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Transcript of Practice Business November 2012
PracticeINSPIRING BUSINESS SOLUTIONS FOR PRACTICE MANAGERS NOVEMBER 2012
DON’T SELL YOURSELF SHORTPromoting your services to the CCG
COMPETITION CLAUSEHow to stand a chance against corporate primary providers
The road to long-term health
Practice Business is an approved partner with...
LTCS | PRACTICE PR | CO
MPETITIO
NPracticeBusiness
novemb
er 2012
Are you doing enough to tackle chronic conditions?
editor’s letterEXECUTIVE EDITORroy lilley
ASSISTANT EDITOR [email protected]
CLINICAL EDITORdr paul lamden
ACCOUNT [email protected]
PRODUCTION/[email protected]
CIRCULATION [email protected]
CONTACT USIntelligent Media SolutionsSuite 223, Business Design Centre52 Upper Street, London, N1 0QH
t: 020 7288 6833 f: 020 7288 6834 [email protected] www.practicebusiness.co.uk www.intelligentmedia.co.uk twitter.com/practice_biz
EDITOR
Public relations in practice
Welcome to the newly designed Practice Business. Our designer, Sarah Chivers, has set to work on making the monthly title even easier on the eyes. We’ve rebranded our logo and updated the look and feel to
all our sections to make your reading experience that much more pleasant. In our ‘Primary Provider’ section this month, we have taken the ‘Any
Qualified Provider’ mantra and worked to make sure we support NHS-contracted GP practices compete for the commissioners’ attention when it comes to additional services and add-ons. We look at what practices are doing to help long-term conditions, a chronic and painful drain on NHS resources. Then on p17 we look at what you can do to promote your practice to commissioners and the community, while on p20 we look at what competition will look like from the big multi-national primary providers.
We know that ‘promote’ is often seen as a bad word in primary care, but practices are promoting themselves in more ways than many people realise. Just the other day I got a leaflet in my letterbox from a nearby practice – I say ‘nearby’, it’s still a good half-hour walk away – encouraging me to leave my current practice and switch to them. They explained how they would help you do the legwork and quoted some very happy patients, while listing their unique selling points. While it was a tempting offer, I’ve had a more-or-less good experience with my GP practice and the idea of sweating to reach the other practice before it closes to pick up a repeat prescription does not really appeal. However, I was impressed by their effort.
In the past there has been talk of ‘gentleman’s agreements’ between practices, coming to the mutual decision not to poach each other’s patients, while other GP surgeries make not poaching patients a priority promoted on their website. However, with the changing NHS, and increased competition, the future may look very different.
sector
primary provider
people
management
work/life
06 Practice news Top news for practice managers this month
08 Executive editor comment The latest from controversial columnist Roy Lilley
10 Provider news A practice manager’s update on providing for a commissioning landscape
13 LTCsBetter in the long-term Are you doing enough to tackle chronic conditions?
17 MarketingSell yourself Promoting your services to the CCG
20 Contracts Competition clause Do you stand a chance against corporate providers?
24 Case studyMilitary precision A Colchester practice gets even bigger in its britches
28 Case studyChanging the system One of the first Scottish practices to introduce the Patient Access system
32 Premises A buyer’s market? The pros and cons of renting or buying your surgery’s premises
37 PatientsHandling complaints What do you do about it?
40 ClinicalQOF This month: hypertension
42 LegalIs your ‘green sock’ clause in place? Partnerships are sometimes closer than marriage. Cover everything
44 CPDBecoming partner Is it still such a good idea in this changing climate?
48 HR Face the facts When to get off the phone and email and explain things in person
50 Diary Grant Burford, IT manager of Imperial College Health Centre, on being ‘paper-light’
contents
32
37
48
sect
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practice news
06 november 2012your
mo
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agem
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More work, less pay for practice managers
Basic pay for practice managers has dropped since last year, despite bigger work
loads. The average income is now £38,758 compared to £39,059 in 2011.
There are also substantial differences based on location and practice size. Greater
London remains the top-paying region of the UK, with average total earnings of
£42,263. However, this demonstrates a decline of three per cent since last year.
