Business Plan

Work-based assignment Business Plan

Title pageSubmission for the Level 5

Diploma in Primary Care Management City and Guilds/AMSPAR

‘Business Plan’ (Unit 505)

Programme presented by:

Cherith Simmons Learning and DevelopmentIn collaboration with

I certify this assignment is my own work. I certify this assignment has not been previously submitted for assessment on this

course. I certify that where material has been used from other sources, it has been properly

acknowledged. I understand that any work submitted may be destroyed after assessment. I permit Cherith Simmons Learning and Development to copy and use my work for

academic purposes. I agree to complete combined ‘optional’ assignments and mandatory assignments.

Note: we are required to have your agreement to combine ‘mandatory’ and ‘optional’ assessments elements. This means fewer separate pieces of work for you to complete.

Business Plan title:

Improving the Financial Position of the Practice by 20%

Centre Number: 065729 Cherith Simmons Learning and Development

Participant name: Farhana Imran

Registration number: VXV5320

Sponsor/programme location: Distance Learning

Submitted on (date): 2nd July 2012

Number of words: 5151

.

Farhana Imran 1

Work based-assignment Business Plan

Acknowledgements

I would like to thank Dr Ashraff at Healthway Medical Centre for giving me the first glimpse of working in a primary care setting where I found my niche.

I am thankful to Dr Misbah Ul Haque for introducing me to the diploma in primary care and inspiring me to put all my energies and focus in this area.

I am indebted to Drs Hamilton-Smith, Oladimeji and Imran for giving me the opportunity to hold a key position of business manager at their practice and thus providing me with access to all aspects of primary care work in a GP setting. Without their permission, I would not have been able to produce this business plan.

I am in awe of the Patient Participation Group (PPG) where I was nominated as secretary. I found the team nothing short of amazing, they always come up with excellent ideas and have so much enthusiasm. I have learnt that ordinary people who have extraordinary vision can get their ideas implemented in practices all over the UK.

I have so much admiration for the web team ([email protected], Tanya Ranby) who helped me to improve the practice website. Their professionalism, openness to ideas, suggestions and friendly approach has shown me how well a team can work if they share common goals.

I would like to thank the Outer North East London (ONEL) team for answering my many queries regarding the many different aspect of primary care work, with special thanks to the Finance Department (Brigid Mallee, Mark Lockwood and Lorna Hutchinson), Relationship Managers(Peter Clark, Bob Barr) and Prescribing Team (Vicki Kong).

Finally I would like to thank my family, Asif, Saif, Zaira and Faiza. I need to look no further than my own doorstep to find my heros.

Farhana Imran 2

mailto:[email protected]


Contents page

Business Case................................................................................................................5Executive Summary.....................................................................................................11Organisational and Personal Background.................................................................12Part 1 - The need for innovation.................................................................................14

1.1 The importance of innovation.............................................................................141.2 The importance of managing change................................................................161.3 The present situation.........................................................................................171.4 The problem driving the change........................................................................18

1.4.1 Financial implications of problem .............................................................181.4.2 Legal framework for problem ...................................................................181.4.3 Human Resource issues surrounding problem ........................................18

Part 2 - Innovative solutions for improvement..........................................................19

2.1 How the investigation was conducted................................................................192.2 Results...............................................................................................................222.3 Analysis and Conclusions..................................................................................242.4 Possibilities........................................................................................................30

Part 3 - Leading Change..............................................................................................32

3.1 Proposal and Recommendations ......................................................................323.2 Managing change..............................................................................................343.3 Quality assurance..............................................................................................36

Part 4 - Appendices .....................................................................................................37

Appendix 1 Organisation Chart ..............................................................................38 Appendix 2a Invoice for chlamydia screening February 2012 ................................39

Appendix 2b Chlamydia screening process for April 11 – March 12 .......................40Appendix 3a Extended hours fax to recover money for work done from Apr 2011 – Mar 2012......................................................................................................41Appendix 3b Extended hours payments for Apr 2011 – Mar 2012.........................42Appendix 4 General Practitioners Report Process..................................................43Appendix 5 Health check procedure.......................................................................44Appendix 6 Locum cover invoice............................................................................45Appendix 7 Analysis of staff overtime from 2008 to 2011.......................................46Appendix 8a Top 20 prescribing drugs for Apr 2011 – Mar 2012...........................47Appendix 8b Prescribing meeting...........................................................................48Appendix 9a Role of Business Manager.................................................................50Appendix 9b Role of Administrative Manager.........................................................52Appendix 9c Role of Information & IT Manager......................................................56Appendix 9d Role of Medical Secretary..................................................................58Appendix 9e Role of Senior Receptionist................................................................60Appendix 10 SPECTRE analysis of issues affecting the practice...........................62Appendix 11 GMS practice summary statement for Apr 2011–Mar 2012...............67Appendix 12 Outline Project Plan...........................................................................71Appendix 13 Gantt Chart........................................................................................79

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Part 5 - Bibliography....................................................................................................81

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Business Case

Improving the financial position of the practice by 20%

Background:

The vision statement of Chadwell Heath Health Centre states ‘We aim to combine the best of traditional family practice with being modern and up to date with advances in health care. This is reflected in our high performance in clinical quality and patient satisfaction performance indicators. But it is not just about performance indicators – what really matters to us is the satisfaction we get from doing a good job, building our relationships with patients and feeling that we are helping people both to stay healthy and to cope better with any illnesses or health problems they have.’

In theory with a list size of 6,240 patients, 3 full time doctors, two Nurse Practitioners and a full complement of support staff, the practice should easily be able to help the patients cope better with illnesses. In order to meet this mission, the doctors and nurses prescribe the medicine which best suits the patient to overcome their illness. The patients are therefore satisfied with this service. The Practice has however been told by the Primary Care Trust (PCT) they are the second worst prescriber in the area and, from the PCT’s point of view, currently prescribing too many high cost drugs. There is an urgent need to look at the alternatives.

Staffing has also recently become an issue. There has been an increase in the number of days staff are taking off sick. The medical secretary has been signed off for six weeks and the senior nurse has taken 30 days leave in the last 4 months. This is an obvious and growing cost to the Practice.

The Practice Manager has handed in her notice and due, to financial constraints, the practice has decided not to replace her. The current roles and responsibilities of practice staff therefore will need restructuring to spread the current Practice Manager’s duties amongst the remaining staff. Although this will bring new opportunities to staff and may help improve their motivation levels it will also affect the cost to the Practice as some staff may be promoted whilst others may increase their hours.

Every month the Practice has to use its overdraft facilities which costs the Practice money. Improved book keeping techniques and revised accounting methods need to be explored.

A good earner for the Practice is the NHS Health Check which has not been carried out during the lead nurse’s absence. This directive states that for all patients aged between 40 to 74 who are not on the register, a health check

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must be done every 5 years. Each health check brings in £21.10 to the Practice.

The partners spend a considerable time and effort filling in medical forms for insurance companies, department of health and social security and taxi companies which should generate income for them. At the moment the money is either very slow in coming in or not coming in at all. Currently no one knows where the problem occurs in the process or how to resolve it.

Another area of concern is the extended hours Directed Enhanced Service (DES) which the Practice has signed up for. The Practice has been approved to provide three sessions every week, three weekday sessions, with an average of twenty-seven appointments over each cycle. Each session brings in £225. At the moment only doctors are providing this service however nurses can also be involved. The directive states that 25% of the patients can be seen by nurses. There is also issues around protected time initiatives (PTI) and bank holidays as full usage of this DES is not happening at this Practice at the moment. The Practice is not offering this service on alternative days when there is PTI or bank holidays and is therefore losing money.

The business side has in the past been neglected by this Practice. Fortunately this is being reviewed by a free external consultant who is studying for her Primary Care Diploma. This was a four month contract which started in October 2011 and finishes at the end of January 2012. The Primary Care student is happy to stay on at the Practice but wants a salary which will have obvious financial implications for the Practice.

The Practice has signed up for the Patient Representative Group Directed Enhanced Service which will bring in £1.10 for every patient who is a member of this group. The directive states that the Practice must show the methods used to get patients on this register, produce two surveys each year and publish the result of these surveys on the Practice website in order to claim the money. The previous survey showed a 95% lack of response from the patients. There is a Practice website which needs to be further developed to incorporate this DES.

Aim:

This report will investigate the current issues concerning finances at the

Chadwell Heath Health Centre. It will research ways to improve, implement

and structure the finances of the Practice and introduce accountability and

independent checking techniques at every level.

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The report will also research the sickness issues and staff re-organisation and

take account of any legal implications.

Recommendations will be made which will benefit patients, Partners and staff

and reduce costs without adversely affecting the provision of clinical care.

Objectives:

1. To research and investigate the following:

To investigate the current financial issues and research alternatives by:

a) Carrying out interviews with the following groups:

Clinicians

o To identify all the DESs the Practice is contracted for

o To identify all the Local Enhanced Services (LES)

o To identify and assess priorities for improvement by brainstorming

Reception and Administrative Staff to identify

o How the petty cash register is set up

o Training opportunities and methods

o Reasons for time off for sickness

o Their roles, what they are doing, what they would like to do

b) Reviewing the current processes for:

The extended hours rota system by auditing last financial years claims made by the practice

Claiming overtime by analysing overtime paid to staff from 2008 to 2011 to determine the trend

Chalmydia claims by liaising with the practice nurse to determine the number of claims made in the last financial year

Travel clinic by liaising with the practice nurse and analysing the figures to determine how much money came in through this medium in the last financial year

c) Carrying out

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A SWOT analysis of the major sources of income and items of expenditure with the doctors, nurses and staff of the Practice

A SPECTRE analysis with regards to future practice growth and challenges with the management team

Prescribing audit to see how many prescribed drugs are high cost and what are the alternatives

Analysis of health checks done on patients aged 40 – 74 who are not on the register

An audit of the medical forms processing system

The patient participation DES which must be published and on the practice website by 31st March 2012

d) Calculating

Costs of current systems

Costs of alternative proposals

Costs of staff sickness

Costs of overtime

e) Researching legal aspects to ensure that:

Processes are compliant with the NHS contract

Proposed changes to staff roles and responsibilities are reflected in their contracts

Risk assessments are carried out where necessary and any actions implemented

All aspects of Clinical Governance are considered

2. To analyse and evaluate:

To analyse information from the research and investigation processes and present relevant statistical data in graphs and charts as appropriate for ease of understanding.

