotas are designed in order to ensure sufficient capacity is available to match patterns of demand as they vary through the week and the year. This requires an ongoing system of measuring demand and adjusting capacity accordingly. It may also involve scheduling routine work (eg annual reviews and clinical audit) for less busy times of the year. The benefits are a reduction in delays for appointments, less stress for staff and patients, and better access.Efficient processesThe application of Lean principles to measure, understand and improve common processes in the practice, in order to reduce waste and errors. Typical targets include clinical follow-up protocols, processing of letters and test results, requests from patients, staff messages and team decision making. Staff themselves often have a wealth of ideas about ways in which processes could be improved to release time. Practices who take a systematic approach to identifying and testing these generally find that this improves care for patients as well as freeing staff time for other things. The use of pre-prepared plans for managing common simple follow-up processes can improve their reliability and efficiency, freeing GP time. Common examples include management of hypertension, monitoring of tests after the initiation of new medication, and adjustment of medication doses to reach a target.Productive environmentThe physical layout within the practice is assessed for its effect on staff's productivity, and improvements are introduced which reduce wasted time. The Lean technique of 5S is the best known approach for doing this. Additionally, work can be undertaken to ensure that staff can access information needed to support their work quickly. This reduces time spent searching for information and can improve patient safety as well.

#GPforwardview

bit.ly/10hiavideo23

#GPforwardview




Take every opportunity to support people to play a greater role in their own health and care. This begins before the consultation, with methods of signposting patients to sources of information, advice and support in the community. Common examples include patient information websites, community pharmacies and patient support groups. For people with longterm conditions, this involves working in partnership to understand patients' mental and social needs as well as physical. Many patients will benefit from training in managing their condition, as well as connections to care and support services in the community.PreventionSome practices are fostering links with their local community and launching new programmes to improve population health and prevent disease. This spans a range of activities, including health education, promoting healthy eating and physical activity, and influencing other aspects of public health. A common feature is a focus on communities helping themselves, with statutory services providing support.Patient onlineTechnology changes are enabling patients to access their personal record online, through web portals and a growing number of health apps for mobile phones. This makes common transactions such as ordering a repeat prescription quicker for the patient and for practice staff. It also allows patients to become better informed about their health and care, and to play a more active role. With explanation and support, patients and their carers are able to check test results, the progress of investigations and referrals, read and share their care plan, and enter details of home monitoring, such as blood pressure, weight, and sugar tests. As well as being popular with patients, GP practices are reporting a reduction in workload as a result of patients using these online services.Acute episodesPractices are increasingly involved in supporting patients with minor ailments to care for themselves. This often includes providing advice and signposting to services provided by community pharmacy. Education also plays a part, with growing numbers of practies contributing to efforts to teach people about the best ways to seek help when ill. This often begins with engagement in local primary schools.Longterm conditionsFor people with longterm conditions, a more proactive approach to care is being adopted, alongside a focused effort to help people play a more active role in monitoring and managing their condition. Initiatives include supporting people to access their full medical record online, the use of health coaching in clinical consultations and the provision of training and support in the community, aiming to build the knowledge, skills and confidence for patients and carers to manage their condition. This builds patients’ own assets and quality of life, as well as reducing their dependence on services such as the general practice.

#GPforwardview

Booking and cancellingof appointments

Ordering ofrepeat prescriptions

Access to GP records

What is Patient Online?

Over 97% of all practices in England are currently offering these online services to their patients. This was a requirement in last year’s GP contract.

This year, the BMA and NHS agreed that all practices should aim to get at least 10% of their patients signed up for online services by the 31st of March 2017.

In the London region 45.2% of practices are already offering online services.

Why should I do it?Convenient way for patients to contact the practice 24/7

Reduces footfall

Frees up phone lines for other patients

Reduces the amount of no shows

More efficient prescription process and less prescription waste

Increases patient satisfaction and self care

Frees up valuable time for other essential tasks

New promotional materials available

Patient Online GP online services

Order promotional materials, including posters, patient guides, leaflets, balloons, bunting and appointment cards, for free via www.england.nhs.uk/materialsforpatient/

http://www.england.nhs.uk/materialsforpatient/

http://www.england.nhs.uk/materialsforpatient/

www.england.nhs.uk/patient-online

#GPforwardview





#TimeforCarewww.england.nhs.uk/gp

Local Time for Care programmes• Bespoke 9-12 month

programme to support a group of practices to implement innovations that release time for care.

• Training for reception and clerical staff, for active signposting and document management (£45m over 5 years).

• Funding towards purchasing online consultation systems (£45m over 4 years, from 2017).

• CCG transformational support (£171m over 2 years, from 2017).

General Practice Improvement Leaders• At least 400 free places a

year for three years.

• Skills and confidence in designing and implementing improvements within the practice rapidly and sustainably.

• RCGP Supporting Federations Network and NHS Collaborate (NAPC & NHS Alliance) for leaders of at-scale primary care.

• Funding facilitated peer networking for practice managers of all 7,800 practices, with support to develop professional skills.

