THE FUTURE OF GENERAL PRACTICE – OR THE END OF THE ROAD - PowerPoint Presentation

Slide1

THE FUTURE OF GENERAL PRACTICE – OR THE END OF THE ROAD

AISMA NATIONAL CONFERENCE

Daventry 12.5.2016

Dr Peter

Swinyard

National Chairman

Family Doctor AssociationSlide2

THE CONTEXTGP’s low morale well known

Practice Managers are also struggling

Struggling to keep surgeries running with fewer doctors

Struggling to find locums

Struggling with falling resources in the practiceSlide3

WHERE DO WE WANT TO BE?GPs want to do the job they trained for

To see and care for patients, not to spend hours and days treating a computer

To provide continuity of care

To work with their patients to improve health and wellbeingSlide4

WHERE DO WE WANT TO BE?We want to be accessible – but to retain a work-life balance (especially younger GPs)

We want the health agenda driven by patients working with their doctors, not by political diktat

We want to spend time with patients, not with inspectorsSlide5

WHERE DO WE WANT TO BE?We need to make a practice a good and challenging working environment for the whole team

More Good than Challenging, please!Slide6

WHERE DO WE WANT TO BE?We want a career structure to retain the experienced and encourage the newer doctors

We need a career structure for PMs to attract the best

We are open to change – but want proper evaluation of pilots, not just their roll-out whether they work or notSlide7

HOW DID WE GET HERE?Relentless workload and demand

Shrinking resource and income

Loss of MPIG

Loss of seniority

Work dumping

Pensions losses

….among othersSlide8

SITUATION

VACANT

GP WANTED

DEAD OR ALIVESlide9

WE ARE STRUGGLINGDoctors working 11-12 hour days?

Unremitting demand?

Reduced resources?

Unsuitable premises?

The inspection/regulation industry?

Do your clients know their financial status?

No, really, do they???Slide10

1. WATCH THE PENNIES £££Do we actually know what our practice

cashflow

is like?

Have we any financial projections for this year or next?

Does your client GP partner avoid you at parties?

Can they meet this month’s payroll???Slide11

OK, so you’re skintGet the recriminations over quickly

Did this surprise you? If so, which GP partner was responsible for watching the money?

Have a cold, hard look at your practice’s viability.

Did you ever think we’d get to this?Slide12

2. TALK TO PEOPLENo-one really wants to see practices failing.

Yet they are closing, even ones you would have thought should be doing OK.

Not just small practices. All sizes are at risk.

So who do you call???Slide13

OR PERHAPS MORE USEFULLY:NHS E local office

Your CCG

Your LMCSlide14

3. INVOLVE YOUR STAFFHow much of our financial affairs we share is up to us

GPs need to be positive. Admit that we are in the poo

Hand out shovels – everyone needs to get digging to get out of this

Reassure on job securitySlide15

4. MOBILISE OUR PATIENTSDo you have an effective PPG?

If not, still talk to patients about the difficulties

Put up notices in the waiting room

Get them to write to their MPsSlide16

4.5 SORT OUT YOUR PREMISESThere is a limit to what can be done.

But no-one wants a doctor and his team working like this:Slide17

A COUPLE OF CAVEATS for your clients

It’s not all wonderful in Australia (just nearly)

Can you cope with the distance from family?

Can you cope with the climate? (yeah, OK)

Can you cope with the other minor problems down under?>>>>>>>>Slide18

THE GENERAL PRACTICEFORWARD VIEW

An interesting document – as much for what it does not say as for what it does

No mention of GP income

Little on continuity of care

Little on retention of existing doctors

Not much yet on indemnity costsSlide19

1. InvestmentAiming to return GP share of NHS budget to 10-11% over 5 years. Steady rise

Sustainability and Transformation package - £508,000,000 over next 5 years. To support struggling practices, develop workforce, tackle workload, stimulate care redesignSlide20

1. InvestmentReplacing

Carr

-Hill formula. Will the new one be better? Winners and losers? – workload, deprivation and rurality taken account of but diseconomies of scale absent from document

Indemnity costs – further information coming in July. Slide21

1. Investment£56m for practice resilience programme starting in 2016/17 + offer of GP burnout support

£206m to grow workforce

£246m to redesign services – CCGs to provide £171m of transformational support and £30m development programme for GPSlide22

1. InvestmentSome coming through “Better Care Fund” – expectation of pooled CCG/NHSE/LA budgets

Additional nurses in GP settings for

Longterm

conditions

GPs working in nursing/care homes (?!)