Scotland and Northern Ireland have traditionally been the lowest paying regions,
however this year it’s Wales, with an average PM salary of £33,906.
For smaller practices (less than 5,000 patients) the average manager’s income is
now £31,589, a two per cent reduction on last year, and for the very largest practices
(more than 14,000 patients) the average is £47,491, a 1.5% increase over 2011.
Bonuses have been in a steady decline for the last few years, however, more
practice managers have partner status – increasing from three to 3.75 per cent in two
years. Partner PMs are more prevalent in medium to larger-sized practices. The average
practice list size for managers with partner status is 12,865 compared to an average
patient list of 8,685 of all respondents. The total average earnings by those managers
with partner status is £55,510 – over 40% higher than for non-partner responders.
For the largest practices, the average manager/partner income is circa £60,000 and
remains unchanged from the previous year.
Steve Morris, of First Practice Management, which surveyed 1,300 PMs, said: “At
a time when activity levels in practices are
stepping up as commissioning gathers
pace, and CQC requirements impose
greater demands on managers and staff,
there is a view that both practice and
personal rewards are inadequate.”
Mark Dowden, sales and marketing
director at Towergate MIA, which also ran
the survey, says PMs are essential for the
“successful running of a practice”, and it is
important they are rewarded accordingly.
Practices must treat ‘health tourists’ or risk discrimination charges
GP practices must register foreign-born patients or
risk breaking human rights, new rules from NHS
London stipulate.
Foreign-born patients include anyone from
overseas students to tourists on holiday as “there
is no set length of time that a patient must reside in
the UK in order to become eligible to receive NHS
primary care services” and they are entitled to the
same NHS primary care as British citizens.
NHS London says “nationality is not relevant”
to whether or not you can be treated in primary
care and practices should not insist on seeing
passports as it could be “discriminatory”. Critics
worry it is not the best use of taxpayer’s money.
STATS
FACTS&
The amount of staff hours per year it is claimed practices could save using online booking
5,218
(Source: Patient Partner)
6-7 NovemberEHI Live NEC Birmingham EHI.co.uk
28 NovemberManaging change: Transforming the public sectorThe Barbican, London PublicServiceEvents.co.uk
dia
ry
fast facts
n 0.87% - the amount basic pay has dropped for practice managers over the last year
n £38,758 – average practice manager’s income
n Greater London is the UK’s top-paying region
n Wales is the lowest paying region.
sector
practice news
november 2012 07
Report raises 111 concernsA report on the progress of NHS 111 has highlighted concerns,
including its impact on out-of-hours GP services.
The report by the NHS Alliance, entitled ‘Getting to grips with
integrated 24/7 emergency and urgent care’, raises concerns about
the impact of working towards an integrated emergency and urgent
care system while at the same time introducing NHS 111. It poses
a number of key questions for commissioning groups, including
how well engaged GPs are in urgent care and development of a
local urgent care strategy; Are they ready to innovate, especially
around access? and How well engaged is the CCG in the local
implementation of NHS 111?
The report warns that the non-
emergency number could cause a steep
rise in demand in general practice and
also have a negative impact on out-of-
hours GP services.
Despite these concerns, the
Department of Health argues that
the overall programme for national
implementation is on course and a
survey of 1,700 users carried out by
the University of Sheffield NHS 111
evaluation team has showed high levels
of satisfaction with the service, according
to the report.
wha
t w
e le
arne
d Practice managers have been illegally selling NHS access. GP practice managers and
‘fixers’ have been filmed illegally selling access to GP
appointments to foreign nationals who would otherwise
not be entitled to free hospital treatment. One practice
manager was secretly filmed for BBC Panorama selling
patient registrations at a health centre to an undercover
reporter for up to £800 a time. The reporter went on to
have an MRI scan, which should have cost her £800 via
private healthcare.
Lone GPs left to cover 500,000 patients out of surgery hoursNHS chiefs are routinely assigning just one family doctor to districts
that stretch over hundreds of square miles, in an effort to cut costs as a
third of PCTs slash night and weekend spending over the past year.