To agree with the partners the criteria to be used for evaluating any improvements.

To consider a range of alternative systems for improving the financial position of the Practice taking into account the agreed criteria to include:

Effectiveness in solving the problems

Clinical governance and risk

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Ease of implementation

Acceptability to Partners, staff and patients

Human resource implications

Training needs

Costs

3. To conclude and draw up recommendations:

To draw conclusions from the evidence compiled during the research, analysis and evaluation processes and make recommendations which:

Reflect the views of all stakeholders

Are supported by a full cost benefit analysis

Identify proposed changes to processes and roles if appropriate

Gives the opportunity for staff to be involved in the decision making process

Uses tried and tested change management and marketing tools

4. To plan to implement the recommendations by:

Producing a written report for the Partners’ consideration to be circulated in advance of a formal meeting

Discussing the report at a scheduled Partners’ Business Meeting by preparing a PowerPoint presentation of the key points in the report

Obtaining an agreement to proceed

Drawing up a plan to implement, monitor, review and evaluate any changes

Communicating with key stakeholders through a series of meetings and presentations

Drawing up a risk assessment to identify major issues in the construction and implementation of the plan

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Executive Summary

Present PositionIn the last 15 years the NHS has been through major reorganisation changes in the way it provides services. With the country going through serious financial crisis, the NHS has had to impose severe austerity measures. This has led to the NHS having to save 20 billion pounds by 2015.

In primary care, this has meant that GP surgeries have to provide more services with either the same budget or reduced budget.

ProblemsThere are many services which the practice has provided for which it has not received the income. There are DESs and LESs which the practice has signed for which it has not completed. The skill mix of staff is the greatest challenge for the practice. Several support staff and at least one doctor are obstructing progress.Procedures and processes need to be updated which the practice needs to address.

ProofAll processes which have a financial bearing has to be reviewed to ensure the practice is optimising its income without compromising its duty of care to the patients.

PossibilitiesThe practice can choose to maintain the status quo and continue as before, implement part of the proposal such as the roles of staff but not do any analysis or fully implement the proposals which involves analysis, audits and revised roles.

ProposalsThe proposals will generate an income of £82,606.32 which is detailed in the cost benefit analysis(section 3.1).

Plan

By applying Kaizen five S’s, the practice will be well placed to share their work ethics with other practices and help to move primary care forward. The partners will see financial rewards, a more productive staff and most importantly a higher quality of patient care.

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Organisational and personal background

We are a small, friendly Practice and the doctors, nurses and staff are dedicated to providing high standards of health care, offering personal care and attention to our patients, with a comprehensive range of facilities.

The Practice has a list size of 6,200 with 3 partners, 2 nurses, 1 part-time business manager, 1 administrative manager and 12 support staff (Appendix 1).

The purpose of the practice is to provide a full range of high quality primary healthcare services to the patients through the GPs and nursing staff, and to facilitate access to appropriate secondary care when required.

The Practice offers several clinics such as counselling and well woman.

We provide services in one of the most diverse communities in London.

Our practice area lies between A12/Eastern Avenue, Romford Greyhound Track, Barley Lane (Chadwell Heath side) and Green Lane, Whalebone Lane End. Patients can be registered in surrounding areas by arrangement after discussion with the doctor.

My role

I support the doctors in the delivery of high quality primary care by analyzing all systems and processes which impact the finances of the practice (Appendix 9a).

Financial Management

To provide all financial papers to the accountant in good time for the

preparation of practice accounts.

Attend all internal financial meetings and any other meetings which

the partners feel would be appropriate.

Attend external meetings which may affect the finances of the

practice.

Maintain an efficient filing system.

Personnel Management

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Arrange training opportunities for staff as appropriate.

Fill in a daily to do list outlining own duties for the day.

To ensure confidentiality at all times.

My responsibilities for quality

‘’An empowering point of view occurs when I accept responsibility for my thoughts, feelings, actions and the overall tone and outcome of the situation. When I take an accountable position, I focus on actions and feelings that will bring about success in my projects and my relationships.’’

Quality is very important to us. We have a Practice Co-Ordinator and an Information Officer who work closely with the Havering Primary Care Trust (PCT) and the practice clinicians. They are responsible for monitoring statistics to help us assess the quality of our services. We always strive to attain the best.

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Part 1 – The need for innovation (1355 words)

1.1 The importance of innovationIn the last 15 years, since the last labour government was in power, the NHS has been through reorganisation and changes in the way it provides services. Although there has been lots of investment put in the NHS, with the country going through serious financial crisis, many austerity measures have also been imposed. This has led to the NHS having to save 20 billion pounds by 2015.

The NHS brought out a white paper in 2010 and they passed the NHS bill in 2012 for a major change in the way NHS works, with the core of NHS funding going through primary care and GPs.

Multiple layers of management have been abolished to decrease the spend on administration.

Every GP surgery now has to be part of the new clinical commissioning group (CCG) where every practice will be accountable for the money it spends on its patients.

It is important for the organisation to innovate as GP practices have to provide more services at lower cost, this puts financial burden on GP practices.

Listed below are some examples of this financial burden:

Rise in unemployment level leads to an increasing need of Primary Care due to depression, stress, poor nutrition, lack of exercise.

Aging Population has led to more home visits and more use of additional services such as district nurses.

High levels of obesity has led to more cases of diabetes management within primary care.

High levels of alcohol abuse has led to more counselling needs within a Primary care setting.

Increase in mental problems has led to more counselling needs within a Primary care setting.

Diverse population means there is a need to have translators and Practice booklets in different languages in a Primary care setting.

Primary Care plays an important role in Primary Prevention. Decrease the burden of chronic illness by doing all the things for primary prevention opportunistically and in a target way.

The government faces a considerable challenge to convince doctors that the reforms proposed in the White Paper will improve patient care.

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Clinicians are also concerned that the reforms risk distracting the NHS from making the necessary efficiency savings.

As GPs get financial control, this has the potential to lead to chaos as GPs are not businessmen, their primary role is to provide the best clinical care for their patients.

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1.2 The importance of managing change

The Practice needs to take a pro-active approach to manage change. One of the ways this can be done is through the PPG. This group, if given time and respect by the Practice, can be a powerful resource for the Practice in the improvement of patient care. This group can also raise money for the practice through its fund raising activities.

Another aspect of change which needs to be addressed quite urgently is the role and responsibilities of staff. As the practice manager has left and it has been decided that she will not be replaced, her duties which have evolved considerably in the last financial year, must be filled completely by existing staff. To do this successfully the practice has to consult their staff on how best to achieve this goal. The practice manager has to be financially literate to survive in the current climate, if the Practice does not look at this aspect, this may lead to gross inefficiency and the practice will not be able to cope with the many changes which are presently taking place in the NHS.

If the Practice does not budget this may lead to overspend.

If the Practice overlooks some of the enhanced services it signed up for, this will lead to loss of potential income for the Practice.

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1.3 The present situation

The Practices vision is to provide the best healthcare to its patients. In order to meet this mission, the doctors and nurses prescribe the medicines which best suit the patients but the Practice has been told to cut back on the high cost drugs as it is too expensive. This has led to a gross overspend in the financial year 2011/2012. The prescribing team at ONEL has been very proactive in helping the practice to keep the cost down. The doctors and the ONEL team hold regular meetings to address this issue.

There are three underlying staff issues which were inherited when the partnership was formed in 2006. The first is the skill mix of the staff, the second is the sickness issue and finally the overtime issue.

The skill mix is the greatest challenge for the practice to address. Several support staff and at least one doctor are obstructing progress. Restructuring has become apparent as the Practice Manager has left and cannot be replaced due to financial constraints. This means the roles and responsibilities of the current staff needs to be looked at and revised to ensure all work is covered. The Practice needs to consider if it can afford a business manager. There is a grave concern that if this practice does not bring in the right staff to address this issue it will not meet its contractual obligation.

The second issue arises as a direct result of the first. Once the roles of staff have been agreed and established, sickness may become negligible. There are no data of prior years sickness records which means this area cannot be analysed for trends.

The income streams have never been analysed such as the directed enhanced services (extended hours, PPG, health checks etc) and the General Practitioners Records (GPRs). There does not appear to be procedures or structures around these processes.

There is a practice website but it seems to have been neglected as has the PPG. Fortunately both of these have now been addressed but the challenge for the practice is to make sure they build on the foundations and go with the impetus.

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1.4 The problem driving the changeThe practice lacks structure, there are little or no procedures, staff have little direction. As a result some audits and DESs have never been done. This lack of initiative will affect patient care.

1.4.1 Financial implications of problem

There are many services which the practice has provided but has not received the income. Past analysis must be done to ensure the practice gets all the income it is owed. Some examples of pending payments are:

Locum cover payment of £12,714 agreed to be paid by the PCT The practice has freed up resource of £48,000 confirmed by the PCT The practice has done extended hours for which it has not been paid The practice has provided medical reports for which it has not been paid

The practice has provided health checks for which it has not been paid The practice has provided chalmydia kits for which it has not paid The overtime claims year on year has increased which the Practice was

unaware of There is disparity year on year on the claims made for extended hours

1.4.2 Legal framework for problemThe Practice needs to consider any legal implications resulting from role restructuring to ensure any proposed changes to staff roles and responsibilities are reflected in their contracts. Peninsula will be able to assist the practice in these matters.

