making life better for patients and practices improving resilience and efficiencies creating development opportunities Show me the money Sam Dawlatly 1662016 South Birmingham VTS Our health partnership ID: 575010
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Slide1
Our Health Partnership
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
“Show me the money”
Sam Dawlatly
16.6.2016 South Birmingham VTSSlide2
Our health partnership
What are we going to discuss?
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
Who am I?
What are your plans?
The bigger picture
How this affects youSlide3
Our health partnership
A bit about me
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
University of Birmingham; Jul 2005
South Birmingham; VTS 2007 – 2012
Locum and Salaried work; Aug 2012 – May 2013
GP Partner Leach Heath Medical Centre; June 2013 – March 2014
GP Partner
Jiggins
Lane Medical Centre; May 2014 – present
Managing Board Partner; Our Health Partnership Nov 2015 - presentSlide4
Our health partnership
Other interests
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
Social Media
BMJ Blogs
Pulse Today blogs
BMA News
Medical Education
Creative bits and bobsSlide5
Our health partnership
Quiz Question: How much money was invested in general practice in 2014-2015?
£7.9bn
Currently 7.2% of total NHS expenditure
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide6
Our health partnership
What percentage of the NHS budget was invested in general practice 10 years ago?
11%
So a reduction of 34%
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide7
Our health partnership
Are we doing less work for a smaller slice of the pie?
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide8
Our health partnership
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide9
Our health partnership
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide10
Our health partnership
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide11
Our health partnership
So we’re getting a smaller share of the budget for doing more work…
Where is the we have money going?
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide12
Our health partnership
What are the definitions of the following income streams?
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
Global Sum
MPIG correction factor
Premises payments
Seniority payments
QOF
payments
DES
NES
LES
Which are being phased out?Slide13
Our health partnership
How much of spending on primary care overall goes on:
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
Funding stream
Spend
Percentage
Global Sum
MPIG correction factor
Premises payments
Seniority payments
Total QOF payments
Total DES
Total NES
Total LES
Other spend*
40.79%Slide14
Our health partnership
https://www.bma.org.uk/advice/employment/gp-practices/focus-on-gp-funding-changes
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
Funding stream
Spend
Percentage
Global Sum
£2,306,454,858
28.87%
MPIG correction factor
£106,751,260
1.34%
Premises payments
£671,774,253
8.41%
Seniority payments
£124,101,375/td>
1.55%
Total QOF payments
£722,393,794
9.04%
Total DES
£577,496,187
7.23%
Total NES
£9,664,849
0.12%
Total LES
£212,470,789
2.66%
Other spend*
£3,259,216,796
40.79%Slide15
Our health partnership
“Other payments”
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
retainer scheme
payments
locum allowances
prolonged
study
leave
appraisal-appraiser
costs (
locums)
PCO
admin
costs (CCGs)
IM&T
,
balance
of PMS
expenditure
non-DES
item pneumococcal vaccine/childhood immunisation main
programme
prescribing
fee
payments
dispensing
fee
payments
reimbursement
of drugsSlide16
Our health partnership
Added to that is the need for efficiencies in the NHS
But perhaps some good news
The GP Forward View
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide17
Our health partnership
GP Forward View
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
£2.4
bn
extra for primary care over next 5 years
Government at least realise now that there is a problem
Too little too late?
Conditional – what is needed in return?Slide18
Our health partnership
Take home message is:
Constantly changing streams of income
Leading to increased bureaucracy for partners and practice managers
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide19
Our health partnership
How does this affect you?
Variable incomes
Variable outgoings
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide20
Our health partnership
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
GP Reg
Salaried GP
Partner
Gross
52200
64000
100000
Pensions (Employer Contribution 14%)
14000
New Gross
52200
64000
86000
Pensions (Employee Contribution 13%)
6800
8320
13000
Taxable Income
45400
55680
73000
Basic Rate Tax (20%)
8000
8000
8000
Higher Rate Tax (40%)
2160
6300
13200
Income after Tax and Pensions
35240
41380
51800
Per Month
3000
3500
4300Slide21
Our health partnership
It’s not just about the money
What are the other benefits/drawbacks of partnership, salaried and locum work?
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide22
Our health partnership
What are the effects of the imbalance between income and workload?
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide23
Our health partnership
“Triangle of Doom”
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide24
Our health partnership
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
Put another way ->Slide25
Our health partnership
Can you come up with any solutions to break this vicious circle?
Discuss in groups of 3-4 and then we’ll discuss
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide26
Our health partnership
We may have come up with some of the following:
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
Decreasing workload
Decreasing patient demand
Decreasing regulation
Recruit more GPs
Retain more GPs
Improve morale
… but how?Slide27
Our health partnership
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
Could general
practice at scale can offer effective
solutions?Slide28
Our health partnership
What are the following?
What are the differences?
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
Federation
Super-practice
Super-partnershipSlide29
Our health partnership
What can be the benefits of working at scale?
Benefits of scale – economy, workload
Share challenges and solutions e.g. salaried doctor pool rather than
ad hoc
locum cover
Influence as ‘system player’ – a strong voice to start shifting the emphasis of care provision
Potential to develop into broader provider (MCP)
Ability to adapt to the political pressure for change and care to be delivered through larger
organisations
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide30
Our health partnership
How could future streams of income change?
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide31
Our health partnership
If there is not much more money – how could we be more efficient?
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide32
Our health partnership
What are the potential downsides to GP at scale
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide33
Our health partnership
Not just about the money
Workload
There is an impending workforce crisis
Bureaucracy
Shared back office function can decrease this
Regulation (CQC
)
Support and shared registration
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide34
Our health partnership
Our Health Partnership as a case study
Formed in November 2015
Largest super-partnership in the UK
32 member practices (35 sites)
146 partners, >750 staff
280,000 patients
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide35
Our health partnership
Our Health Partnership as a case study
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide36
Our health partnership
Our Health Partnership as a case study
Strategic management board of 7 elected partners
Managing director, Operations director and Finance Director run the business
“Profit centre” model – to preserve as much autonomy for practices as possible
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide37
Our health partnership
Strategic
aims
Twin
aims:
Strong and sustainable General Practice
Broader service provision
Priorities:
Make GP partnership an attractive option for doctors
Sustain and improve the local services that patients value
Integrate and influence at system level – a strong voice
Develop a wider range of services
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide38
Our health partnership
Relevance to GP registrars
GP at scale is here to stay
Important to understand the flexibility and stability that can be offered
Preferred locum list
Flexible salaried jobs across sites
Partnership
The bigger, long term picture
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide39
Our health partnership
What a super-partnership salaried position may look like
2 year post-CCT “fellowship
Mentor and study budget (£1.5k pa)
One day a week at “home site”
Flexibility for other sessions
Chance to see what practices like, hopefully leading to partnership
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide40
Our health partnership
Some final thoughts
We believe in the partnership model for general practice (vs. all salaried)
To work it needs more people to become partners
Could argue that GP
a
t scale is response to poor funding
Pragmatic response
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide41
Our health partnership
Thank you
Any thoughts, questions or comments?
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities Slide42
Our Health Partnership
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities
Samir.dawlatly@gmail.com
www.ourhealthpartnership.com