Mental health “professional” in GP setting

Hosting social worker in GP surgerySlide23

2. WorkforceStill talking of 5000 extra GPs. Increasing training places no use if not filled.

Recruitment campaigns here and overseas

Better returner routes

Pharmacists in practices – still co-funded.

Practice nurse and staff training

Physician associates (?a con?)Slide24

3. WorkloadFDA instigated workload survey – done by NHS Alliance and Primary Care Foundation

Streamlining claims process

800 practices found vulnerable under present scheme. £10m allocated – makes £12500 per practice on average.

Aim to reduce work dump from hospitalsSlide25

3. WorkloadCQC inspections to be less frequent after present round. If good or outstanding – move towards 5 year inspections

For

megapractices

will inspect centrally for governance, leadership, learning structures

Will this reduce CQC fee demands?

QOF may go. Unplanned admissions ES goingSlide26

4. InfrastructureEstates and infrastructure investment “estimated” to reach £900m over 5 years

Premises costs cap up from 66% to 100%

Stamp Duty Land Tax on leases 5/16-10/17 (or 10/16? 2 different dates in document) to be reimbursed, VAT reimbursed

IT investment – online consultations

WiFi

in practicesSlide27

4. Infrastructure“We

will also work more

closely with

NHS Property

Services using

existing premises rules

to unlock opportunities

to transform

primary care

services, for

example, considering wider

commissioning gains

against underwriting

lease

arrangements or

buying out GP or third party

owned premises

.”Slide28

5. Care RedesignExtra recurrent funding for increase in capacity

Reform of NHS 111

7 day working not required from all – just “sufficient routine appointments at evenings and weekends to meet local demand”Slide29

SOME QUESTIONS TO RAISE WITH PRACTICESSlide30

HOW DO WE GET THERE?Start thinking big – and small

There are no thoughts too “out-of-bounds”

Should your practice stay as it is?

Should it merge? Co-operate? Share functions and risk?Slide31

HOW DO WE GET THERE?Government “thought” appears to be towards practice groupings of >30,000 patients

What would work for you and your practice?

Sharing backroom functions?

Sharing clinicians?

Sharing staff?Slide32

LET’S THINK ABOUT SHARINGPayroll.

But is that really a saving of time or money from outsourcing? IRIS GP seems fairly straightforward and most of data would need entering into a shared payroll submission anyway

HR functions.

There is certainly scope for a “super-manager” to ensure law followed etc.Slide33

LET’S THINK ABOUT SHARINGBook-keeping.

Should we share? Is the PM the right person to do what is a glorified double-entry ledger on the computer?

Sourcing.

Clearly the larger the buying power the better the deal. Some mileage in buying groups, many practices could shareSlide34

LET’S THINK ABOUT SHARINGLocum booking

– major nightmare in many areas

Practices could share booking process – but who gets the last locum when 3 practices looking?

Large group could

employ peripatetic doctorSlide35

LET’S THINK ABOUT SHARINGQOF management, KPI monitoring, performance management of doctors

(yes, really) are possible in larger groups

Complaint handling

Outside relationship handlingSlide36

LET’S THINK ABOUT SHARINGThe BIG ideas…

…what about amalgamation of practices?

Keeping the front door, making the engine room common.

Look at the megapractice models – and listen to today’s talks – is it for you?Slide37

PRACTICES & NHS HAVE TO….Save 2-3% pa on NHS spend (never before achieved)

Provide a 7 day 8-8 GP service (

Really?!)

Provide continuity of care

Keep people out of hospitals

Remain financially viable

Recruit and retain 15000 new GPsSlide38

SO WE HAVE TO…Support self care

Direct patients to the most appropriate health care – pharmacies, walk in centres, nurses, health care assistants

…………or indeed, nobody….Slide39

WHILE ACHIEVING….Quality

Care

Continuity

Financial viability (no cons here….)Slide40

WHILE ACHIEVINGHappy staff in a good therapeutic environmentSlide41

AND FINALLYA GP service ready for the 21

st

century, the consumerism, the health-seeking behaviour and the diktats of our political masters.

A great practice thinks independently, takes a helicopter view of their environment and guides their practice to success