1.4.3 Human Resource issues surrounding problemThe Practice needs to consider how the gap left by the Practice Manager will be filled, will staff be happy with their new roles, will they expect more pay, can the practice afford a pro active business manager? Will they be able to take direction from someone who wants to address the staffing issues facing this practice? There are many analysis and audits which the practice is not doing which will impact patient care. Can the existing staff cope with the workload in an efficient and effective manner is a serious issue facing this practice. This is an issue which unfortunately is relevant to both support staff and clinical staff. This report only covers the support staffs work and even then it is restricted to key support staff. Another report needs to be written to address the issues facing the clinical staff.

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Part 2 – Innovative solutions for improvement (2989 words)

2.1 How the investigation was conducted The partners were concerned that at any point in time they did not know what their income and expenditure streams were. This conversation led to the investigation of the current financial issues by various means as outlined below: Interviews were carried out with the doctors to find out what DESs and LESs the Practice has signed up to so it will be possible to determine how much income can be generated from these sources. The Outer North East London team were also contacted to verify the partners statement.

Interviews were also conducted with the administrative and reception staff. Questions were asked about how the petty cash register was set up as this contained monies from the travel clinic. It was important to determine if this was a viable clinic for the practice so the involvement of the Practice nurse was also vital during this interview. Liaising with the practice accountants also became very important at this stage as the staffs answers could be verified by numbers and figures prepared by the accountants in prior years.

The previous appraisals showed gaps in staffs understanding of their duties which led to interviews about training needs of staff to improve efficiency, productivity and morale of all staff, this led directly to the sickness issues currently affecting the practice.

All current processes which have a financial bearing was reviewed to ensure the Practice was optimising its income without compromising its duty of care to the patients. The areas looked at were:

Locum CoverIt was necessary for the practice to use locum for a three month period. The practice had liaised with ONEL where an agreement had been reached that ONEL would pay £12,714 to cover this period. Six months later the practice had not been able to claim the money so an analysis was done to attempt to retrieve the money. The practice interacted with the locum agency Beacon Care Services (BCS) whose locum doctors were used during this period.

Extended hoursThe finance department at ONEL provided invaluable feedback on the claims made in the last financial year, the Practice managed to get an agreement from ONEL that back dated claims from the 2011/2012 financial year would be

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approved. This led to a full analysis from April 2011 to March 2012 to determine if the Practice had made correct claims.

OvertimeThe partners were unaware of both the pay scale of their staff and the associated overtime. An analysis was conducted to determine staff cost to the practice. The accountants unaudited financial statements was used to verify the analysed figures.

Chalmydia claimsThe Practice did not have any process in place so meetings were set up with ONEL to start this process as the Practice had been issuing chalmydia kits but had not been making the claims.

Travel clinicsThe Practice did not know how much profit was being generated by the travel clinic as there was no process in place. Meetings were arranged with the Practice nurse and the administrator who was responsible for handling the money so month on month it would be clear to see if the income exceeded the expenditure.

Key audits and analysis were carried out to ensure all financial streams were captured. These were:

A SWOT analysis of the income and expenditure was carried out with the doctors, nurses and staff to enable the practice to expand on its strength and improve on its weaknesses.

A SPECTRE analysis with regards to the future practice growth and challenges was carried out to enable the practice to deal with the many changes it faces by putting in place all the structures and processes in advance.

Prescribing audit was carried out with the help of the ONEL prescribing lead. This was done in several stages with meetings and analysis using EMIS LV.The Practice has been told to reduce the number of high cost drugs which it is currently prescribing by looking at cheaper alternatives. ONEL has told the Practice that it has exceeded the budget and must now be in line with its spending as this is putting a strain on other practices.

Health check analysis has been carried out on all patients registered with the Practice who are aged between 40 and 74 but are not on a disease register. This is a very good way of capturing any underlying conditions which may have been missed and this has been incentivised by giving the Practice financial reward for each patient who satisfies the criteria who is seen once every five

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years. A process has been written for the Practice using material provided by the NHS.

General Practitioners Report (GPRs)Other ways in which income is generated in a GP Practice are by filling in different type of forms required by various companies. An analysis of this processing system has been conducted to ensure the Practice receives monies for work provided.

Patient Participation DES was prepared and published on the Practice website. This is part of a two year DES which will bring in an income of £1.10 for each patient registered with the Practice. More importantly, it provides a valuable resource for the Practice in the improvement of patient care as the best ideas usually are from the patients on how to improve services and processes to bring about increased efficiency and productivity.

Practice Website was further developed by looking at what other practices were doing with their websites, during PPG meetings and suggestions from one of the doctors.

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2.2 Results (findings)

The table below is divided into 5 columns, the first column gives the name of the process looked at, column 2,3 & 4 highlight the amount of work carried out. The figures are either the income or expenditure amount which the practice has got/will get if it carries out the necessary work. Finally column 6 shows where the details of the analysis can be found.

Name Not Done Potential Income£

Partially Done

Fully DoneIncome(Expenditure)£

Appendix

Alcohol Related DES

X

Chalmydia Claims

72.00 2

Extended Hours reclaimed

7,200.00 3a

Freed up resource

48,000.00

GPRs 4,969.22 4

Health Check reclaimed

2,489.80 5

Learning Disabilities DES

715.12

Locum cover recovered

12,714 6

Osteoporosis DES

2,003.0031/07/12

Overtime analysis

(12,370.00) 7

PP DES claim for one year

6,864.00 www.upstairs-surgery.co.uk

Petty Cash X

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Register

Prescribing Audit

X 8

Roles of staff X 9(a-e)

Sickness Issues

X

SPECTRE Analysis

X 10

SWOT Analysis

X

Training Needs X

Travel Clinics X

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2.3 Analysis and conclusions

Interview with the clinicians revealed:

The practice had signed up for the following DESs and LESs which was confirmed by ONEL.

A B C D E F G H I J K

1

Practice Code

Polysystem

Practice Name Alcohol-Related Risk

Reduction Scheme

Learning Disabilities

Health Check Scheme

Osteoporosis Diagnosis and

Prevention Scheme

Patient Participati

on

FLU DES

FLU LES

Health Checks

IUD

2 F82019North Romford

Chadwell Heath Health Centre (Dr Hamilton-Smith) √ √ √ √ √ x √

The Alcohol Related Risk Reduction DES was not looked at by the practice. The deadline for submission was 28th April 2012.

The Learning Disabilities Health Check Scheme DES has 7 patients on the register. If this DES had been followed through, then for each patient on the register the practice would have received £102.16 with a potential income of £715.12. The deadline for submission was 28th April 2012.

The Osteoporosis Diagnosis and Prevention Scheme DES has 10 patients on the register. A maximum payment of £200.30 is available per patient this makes a potential income of £2,003.00. The deadline for submission is 31st July 2012.

The patient participation DES was completed and published on the websitewww.upstairs-surgery.co.uk There is a payment over a two year period of £1.10 for each patient registered with the practice. This is worth £6,864.00 to the practice.

The practice has held regular internal meetings to improve the website, other practices websites have been analysed, and the PPG have also provided valuable insight. This has led to changes constantly being made to the website with the practice looking into the benefits of online prescribing and appointment system.

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http://www.upstairs-surgery.co.uk/


There are 1,793 patients who qualify for health checks of which 118 patients have had a health check but the money has not been claimed.

Date Number of health checks

1st April – 30th April 15

1st July – 30th Sept 2010 43

1st Jan – 31st Mar 2011 21

1st Jan – 31st Mar 2012 39

Each health check brings in £21.10. The 118 health checks which is owed to the practice is worth £2,489.80.

The total potential earnings from health checks is £37,832.30. A procedure has been written using NHS guidelines. (Appendix 5)

Interviews with reception and administrative staff revealed:

Lack of ownership with regards to the maintenance of the petty cash register, no reconciliation of the figures on a regular basis, missing data from the register.Lack of both formal and informal training of staff.Low morale, stress at work, favouritism, dislike or indifference to work were the main reasons for time off for sickness.To reduce the above issues a revised set of job description for key staff members have been written based on current roles and taking account of no practice manager.(Appendix 9a Business Manager, Appendix 9b Administrative Manager, Appendix 9c Information & IT Officer, Appendix 9d Medical Secretary, Appendix 9e Senior Receptionist). Return to work interviews have also started to attempt to control sickness times.

The practice needs to decide if there is a need for a business manager. The cost to the practice will be:12 hours a week at £20 per hourAnnual cost 52 * 12 * £20 = £12,480

The business manager can attempt to train existing staff for roles which the partners want them to fill as it is very clear that there are skill mix issues in this practice. This could be a fixed term contract for one year.

The cost to the practice of promoting the receptionist to a senior receptionist will be:Receptionist works 14 hours a week at £7.70 per hour.

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Annual cost 52 * 14 * £7.70 = £5,605.60Senior Receptionist will work 23 hours a week at £8.80 per hour.Annual cost 52 * 23 * £8.08 = £9,663.68The cost to the practice will be £4,058.08.

The practice has to decide if there is a need for a medical summariser. The savings to the practice will be:5 hours a week at £5 per hourAnnual savings 52*5*£5 = £1,300.00

The practice has to decide if there is a need for an administrator assistant. The savings to the practice will be:16.5 hours a week at £6.71 per hourAnnual savings 52*16.5*£6.71 = £5,757.18

Reviewing the current processes showed the following:

The extended hour analysis revealed the following claims were missed:August 2011 claim of £2,250.00September 2011 claim of £2,475.00April 2011 to March 2012 claim of £2,475.00 (Appendix 3a)These were subsequently recovered.

