nagpc nagpc national association of gp co-operatives represents & supports gp co-operatives...
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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
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
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£££££
• 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