• 24 regional GPFV roadshows• 30 local High Impact Actions

showcase events• Web resources (60 and

growing)• Fortnightly webinars• Network of champions


#GPforwardview

Associated fundingCCG transformational support• 2017-2019, CCGs to spend at least £3/patient to support

transformation of primary care services for the future• typical uses: backfill for development, leadership development, OD

for federations

Training for clerical & reception staff• 5 year fund: total 80p/patient (eg £8,000 for 10,000 list practice)

• 2016/17 portion allocated to CCGs Sept 2016• Full information: www.england.nhs.uk/gp/gpfv/redesign/gpdp/reception-clerical/

Online consultations• 4 year fund: total 80p/patient • First portion in Apr 2017• Full information:

www.england.nhs.uk/gp/gpfv/redesign/gpdp/consultation-systems/

#GPforwardview




Consultation auditwww.primarycarefoundation.co.uk

/audit-tool.html

#GPforwardview

Running an effective & efficient practiceWhat are the challenges? What's worked for you?

1. Managing the business

2. Managing the team

3. Prescription requests

4. Incoming clinical correspondence

5. Test results

6. Using technology (eg Patient Online, etc)

7. Active signposting

8. Freeing up GP appointments (other ideas)

#GPforwardview


Leading primary care into the future - lessons so farDr Robert VarnamHead of General Practice DevelopmentNHS England

@robertvarnam

@robertvarnam

Where are we heading?

What size should we be?

How do we realise the benefits of scale?

What capabilities will we need?

#GPforwardview

Specialists

Non-specialist / failed consultantGatekeeper / door-holderKing of my castleIt’s all in me

Community services

#GPforwardview

Self Care

Broader skillmix

Self management /

social prescribing

Emergencycare

Collaborationwith specialists

At scale

Population wellbeing management and holistic person-centred care provided by a multiprofessional team led by the GP, supported by at-scale collaboration and efficiencies.

@robertvarnam





@robertvarnam

STP footprint: 300k-2mWorkforce & infrastructure planningLarge scale service reconfigurationMajor partnerships & shifts in priority

MCP: 100-350kOrganisational infrastructure & governanceSpecialist staff & servicesEmployment & career developmentModel design (population management, care models)Strategic partnerships

Hub/Home: 30-60kAcute careLocality-tailored servicesShared MDTPlace of ‘belonging’

Core team: 3-4kCoordinated, complex multidisciplinary careContinuity

@robertvarnam





@robertvarnam

Working at scale: Opportunities for practices

#GPforwardview

Staff pooling• nurses, reception & clerical staff, sessional GPs

Overflow support• phone consultations• access hub (phone +/- face-to-face)• home visiting

#GPforwardview

Purchasing• Indemnity• Supplies• Utilities

Shared functions• Policies & procedures• Procurement• Correspondence management• IM&T (eg support & maintenance, intranet, web, social media)

Specialist functions• HR• Finance• Clinical governance• Business intelligence

#GPforwardview

Planning• Workforce• Infrastructure development• Service reconfiguration• Public health

Provision• Acute care• Community pharmacy• Dentistry• Optometry• Social care• Housing• Welfare• Voluntary sector

#GPforwardview

Traditional healthcare roles• Pharmacists• Specialist nurses• Physiotherapists• MH therapists• Paramedics

Wellbeing workers• Social workers• Care navigators• Health trainers & coaches• Welfare advisors

#GPforwardview

QI expertise

Analytics• Population health analytics• Priority setting• Benchmarking• Realtime measurement

Project management

#GPforwardview

HR

CPD

Career development• Leadership• Mentoring• Service improvement• Research

@robertvarnam





@robertvarnam

Leadership

Creating shared purpose

Strategic planning &

partnerships

Leading through change

Being a leader

Improvement

Patients as partners

Process design

Using data for improvement

Rapid cycle change

Business

Team leadership

Operations management

H R

I T

At-scale working

Governance

Contracts

Workforce

Business intelligence

Capabilities for the future

Interdependent capabilities for leaders & organisations

@robertvarnam





Implications for me?


Opportunities for sharing and development

James DillonPractice Index

#GPforwardview

Connect with other practice managersJoin a networkWrite up one of successesSign up for a courseDo some eLearningSelf-directed reading / viewing

Your personal development

#GPforwardview

Share…

best things you've done what you’re going to do next

Your personal development

#GPforwardview

PreparationAligning plans, federation

development, local champions

Online consultation systems (bursaries from 2017)

Reception & clerical staff training (bursaries from 2016)

Changes

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Launch event

Development Advisor Support

Learn from innovators

General Practice Improvement Leaders Programme

CCG investment & support

Your Time for Care programme

Showcase event

Productive General Practice

#GPforwardview

General Practice Improvement Leaders programmeAim: Skills development

Build capabilities and confidence to support colleagues in implementing change in practices

To ensure every locality has a local improvement facilitator who can access both local and national resources in the future

Fundamentals of change and improvement (2-day session)

Human Dimensions of change (2 x 1-day sessions)

Facilitation skills (2 x 1-day sessions)

Primary care improvement community

Your own change project

#GPforwardview

PreparationAligning plans, federation

development, local champions

Online consultation systems (bursaries from 2017)

Reception & clerical staff training (bursaries from 2016)

Changes

Changes

Changes

Changes

Changes

Changes

Changes

Changes

Changes

Changes

Changes

Changes

Changes

Changes

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Launch event

Development Advisor Support

Learn from innovators

General Practice Improvement Leaders Programme

CCG investment & support

Your Time for Care programme

Showcase event

Productive General Practice

www.england.nhs.uk/gpdp


bit.ly/gpfvpmsurvey1

How should NHS England support practice

managers’ development?


bit.ly/gpfvpmsurvey1www.england.nhs.uk/gp

[email protected]



[email protected]