In the last financial year, the income generated from extended hours was £31,750.00 (Appendix 3b).In any financial year, there are potential earnings of £46,800.00 from extended hours if nurses are also involved in this process.4*52*£225 = £46,800.00

Analysis of staff overtime revealed the following:A 52% rise in overtime claim from 2008 to 2009A 16.30% fall in overtime claim from 2009 to 2010A 73.25% rise in overtime claim from 2010 to 2011The staff wages have been averaged out to work out the cost to the practice in the last financial year due to overtime claims, this came to £12,370 (Appendix 7).

Meetings were held with the Practice nurse with regards to chalmydia claims. The result of the meeting revealed no claims have ever been made by this practice in the last financial year or prior years for chalmydia as the nurse was unaware of the process. There was no procedure and the practice could not produce any data for analysis. In February 2012 the first claim was made of £72 (Appendix 2a). Procedures have been written (Appendix 2b).

Farhana Imran 26


Meetings were held with the nurse and administration team to determine if the travel clinic was making a profit for the practice. Neither the nurse nor the administration team were aware of how much this clinic was generating. The following was determined:

The nurse sets up her clinics every two weeks The nurse pre orders the medicines required The receptionist at the desk takes the money from the patient The receptionist makes a note of it in the petty cash register The receptionist puts the money in the cash box

No analysis could be prepared as the register is incomplete and does not state if the money came from the travel clinic or some other source. This needs to be addressed.

An analysis of the major sources of income and items of expenditure with the doctors, nurses and support staff revealed the following:

GMS statement provides the main income sources(Appendix 11 ) which generated an income of £541,958.12 for the financial year 2011/12. This includes:

Global sum Aspiration Seniority Immunisation Extended Hours Flu Gold Standard Framework Minor Surgery IUCD

The other main income source is the general practitioners reports.This showed that from December 2011 to May 2012, the practice received cheques of £3,347.61Monies from the Department of Works and Pensions came to £1,158.36 Fortyone non payment chaser letters were written worth £2,470.99 of which £463.25 were recovered which is 19% (Appendix 4). A SPECTRE analysis with regards to future practice growth and challenges was conducted with the team (appendix 10). This highlighted a need for audits to improve patient care.

A prescribing audit of high cost drug was conducted with the prescribing lead from ONEL (Appendix 8a) which revealed £463,785.53 had been spent on medicines for the last financial year. Meetings have been held with ONEL to

Farhana Imran 27


look at the alternatives(Appendix 8b). The practice is looking at reducing this figure by 20%.

Conclusion

Actual income recovered

Name Amount (£)

Extended Hours

7,200.00

Locum Cover

12,714.00

Chalmydia 72.00

GPRs 4,969.22

TOTAL 24,955.22

Potential additional income

Name Amount (£)

Osteoporosis DES

2,003.00

PP DES 6,864.00

Health Check 37,832.30

Prescribing 92,757.11

Freed up Resource

48,000.00

Medical Summariser

1,300.00

Administration Assistant

5,757.18

TOTAL 194,513.59

Actual expense

Name Amount (£)

Farhana Imran 28


Overtime 12,370.00

TOTAL 12,370.00

Potential additional expense

Name Amount (£)

Business Manager

12,480.00

Senior Receptionist

4,058.08

TOTAL 16,538.08

2.4 Possibilities

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Based on the findings and conclusions there are three possible solutions which the practice team has come up with after group discussions. Each will be considered in turn with its strengths and weaknesses. The team considered the following range of criterias when coming up with possibilities:

Practicality of the solution Financial benefits How it will affect staff How it will affect the practice and primary care How acceptable the solution is for all stakeholders

The solutions are:

Do nothingThe practice continues as it is with little structure and incomplete knowledge of income and expenditure streams

StrengthThe staff remains unaffected

WeaknessThere will be uncertainty on whether optimal income level has been achievedThere will be uncertainty on whether all tasks are being doneThere is uncertainty if the practice can survive the rules to be imposed by the CCG eg the continuation of the PPGThe practice remains low profileThe morale of the practice may be lowExpansion opportunities may be missed

This is not a practical solution. The cost to the practice will be great as seen earlier from the SPECTRE analysis as patients needs will not be met if key audits are not performed. Staff will remain demotivated as there will not be clarity in their roles and responsibilities. There will be a possibility that the practices management will be taken over by ONEL as the contractual obligations may not be met.

Apply short-term solutionsThe practice adopts some of the analysis and audits such as extended hour submissions and revised roles of staff

StrengthThere will be a feeling of achievementStaff morale will be improved as there is more structureImmediate financial benefits from monthly extended hour submissions

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WeaknessThere will be uncertainty on whether optimal income level has been achievedStaff do not want to reduce staff numbersStaff do not want to bring in external business manager Staff feel threatened

This is not a practical solution. The team are not keen to bring in an external business manager but prefer the information officer to be trained up to this level. Unfortunately this is not a viable option as the information officer does not have the correct skill mix. This option will not be able to address the issues facing this practice.

Apply long-term solutions by addressing the root causeThe roles and responsibilities of staff are fully addressed and implemented with regular feedback in the first year All the processes and procedures are being followedThe business manager is appointed for at least one year to ensure accountability

StrengthOptimal level of income will be achievedStaff aware of their rolesStaff take ownership for their workStaff take accountability for their work which leads to efficiency and productivityTeamworkPractice can become more innovative by participating in ground breaking audits which serves the wider population and other practicesReduce wastageThe profile of the practice goes up

WeaknessSteep learning curve for staffFeeling of insecurity amongst long serving staff and clinicians as they struggle to cope with their revised rolesTraining cost increased

This is a practical solution from the patients perspective and for the financial wellbeing of the practice. Some members of the current staff do not want any external staff as they feel the workload is immense. The practice should reach a compromise by employing the business manager for a fixed term contract where this person can attempt to train existing staff to roles which the partners want them to fill as it is very clear that there are skill mix issues in this practice.

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Part 3 – Leading change (801 words)

3.1 Proposal and Recommendations (including benefits for stakeholders)

The cost benefit analysis prepared below shows the value in monetary terms of implementing the proposal.

All the monies owed to the practice would have been lost if the analysis had not been done.

£7,200.00 extended hours amount would have been lost.

£12,714.00 locum cost would have been lost.

£37,832.30 health checks which the NHS is promoting would have been lost.

£48,000.00 freed up resource (details can be found in the action plan at www.upstairs-Surgery.co.uk) is worth pursuing as this money will be used to bring in a part time female GP which is what the patients want.

The project plan (Appendix 12) provides details of the proposals with timeframes. A Gantt chart has also been prepared (Appendix 13).

The revised roles and responsibilities (Appendix 9a – 9e) will help staff to learn the importance of being part of a team with shared goals, it will also keep them focused and motivated.

The partners will see financial rewards by implementing the proposals. They will see happy and productive staff and most importantly they will see a higher quality of patient care. By doing the DESs and LESs, performing the audits, the practice will be well placed to share their work ethics with other practices and help to move primary care forward.

Cost Benefit Analysis of the proposal

Alcohol related DES (estimate 100 patients) 23.80

Chalmydia (£72 per quarter) 288.00

Extended hours reclaimed 2011/2012 7,200.00

Extended hours 2012/2013 46,800.00

Extended hours 2011/2012 (31,750.00)

Freed up resource 48,000.00

Freed up resource used to bring in part time female GP (48,000.00)

GPRs (estimate £800 per month) 9,600.00

Farhana Imran 32

http://www.upstairs-Surgery.co.uk/


Health Checks 37,832.30

Learning Disability DES 715.12

Locum amount recovered from ONEL 12,714.00

Osteoporosis DES 2,003.00

Overtime savings 12,370.00

Overtime savings used to employ part time Business Manager

(12,480.00)

Petty Cash (estimate £100 per month) 1,200.00

PP DES 6,864.00

Staff roles cost of senior receptionist (4,058.08)

Staff role saving on Medical Summariser 1,300.00

Staff role saving on Administrator Assistant 5,757.18

Travel Clinic (estimate profit £50 per month) 600.00

Income generated for the practice 82,606.32

3.2 Managing change

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The force field analysis below highlights the main challenges in implementing the proposal. The biggest challenge will be to get the current staff to do the work in an accountable way.

Force Field Analysis

Driving Forces Restraining Forces (positive forces for change) (Obstacles to change)

Positive attitude of doctors Reducing cost by redundancies

Discipline in the work place Insecurity among long serving staff

Staff loyalty to senior partner Inadequate skill set of staff

Kotter’s simplified 4-step change management framework will address the challenges which the practice faces in implementing the proposal.

Pressure for ChangeStaff are aware that the practice is not efficient and change is imperative, they are happy to have revised roles and responsibilities to incorporate these changes but feel threatened by how much is expected of them.

Clear, shared visionThe mission statement of the practice is clear to staff.

Capacity for changeThe practice will be successful in implementing the change if they bring in an external business manager as the skill of the current staff is not adequate at

Farhana Imran

Current Situation:

The practice is not optimising its income

Desired Situation:

The practice does all the work to optimise its income

34


the moment. The practice needs to let go of some of its staff whose work can easily be done by other staff.

ActionKaizen’s ( continuous improvement) five S’s

1) SortDo all the analysis, past and present

2) Set in orderDo a timetable of the activities resulting from the analysis

3) ShineReview the activities every quarter to make sure they are still relevant

4) StandardizeSet a procedure or process for each activity

5) SustainReview the procedure or process every quarter for accuracy and update as required

3.3 Quality assurance

Farhana Imran 35


The main risks are:

The staff and doctors at this practice are not keen to bring in external staff. There are many long standing staff who do not want the status quo disturbed so new staff have not been able to stay for long at the practice. It will be a challenge to employ an external business manager. The doctors at this practice have a very relaxed attitude, if support staff apply enough pressure, the doctors will submit under pressure and not employ an external business manager.

The doctors may not see the benefit of doing work for small financial return such as the alcohol DES which pays £2.38 for each patient on this register.

Staff may resent the loss of overtime.

Staff may be overwhelmed by the revised roles and responsibilities, they may feel they are being asked to do too much with little financial benefit.

Some of the audits may highlight clinical weaknesses which will anger the doctors.

Staff may resist the use of to do list where they have to account for their time.

The model below can help to put contingency plans in place by ensuring work is checked by another person and the processes are up to date. Unfortunately no contingency plan can take the place of key personnel.

Continuous Improvement

Farhana Imran

Plan

Do

Check

Act

Set up timetable for

analysis

Write the

procedures

All work 2nd checked

Review

the processes

regularly

36


Part 4 – Appendices

Appendix 1 Organisaion Chart …………………………38 Appendix 2a Invoice for chlamydia screening February 2012 ................................39

Appendix 2b Chlamydia screening process for April 11 – March 12 .......................40Appendix 3a Extended hours fax to recover money for work done from Apr 2011 – Mar 2012......................................................................................................41Appendix 3b Extended hours payments for Apr 2011 – Mar 2012.........................42Appendix 4 General Practitioners Report Process..................................................43Appendix 5 Health check procedure.......................................................................44Appendix 6 Locum cover invoice............................................................................45Appendix 7 Analysis of staff overtime from 2008 to 2011.......................................46Appendix 8a Top 20 prescribing drugs for Apr 2011 – Mar 2012...........................47Appendix 8b Prescribing meeting...........................................................................48Appendix 9a Role of Business Manager.................................................................50Appendix 9b Role of Administrative Manager.........................................................52Appendix 9c Role of Information & IT Manager......................................................56Appendix 9d Role of Medical Secretary..................................................................58Appendix 9e Role of Senior Receptionist................................................................60Appendix 10 SPECTRE analysis of issues affecting the practice...........................62Appendix 11 GMS practice summary statement for Apr 2011–Mar 2012...............67Appendix 12 Outline Project Plan...........................................................................71Appendix 13 Gantt Chart........................................................................................79

Appendix 1 – Organisation Chart

Farhana Imran 37


ORGANISATION CHART

DRS HAMILTON-SMITH,OLADIMEJI & IMRAN

Partner Partner Partner

Dr Hamilton-Smith Dr Oladimeji Dr Imran

Administrative Manager Business Manager

Lorraine Stebbings Farhana Imran

Senior Receptionist Information Officer Senior Practice Nurse

Angie Conroy Diane Maskell Margaret Byers

Receptionist Medical Secretary Practice Nurse

Michelle Jackson Anne Mantripp Susan Oldhamstead

Receptionist Medical Summariser

Val Mattock Bosie Oladimeji

Receptionist Medical Secretary

Marilyn Abramov Theela Bourne

Receptionist

Sue Day

Receptionist

Jan Maggs

Receptionist

Barbara Quinton

Appendix 2a – Invoice for Chlamydia Screening 2012

Havering PCT CA4

Payables 6725

Shared Business Services

Phoenix House

Topcliffe Lane

Farhana Imran 38


Wakefield

WF3 1WE

XXDHOWLETT

Surgery Name: Drs Hamilton-Smith, Oladimeji & Imran

Lead GP: Dr Hamilton-Smith

Surgery Address: Upstairs Surgery

Chadwell Health Health centre

Chadwell Heath

Essex RM6 6RT

Invoice Number: CS1

Month: February 2012

Total Number of Screens: 9

TOTAL INVOICE AMOUNT: £72.00

Please Pay: Drs Hamilton-Smith & Partners

Sort Code: xx xx xx

Account No. – xxxxxxxx

Bank: - HSBC

Or send a cheque to:

Appendix 2b – Chlamydia Screening Process for 2012

Drs Hamilton-Smith, Oladimeji & Imran F82019

The Practice orders Chlamydia kits from:

Chlamydia Screening Office

Terence Higgins Trust

Farhana Imran 39


20 East Street

Barking IG11 8EU

Telephone: 0208 591 2561

Contact name: Anastasia

Email: [email protected]

The patient fills in a test request form and takes the kit which has a unique reference number

The patient fills in the label and sticks it on the smaller bottle

The patient free posts this to Terence Higgins Trust

When the lab results are complete, the Terence Higgins Trust gives ONEL the number of screens for the month for the practice

ONEL contact:

Dawn Howlett

Email: [email protected]

Telephone: 01708 431809

Terence Higgins Trust should provide this same number to the Practice so we know how many screens to claim for – at the moment this part of the process is missing

I have requested this information to be sent to us on a monthly basis, it will be addressed to me, awaiting confirmation from Simon Cordon

Appendix 3a – Extended Hours Fax to recover money for work done for Apr 2011 – Mar 2012

PRIVATE & CONFIDENTIAL

FAX MESSAGE

Farhana Imran 40

mailto:[email protected]


To: Mark Lockwood From: Farhana Imran

Fax: 020 8926 5005 Senders Fax: 020 8597 7819

Cc: Senders Phone: 020 8590 1461

Re: Extended Hours Date: 02.02.12

Number of Pages (Including cover sheet): 13

Urgent Please Comment Please Reply For Review Please Recycle

Message:

This relates to extended hour session for Jan 2012. There are four 30 minute sessions done by the nurse to cover the bank holiday period. Please confirm £3,375 for Jan 2012.

Please confirm £2,250 for Aug 2011 and £2,475 for Sept 2011 sessions will also be paid with Jan 2012

Also attached are the back dated claims for 2011. There are 33 thirty minute sessions done by the nurse. We are claiming £2,475 for 11 back dated sessions for 2011.

Appendix 3b – Extended Hours Payments for Apr 2011 – Mar 2012

F82019

April 2011 to Mar 2012

Date Extended Hours

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23/03/12 3,375.00

29/02/12 10,825.00

31/01/12 5,400.00

30/11/11 2,025.00

31/08/11 2,475.00

31/07/11 2,475.00

30/06/11 2,475.00

28/04/11 2,700.00

TOTAL 31,750.00

Appendix 4 – General Practitioners Report Process

DRS HAMILTON-SMITH, OLADIMEJI & IMRAN

Chadwell Heath Health Centre

Ashton Gardens

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Chadwell Heath, Romford

Essex, RM6 6RT

20th January 2012

INTERNAL MEMO

MEDICAL RECORDS INVOICE

We have reviewed our procedure and have made some alterations in our process. Copies of medical records will only be made available after we receive the correct fees.

All cheques must be made to the Practice and not to individual doctors. We do not accept cash.

From a risk and control perspective, cash is not an acceptable method of payment as there can be a loss of audit trail.

Appendix 5 – Health Check Procedure

Background

Farhana Imran 43


A list has been produced by Margaret Byers. There are 1,793 patients who qualify for health checks. The patient can be invited once every 5 years for a health check.

For a five year programme, the practice needs to do 358 health checks every year.

Therefore, every quarter, 90 health checks need to be done and claimed for by the practice. Margaret Byers wants to do the submission.

Therefore, every month, 30 health checks need to be completed by the clinicians. If each doctor does 5 a month and Margaret does 15 a month this is a very achievable target.

As the practice is two years behind, an agreement has been reached with ONEL that the practice can submit as many health checks as it can.

Procedure

The patient must have a blood test within 6 months of the health check

Eg If the patient comes in for a health check in June 2012, he/she must have had a blood test from Jan 2012 to June 2012.

With the patient, fill in a ‘General Practice Physical Activity Questionnaire’ (see attached)

Fill in ‘Minimum Data Set ‘ (see attached)

At the end of each month, give a copy of the General Practice Physical Activity Questionnaire and Minimum Data Set to Margaret.

Every month please provide the Business Manager with an update.

Appendix 6 – Locum Cover Invoice

Dr J A HAMILTON SMITH & PARTNERS INVOICE NO.

Farhana Imran 44


Chadwell Heath Medical Centre 1/JHS/FI1

Ashton Gardens

Chadwell Heath

Romford

Essex RM6 6RT DATE: 05.10.11

Comments or special instructions:

ACCOUNT NUMBER

P.O. NUMBER REQUISITIONER DELIVERY NOTE

TERMS

XXLHUTCHINSON

QUANTITY DESCRIPTION UNIT PRICE

AMOUNT

24 Locum cover for Dr xxx while on suspension

Period from 7.4.11 – 16.6.11

Back up papers from Beacon Care Services Ltd

N/A £12,714.0

Bank Details: Sort Code xx xx xx

Account Number: xxxxxxxx

Please make cheques Payable to: Dr J A Hamilton Smith & Partners

Practice Code: F82019

Remittance Address [email protected]

SUBTOTAL

DISCOUNT

HANDLING

VAT

TOTAL DUE £12,714.00

Appendix 7 – Analysis of staff overtime from 2008 to 2011

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DRS HAMILTON-SMITH, OLADIMEJI & IMRAN – F82019

Overtime in hours

Name of Staff 2008 2009 2010 2011

A 80.5 41.5 9.5 76

B 17 35 10

C 41.5 29 37.5 4

D 55 51 63.5 172

E 66.5 53.5 70.5 90

F 90 81 62 132

G 116.5 127 118 116

H 27.5

I 18 30.5 79 86.5

J 67 90.5 38 186

K 19.5 19 33.5 98

L 300.5 164.5 235

M 5.5 12.5 3 4

560 853 714 1237

Appendix 8a – Top 20 Prescribing drugs for April 2011 – March 2012

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Drs Hamilton-Smith,Oladimeji & Imran

BNF Name Total Act Cost £

Cost per item £

Fluticasone/Salmeterol_Inh 250/25mcg 120D 18,209.15 93.38

Pregabbalin_Cap 75mg 11,580.63 74.23



Atorvastatin_Tab 20mg 10,072.86 30.25

Budesonide/Formoterol Inh B/A 200/6 120D 9,883.34 61.77

Sitagliptin_Tab 100mg 9,673.19 44.99

BuTrans_Transdermal Patch 20mcg/hr 9,606.04 55.53

Pioglitazone/Metformin HCI_Tab 15mg/850mg 9,252.86 49.75

Donepezil HCI_Tab 10mg 8,568.60 64.43

Tiotropium_Pdr For Inh Cap 18mcg 8,530.66 50.48



Spiriva Respimat_Inha 2.5mcg 60D+ Dev 7,728.48 42.46

Influenza_Vac Inact 0.5ml Pfs 7,295.36 6.07

Qvar 100_Inha 100mcg 200D 7,180.43 26.02

Candesartan Cilexetil_Tab 4mg 7,167.21 18.52

Ezetimibe_Tab 10mg 6,965.09 49.40

Candesartan Cilexetil_Tab 16mg 6,919.65 17.21

Rosuvastatin Calc_Tab 10mg 6,914.69 25.14

TOTAL COST 463,785.53

Appendix 8b - Prescribing Meeting

Farhana Imran 47


29/11/11 12:45 – 13:35

Present: Dr Hamilton-Smith Vicky Wong

Dr Francis Farhana Imran

Dr Imran

Item Action by who

Action by When

1 Reason for visit by Vicky:

Projected overspend by this Practice is £136,000

GOAL: The Practice needs to cut back by 20%

Feb 2012

2 Inhaler review to carry out an audit for Seretide 250 (500)

It is our 1st, 3rd & 5th high costing drug

Dr AI Feb 2012

3 Diabetes – Sitagliptin_Tab 100mg

It is our 4th high costing drug

Who is monitoring this? Nurse

Monitoring HBA1c

Margaret

Dr AI

Dr JAH

Feb 2012

4 Pregabalin 75mg

It is our 2nd highest costing drug

Audit the use of this drug

Dr Francis

Feb 2012

5 SIP FEEDS

Dietician Raveena will come to help audit this

(Ensure, Peptamen, Fortisip extra)

Dietician Feb 2012

6 SPECIALS

Levothyroxine capsules cost £100

Check which patients are using, to be changed to tablets

Dr JAH Feb 2012

7 BuTrans Patches all strengths

Need to reduce use

Dr Francis

Feb 2012

8 QIPP Score Cards

Quick Wins:

Prednisolone EC to be changed to normal

Ferrous Sulphate change to Ferrous Fumarate

Naproxen EC changed to normal

Glucosamine & Clopidogrel - ok

Dr AI Feb 2012

9 QP2 Dr AI Feb

Farhana Imran 48


Felodipine to amlodipine

Target:less than 10% of all felodipine to amlodipine

2012

10 QP2

Generic bisphosphonates

Currently 78% need to get to 90%

Dr JAH Feb 2012

11 QP2

Blood Glucose Testing Strips

Current £140 should be under £110

Dr Francis

Feb 2012

12 ACE Inhibitors

Current 64% should be 75%

Dr JAH Feb 2012

13 In general:

Havering underspend is under 1 million but there are 2 reasons for concern for Vicky:

1) FLU season2) Report runs 2 months behind

14 Vicky will give us a copy of Epact data Vicky

15 AIM OF PRACTICE: 20% savings Drs

Nurses

Feb 2012

Farhana Imran 49


Appendix 9a – Role of Business Manager

JOB DESCRIPTION

Job Title: Business Manager

Responsible to: The General Practitioners in the Partnership

Grade: Administrative and Clerical Grade

Aim of Post:

To support the doctors in the delivery of high quality primary care by

analysing all systems and processes which impact the finances of

the practice. To consider a range of alternative systems for

improving the financial position of the Practice taking into account the

agreed criteria to include:

Effectiveness in solving the problems

Clinical governance and risk

Ease of implementation

Acceptability to Partners, staff and patients

Human Resource implications

Training needs

Costs

Financial Management:

1. To research and investigate

Bank statements

Extended Hours DES

Health checks for 40-74 year olds

Medical Reports required by insurance companies

Patient Representative Group DES

Practice website development process

Prescribing habit

Sickness policy

Staff contracts

Staff roles and responsibilities

LES which the practice has signed up for

DES which the practice has signed up for

Audits

Health Analytics

Chalmydia Screening – write the procedure

Travel Clinic –write the procedure

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Repeat prescribing protocol – write the procedure

Liaise with MDU –can practice members be patients of their practice?

Recommend cost saving ideas

Introduce accountability – daily to do list to be completed by staff

Health & Safety Issues

2. To provide all financial papers to the accountant in good time for the preparation of practice accounts.

3. Attend all internal financial meetings and any other meetings which the partners feel would be appropriate.

4. Attend external meetings which may affect the finances of the practice.

5. Maintain an efficient filing system.


1. Arrange training opportunities for staff as appropriate.

2. Fill in a daily to do list outlining own duties for the day.

3. To ensure confidentiality at all times.

This job description may need to be reviewed from time to time

as the practice develops.

Farhana Imran 51


Appendix 9b – Role of Administrative Manager

JOB DESCRIPTION

Job Title: Administrative Manager


Aim of Post:


managing the day to day administrative systems within the practice.

General Administration

Register new & temporary patients ensuring the appropriate forms

are completed and forwarded to the Health Authority.

Patient List reconciliation. Check the number of new patients. Check

the patients are shown on the quarterly GMS total.

Ensure all new patients are offered a new registration health check.

Check patients who have not had doctor contact for 18 months. They

need to be contacted to check details are up to date eg phone

number, address, still alive etc

Supervise the repeat prescription process in the surgery, preparing FP10s for the doctor’s signature.

Liaise with Diane to ensure statistical information relating to asthma,

diabetes and CHS for inclusion in the Annual Report are up to date

(QOF).

Liaise with Diane & oversee the practice computer system and the

development of its use.

Monitor security of the premises.

Ensure stationery, equipment and medication stock is available.

Ensure the extended hours rota has four sessions each week

irrespective of clinicians holidays, bank holidays and protected time

Farhana Imran 52


initiatives.

Ensure the health check rota is maintained and agree a minimum

number to be booked in each day to be seen by the healthcare

assistants and the nurses. Ensure that there is one evening slot

each week for working age patients who cannot come in at any other

time.

Ensure all complaints are handled appropriately and documented as

outlined in the complaints procedure.

Ensure all Practice procedures are up to date and all staff are aware

of them. Make the procedures accessible to all staff.

Ensure that all practice staff maintain patient confidentiality at all

times.


To be responsible for all day to day personnel management at

the surgery.

Arrange training opportunities for all staff as appropriate. To

arrange training, internal and external, for new members of staff. To

provide new staff members with an induction pack.

Arrange work and holiday rotas to ensure adequate cover at all times.

Maintain a Staff Appraisal System within the practice.

Implement the practice disciplinary and grievance procedures where

necessary.

Encourage good team working.

Ensure the absent doctor has a Locum Cover. To provide locum

pack to the locum doctor. To ensure the locum doctor uses the end

consulting room and not the partners room.

Farhana Imran 53


Fill in a daily to do list outlining own duties for the day. Ensure all staff comply

to this and hand the sheet to her .

Financial Management

Liaise with the Health Authority and ensure documentation relating to

new patient registrations, Deductions from the practice list and all

item of service payments are despatched promptly (e.g. Maternity,

Temporary Residents, New Registration Health checks etc.).

Operate an efficient stock control system for clinical and non clinical

items e.g. stationery and vaccines.

Set up meetings for the year

Weekly QOF update for the months of February and March with

the partners and administrative manager otherwise monthly

Monthly financial meetings with partners and business manager

Monthly meeting with partners and reception manager

Monthly meetings with administrative manager and her staff

Monthly clinical meetings with partners and nurses

QOF Work

Be responsible for the yearly QOF submission report

Preparation – new and old changes

Organisation – allocation for QOF work

Implementation – Setting up clinics, audits, telephone

Meetings Significant Event

Palliative Care

Practice Meeting

DES/LES

Ensure the work has been done and the claim is made for:

Extended Hours – person responsible Farhana Imran

Alcohol

Learning Disability

Osteoporosis – person responsible Farhana Imran

PRG – person responsible Farhana Imran

Health Checks –person responsible Farhana Imran

Audit

Farhana Imran 54


A&E audit as advised by all three doctors



Farhana Imran 55


Appendix 9c – Role of Information & IT Officer

JOB DESCRIPTION

Job Title: Information & IT Officer


Aim of Post:


managing the day to day information and IT systems within the

practice.

IT Administration

Update and manage all IT related issues on a day to day basis

Liaise with EMIS/PCT if there are any problems

QOF – update, analyse and organise activity on a weekly basis

Liaise with Lorraine to ensure statistical information relating to

asthma, diabetes and CHS for inclusion in the Annual Report are up

to date (QOF).

Liaise with Lorraine to update QOF on a weekly basis

Liaise with Practice team on monthly basis with QOF and IT related

issues

Liaise with Lorraine regarding the practice computer system and the

development of its use


Read code all important data from patient letter/communications for

QOF/summary update of computer records

Blood test results - update, call and recall

Communicate with patients via email/letter for call/recall as advised

by the doctors

Answer calls for patient queries regarding blood test and various

other investigations once approved by the doctors

Ensure patient confidentiality at all times


Fill in a daily to do list outlining own duties for the day. Give this to

Lorraine at the end of each day.

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Audit

Prescribing audit as advised by Dr Imran



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Appendix 9d – Role of Medical secretary

JOB DESCRIPTION

Job Title: Medical Secretary

Responsible to: Administrative Manager

Aim of Post:


managing the day to day secretarial duties within the practice.


Do all referral letters for the doctors, patients referrals via choose and

book, standard referrals and online referrals within 48 hours of the

referral being created, 2WW referrals, liaise with choose and book

Answer calls and queries regarding referrals

General letters to whom it may concern as and when required by the

Doctors

Private medical records, maintain a database, ensure the money is

received in the name of Drs Hamilton-Smith & Partners before

sending off the patients records. Provide a list to the Business

Manager on a monthly basis of all monies which has come in and

what is outstanding



Fill in a daily to do list outlining own duties for the day. Give this to

Lorraine at the end of each day.

Audit

Palliative Care audit as advised by Dr Francis

Referral audit as advised by Dr James

Meetings

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Liaise with Lorraine to set up in house clinical meetings

Take minutes of the meetings



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Appendix 9e – Role of Senior Receptionist

JOB DESCRIPTION

Job Title: Senior Receptionist

Responsible to: The Administrative Manager

Aim of Post:


managing the day to day reception duties within the practice.

Reception Administration

Organise the following reception activity:

Telephone

Scan

Appointment booking

Organise rota for each activity and staff member. Liaise with Lorraine

and get it approved 4 weeks in advance

All activities linked to reception:

Handling of information

Petty Cash

Fax

OTC – request

Prescription & repeat prescription



Ensure the reception area and the waiting room is clean and tidy, the

posters on display are relevant and up to date

The LED screen is constantly updated with relevant news

The TV monitor is used in a more appropriate way with relevant

medical information

Farhana Imran 60



Fill in a daily to do list outlining own duties for the day. Ensure all staff comply to this and give this to Lorraine at the end of each day.



Farhana Imran 61


Appendix 10 - SPECTRE analysis of issues affecting the practice

Factors The trends expected

Social

The demographics of society and how people behave

Rise in unemployment level

This leads to an increasing need of Primary Care due to depression, stress, poor nutrition, lack of exercise.

Aging Population

This has led to more home visits and more use of additional services such as district nurses.

High levels of obesity

This has led to more cases of diabetes management within primary care.

High levels of alcohol abuse

This has led to more counselling needs within a Primary care setting.

Increase in mental problems

This has led to more counselling needs within a Primary care setting.

Diverse population

This has led for the need to have translators and Practice booklets in different languages in a Primary care setting.

Primary Prevention

Primary Care plays an important role in Primary Prevention. Decrease the burden of chronic illness by doing all the things for primary prevention opportunistically and in a target way.

Eg

Screening, Health Checks

Political Government White Paper

The government faces a considerable challenge to

Farhana Imran 62


What political initiatives or aspirations might affect us?

convince doctors that the reforms proposed in the White Paper will improve patient care.

Clinicians are also concerned that the reforms risk distracting the NHS from making the necessary efficiency savings.

End of PCTs and SHAs.

Implementation of Practice Based Commissioning

GPs believe that they have the capacity to lead commissioning.

When the Consortia is up and running this may be an advantage as the services can be tailor made for our Practice population.

Design care pathways.

Choice of which GP Practice to choose

This can lead a GP Practice to levels of insecurity as competition is introduced.

This can increase the doctors workload by having to travel longer distances to do home visits.

Economics

The health of the economy, spending patterns and the availability of funds

Recession

GP Practices have to provide more services at lower cost, this puts financial burden on GP Practices. It is more important now to have business plans in place.

GPs to get financial control

GPs are not businessmen, their primary role is to provide the best clinical care for their patients. Has the potential to lead to chaos.

Identify training Needs

The Practice Manager must be financially literate. Increase in training costs.

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Income Earned in GP Practice needs to be activity based

The NHS was not designed as an efficient model in respect of the level of activity in a GP Practice ie how many times a patient is seen and the financial benefit derived from that.

Procurement issue

PFI disaster which is a very expensive way to fund building projects in a Primary Care setting as payments can hit the roof.

Decrease Spending

Already told to decrease spending by 15-20%. Must be judicious.

Access

Patient access of secondary and tertiary care.

Emergency will be closely monitored.

More services will be made available in Primary Care settings

More will be done in the community which will be cheaper.

Local clinics such as

podiatry

physiotherapy

Diabetic specialist nurse led clinic

Leg ulcer clinics

Customer

How are customer needs, wants or expectations changing?

PRG

This group, if given time and respect by the Practice, can be a powerful resource for the Practice in the improvement of patient care.

Patients expectation

As patients become more demanding this can put a strain on the Practice. People are less keen to do

Farhana Imran 64


things at home or self-care. They land up in A&E or GP surgery.

If the people attending A&E are analysed, many did not need to be there.

Lifestyle choices

A sedentary lifestyle leading to obesity and diabetes can increase the demands on GP Practices.

Access

Access has increased but this has led to patients becoming more dependant on their doctors.

Patients have choice who they register with

The Constitution's inclusion of rights for members of the public to choose their GP practice and a specific doctor within that practice will be welcome news for patients. However, it will have repercussions for PCTs and doctors' practices, and the appropriate funding and staff levels will need to be in place to ensure that this can be made to work.

Patients as consumers are assuming a more active role in their medical care decision-making, which has been prompted by better access to medical information. Patient use of medical information may affect physician practice incentives to provide care, which critically depends on the agency relationship between physician and patient. If patient use of medical information improves communication and understanding, physicians may need to spend less time explaining what treatments are needed and convincing patients about the appropriateness of their recommendations, increasing incentives to provide care. If patients use information to demand treatments and procedures that are at odds with what the physician would recommend, this might lead to a contentious relationship, making it more difficult to agree upon any course of treatment.

Technology New telephone system to be installed

This will allow more patients to get through to the Practice in busy times as more lines will be available.

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What will changing technology do for your team or service? What will you be able to do that you cannot do now? What will be cheaper or faster?

Using skype for patient consultation

This will help patients who find it hard to get to the Practice due to ill health, mothers with young children, the very old. Face to face consultation without patient coming to the surgery. At the moment they come, but once the web has been developed and is secure – patients accept that form of treatment from the comfort of their home. This will save time, money and is convenient for both patients and doctors.

Remote Access

Consideration should be given to remote access to non front line staff so they can work from home.

The level of engagement between technology suppliers and the NHS

The commissioning process within the NHS is seen as fragmented and complex, and varies between commissioning groups. Every commissioning group has a different set of requirements against which it assesses new business cases for technologies.

Awareness of technology and understanding of the benefits that it can bring

Consumer demand is an important driver for the adoption of technology as consumers become more empowered and more demanding about the kinds of treatment they want.

Concerns about confidentiality and usability How safe are the data held on computers?

Government policy

Policy can have an impact on the adoption of technology either directly, by setting guidance or targets, or indirectly, by setting objectives that could be met via technology.

Regulation Government White Paper

Legal implications around changes to GP contracts for

Farhana Imran 66


How will forthcoming laws or regulations affect us?

working Practices.

Revalidation of GPs

The General Medical Council will be changing the way doctors within the UK are regulated to Practice medicine. Revalidation is the process by which licenced doctors will demonstrate to the GMC that they remain up to date and fit to Practice.

Privacy and confidentiality need to be secured.

Primary care Services will be asked to produce Quality Accounts for 2011/2012 as set out in the Health Act 2009

Practices will have to review the quality of service they provide and they need to express this in terms of the three domains of quality:

Patient safety

Clinical effectiveness

Patient experience

This will mean more work for the Practice.

Environment

How must we adapt to changes in our environment? What might affect us?

Reduce waste, increase recycling

Practice need to work towards becoming paperless. This can be achieved by using computer technology more ie emails, fax, hardware and software storage devices.

Consider remote access for non front line staff.

Extreme weather conditions

Flood or rain

Increasing pollution

More allergies

Aging population

Have systems in place, local governments will have to be efficient and plan from before.

Farhana Imran 67


Seasonal affective disorder (SAD)

Depression with fatigue, lethargy, oversleeping, overeating and carbohydrate craving recurring cyclically during specific seasons, mostly in winter months. This could result in a reduction in morale and motivation of staff.

Appendix 11 - GMS Practice Summary Statement for Apr 2011 – Mar 2012

F82019

Date Global Sum Aspiration

Seniority

Superannuation

Prescribing

Immunisation

Contract Adjustment

Total confirmed checked to

Bank Statement

23/03/12 33,235.68 7,788.22

2,639.57

(9,804.07)

2,629.80 2yr

859.98 5yr

2,899.67

made up of:

3,375.00 EH

99.32 Flu

-463.43 lev

-111.22 levy

40,248.85

21/03/12 1,212,33 1,212.33

29/02/12 33,235.68 7,788.22

(6,862.50)

10,825.00

made up of:

10,825.00 EH

44,986.40

21/02/12 1,387.62 1,387.62

31/01/12 33,235.68 7,788.22

(6,862.50)

9,759.80

made up of:

5,400.00 EH

389.64 Flu sep

909.16 Flu nov

1,530.50 GSF

1,530.50 2 HFC

43,921.20

23/01/12 3,403.71 3,403.71

23/12/11 10,273.78 10,273.78

22/12/11 33,297.51 7,788.22 2,878.59 2yr -572.79 39,981.96

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2,616.50

(6,862.50)

836.43 5yr

30/11/11 33,297.51 7,788.22

(6,862.50)

15,880.43

made up of:

157.52 IUCD

6,393.00 M/Sur

2,025.00 EH

7,173.96 Flu

130.95 Zoladex

50,103.66

22/11/11 1,210.22 1,210.22

31/10/11 33,297.51 7,788.22

(6,862.50)

9,627.16

made up of:

5,295.60 FO

0.03 FO

2,269.56 FO

908.79 FO

1,153.18 FO

43,850.39

21/10/11 981.74 981.74

30/09/11 33,633.23 7,788.22

2,585.28

(6,862.50)

3,034.95 2yr

779.40 5yr

-14,486.57

made up of

-463.50 Levy

-111.24 Levy

-2,618.46 FO

-2,705.26 FO

5,752.51 AI

-999.37 AI

-977.62 AI

-1,122.18 FO

-1,449.26 FO

2,465.38 AI

32.54 AI

-1,284.78 AI

-1,739.13 FO

-0.04 AI AVC

-4,363.08 AI AV

-4,903.08 AI AV

26,472.01

Farhana Imran 69


31/08/11 33,633.23 7,788.22

(6,862.50)

2,517.00

made up of:

42.00 IUD

2,475.00 EH Jul

37,075.95

18/08/11 1,414.33 1,414.33

31/07/11 33,633.23 7,788.22

(6,862.50)

-35,311.22

made up of:

2,475.00 EH

-37,886.50 QOF

-15.60 Levy

115.88 PBC

35,997.41

19/07/11 1,165.36 1,165.36

30/06/11 34,226.19 6,086.97

2,526.7

(6,862.50)

43,525.18

made up of:

2,787.12 IMM

2,475.00 EH

941.19 BT

37,886.50 QOF

(452.33) Levy

(112.30) Levy

79,502.59

20/06/11 1,624.34 1,624.34

31/05/11

(6,862.50)

38,218.98

17/05/11 1,477.88 1,477.88

28/04/11 34,226.19 6,086.97

(6,862.50)

2,700.00

made up of:

2,700.00 EH

36,150.66

18/04/11 1,296.75 1,296.75

TOTAL 261378

Farhana Imran 70


Appendix 12 - Outline Project Plan

Project goals

Who is your Project Sponsor? (give name and job title)

Drs Hamilton-Smith, Oladimeji & Imran

Who are your stakeholders (clients/users, staff, suppliers, financiers, those in authority; are there others?) and what do they say they expect from the project?

Partners want increased efficiency and productivity

Staff want clear roles and responsibilities

Patients want the best health care

ONEL want correct submissions with back up papers if required

Given the above, what will the project achieve – what are the benefits to the stakeholders and to the organisation?

Partners will have a clearer picture of how the

practice is progressing, they will be able to plan

better which will improve their morale, increase

motivation level, make the practice a good place to

work, improve quality control and reduce errors,

wastage, inefficiency and their associated costs

Staff will be in a position to ask for bonus, improved

morale, higher motivation level, good place to work,

increased job involvement and job satisfaction with

reduced absenteeism, grievances and staff turnover

Patients will receive better care which will increase patient satisfaction and there will be greater involvement of patients through PPG activities

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ONEL can request to see paperwork which is complete and error free

Accountants will not need to send out chasers for documents as all paperwork will be complete and ready in advance

Consultants in hospitals will receive clear, concise records of patients when there are referrals which will improve waiting times

When do your stakeholders want the project to be finished by?

31st April 2013

SMART Project deliverables

What exactly must the project deliver to meet its goals? (i.e. what does “success” look like?). Be specific! List them in priority order if possible.

1. All income steams identified

2. All expenditure stream identified

3. All missing data found

4. All processes in place

5. All areas given to members of staff to take responsibility for completing by a set time each month

6. Each area to be checked by another staff member

7. Everything filed in the correct place so easy to find if needed

Farhana Imran 72


Project schedule

List the things that need to happen. Add as many rows as you need. You do not need to list every single activity at the most detailed level - focus on identifiable outcomes and key activities.

Project Schedule:

Task

Who will

do it?When by?

Who must they work

with?What else will

they need?

A&E Audit LR 30.09.12 and every quarter thereafter

Drs Record of all A&E attendees from April 2012 to March 2013

Alcohol related DES LR 28.04.13 Drs, nurses

NHS directive on this DES

EMIS LV for number of patients this affects

Chalmydia Process SO 5th of every month

Dawn Howlett from ONEL

EMIS LV for list of patients the kit has issued to

Procedure

Invoice template

Extended Hours Process LR 5th of next month

Mark Lockwood from ONEL

EMIS LV printouts on extended hours

EH template

Chase freed up resource of £48,000 until money received by the practice

Drs 5th of every month

Jan Black, Bob Barr from ONEL

Proposal document agreed in principal by ONEL

GPRs RB Daily Drs Forms completed by

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Project Schedule:

Task

Who will

do it?When by?

Who must they work

with?What else will

they need?

Insurance companies

Solicitors

DWP

Taxi companies

doctors

EMIS LV records of patients

Stamps

Envelopes

Health Check Process MB 30th June 2012 and every quarter thereafter

Drs

Dawn Howlett at ONEL

NHS directive on this LES

Learning Disabilities DES DM 28.04.13 Dr FO

Local Authority


EMIS LV set up a health check LD register

Locum Cover analysis to recover funds of £12,744.00

FI 30.11.12 Brigit Mallee at ONEL

BCS Locum agency

All paperwork relating to the locum period

Osteoporosis DES FI 31/07/12 Dr Imran

Lorna Hutchinson at ONEL


EMIS LV to get the number of patients with this condition

Palliative Care Audit RB 30.09.12 and every quarter

Dr FO

District nurses

EMIS LV List of all patients on this register

Farhana Imran 74


Project Schedule:

Task

Who will

do it?When by?

Who must they work

with?What else will

they need?

thereafter St Francis Hospice

PP DES FI 31.03.13 Patients of the practice

PPG

Webteam

2 sets of questionaires

Set up meetings

Petty Cash analysis AC 5th of every month

Reception staff

Completed sheets with details of payments

Prescribing Audit DM 30.09.12 and every month thereafter

Dr Imran

Vicky Kong from ONEL

List of high cost drugs

Minutes of meetings

Referral Audit RB 30.09.12 and every month thereafter

Dr James EMIS LV list of all patients who were referred

Staff – roles, sickness issues, training needs

LR 31.07.12 Drs

Nurses

Staff

Peninsula

Job description for each staff

Record of time taken off due to sickness

Return to work template

Previous appraisals for training needs

Travel Clinic SO 31.07.12 VM Attempt to

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Project Schedule:

Task

Who will

do it?When by?

Who must they work

with?What else will

they need?

Drs

analyse last 3 months of travel clinic

Set up a procedure

Website development FI Every week

PPG

Drs

Webteam

Other practices

Read literature from PULSE, NHS, GP magazines on current themes which practices are employing

Resources Required

Person What do you expect from them? What do they expect from you?

All support staff Accurate timely work

Updated procedures and processes

Partners Guidance

Regular updates

ONEL Updates on NHS changes which impact primary care

Item Where will you get it? What cost?

DESs literature ONEL to provide, contractual obligation

Audits Office computer

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Item Where will you get it? What cost?

GPRs Request by insurance companies

Communications Plan

Who needs to know? What do they need to know?

How will they be told?

Partners Is the work being done

Meetings

Progress report

Nurses How many health checks to do

How to analyse the travel clinic

Meetings

Procedures

Administration Staff What work to do

How to do the work

When to complete the work

Meetings

Procedures

On the job training

PPG Provide ideas to improve patient experience

Meetings

Website

ONEL Finance If there is missing data, there will be a need to request

duplicate

E mail

Accountant This is a financial project so he may have a lot of the information needed.

Also in future he can liaise with me when he prepares the Practice accounts as I will have the

Meetings/Letters

Farhana Imran 77


information he needs

Risk management plan

What might go wrong? How might this be prevented?

If it does happen, what should you do?

Staff not keen to take on an external business manager

Doctors are united Train information officer for this role

Doctors do not see a good financial gain by doing some of the DESs

Reinforcing the practice vision of duty of care to the patients

Reinforce the qualitative benefit to the practice

Staff resent loss of overtime

Introduce bonus Introduce an overtime form which must be signed by the doctors to authorise overtime

Audits may highlight clinical weaknesses

Taking time and care during and after consultation. Good note keeping.

Introduce good record keeping gulidlines from NICE

Staff not keen on ‘to do list’

Highlight its importance

Disciplinary procedures

Practice website neglected

Highlight its value to the practice

Regular meetings to reinforce its importance

Appendix 13 Gantt Chart

Farhana Imran 78


Activities with completion dates

Activity Task Name Completion Date

Completion Date

Completion Date

A A&E Audit 30.09.12 31.12.12 31.03.13

B Alcohol Related DES

28.04.13

C Chalmydia Process

05.07.12 05.08.12 05.MM.YY

D Extended Hours

05.07.12 05.08.12 05.MM.YY

E Chase £48,000 freed up resource

06.07.12 06.08.12 06.MM.YY

F Health Checks 30.06.12 30.09.12 30.12.12

G Learning Disabilities DES

28.04.13

H Osteoporosis DES

31.07.12

I Palliative Care Audit

30.09.12 31.12.12 31.03.13

J PP DES 31.03.13

K Petty cash analysis

05.07.12 05.08.12 05.MM.YY

L Prescribing Audit

30.09.12 31.12.12 31.03.13

M Referral Audit 30.09.12 31.12.12 31.03.13

N Staff roles etc 31.07.12

O Travel Clinic 31.07.12

Gantt Chart over 9 month period

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Jul12 Aug12 Sep12 Oct12 Nov12 Dec12 Jan13 Feb13 Mar 13

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

Bibliography

Guidance and audit requirements for the alcohol-related risk reduction

scheme at http://web.nhs.net/WebReadyViewBody (accessed 23rd April

2012)

Farhana Imran 80


Guidance and audit requirements for learning disabilities health check

Scheme at http://web.nhs.net/WebReadyViewBody (accessed 23rd April

2012)

Guidance and audit requirements for the osteoporosis diagnosis and

prevention scheme at http://web.nhs.net/WebReadyViewBody (accessed

23rd April 2012)

Impact of the health White Paper

www.kingsfund.org.uk

Cherith Simmons Learning & Development (2011)

Project Management Workbook


Leadership, supervision & team building information pack


Motivation information pack

Farhana Imran 81

http://www.kingsfund.org.uk/

Business Plan

Documents

Transcript of Business Plan