The standard of out-of-hours care had been under scrutiny since
2004, when a new contract enabled GPs to opt out of evening and
weekend duties. Now only one in four works out of hours.
Many trusts have since outsourced the cover to private firms that
hire locum doctors to fill the shifts.
Using the Freedom of Information Act, the Daily Mail asked every
PCT in England a series of questions about out-of-hours cover. Of
the 90 that responded, 35 had cut their out-of-hours budgets by an
average of 10% since last year. And 11 trusts employed only one
doctor at night to cover between 180,000 and 535,000 patients.
A spokesman from Serco, the private firm which runs out-of-hours
cover in Cornwall, where GPs were covering the most patients, told the
Mail the company now ensured there were at least two GPs on call.
Almost two-thirds of patients surveyed by the Department of Health
in June found the time it took to get care from their GP service outside
working hours was “about right”. Two-thirds also described their
experience of out-of-hours GP services as “good”.
clin
ical
new
s
Typhoid vaccines recalledMore than 700,000 people immunised against typhoid
recently may not have full protection after a dud vaccine
has been recalled by its manufacturer. Sanofi Pasteur MSD
has called back 16 batches of its Typhim Vi vaccine after
test batches were found not to be strong enough. This
could affect anyone immunised since January last year.
While the faulty vaccine is said to be safe and pose no
threat, the Medicines and Healthcare products Regulatory
Agency (MHRA) worries it could be too weak and
as many as 729,606 people who had the jab may
not be fully immunised against typhoid. The
MHRA is urging people who may be affected
to contact their GP if they feel unwell after
going on holiday. While a working vaccine
is still available, the Department of Health
says it is working with manufacturers to
ensure any supply problems are resolved
as soon as possible. “Anyone who has
been to a typhoid region of the world
and has a fever, abdominal pain and
vomiting should contact a healthcare
professional,” said MHRA’s head
of Defective Medicines Report
Centre, Ian Holloway.
“We must ensure that any fee we charge is fair and proportionate. We have set out six principles to guide how we will charge fees, while we move towards the Government’s policy of full cost recovery from providers. In this consultation we are asking for views about our longer term fees strategy as well as seeking feedback on our proposals for revisions to our current fees scheme and extending it to primary medical services. The changes set out in this consultation demonstrate that we have listened to and acted on the views of service providers.”
David Behan, CQC’s chief executive, on the announcement of a consultation on fees
THEY
SAID
comment
08 november 2012
sect
or
Handing over the controls I saw a graph. It was in one of the health trade
magazines. It was attached to an article about
how the ‘liberation of the NHS’ was turning out.
Frankly, I was astonished.
The whole purpose of the upheaval, the palaver
and upset was to take commissioning out of the
hands of the ‘managers’ and put docs in the driving
seat – GPs to be precise. Over time that intent has
been eroded. The name gives it away. Originally
the commissioning collectives were called ‘GP
commissioning groups’. The hospital consultants
and the nurses didn’t like the idea of that, so the
groups were renamed ‘clinical commissioning
groups’ and their membership widened to include
consultants, nurses and GPs.
Next to go was the idea that commissioning
groups could be formed in sizes and configurations
that suited the locals – three or four practices
getting together in a sort of huddle, based on
a wine society or a lodge night. Indeed, the
legislation would still permit two practices to form
a CCG. The problem with that is they have to be
authorised by the NHS Commissioning Board.
The board has made it clear any group
covering a population of less than about 200,000
won’t see daylight. Over 300 embryonic CCGs
have been bashed and crashed into just over
200. My prediction is they will be made to merge
and reconfigure into even bigger groups. Expect
anything between 300,000 and 500,000.
GPs were expected to be able to commission
all the care for their populations. That wasn’t going
to happen either. Over 80 specialties have been
taken off the CCGs list of things to do and dropped
into the commissioning board’s in-tray.
GPs took it for granted they could involve the
private sector as and when they pleased. You
can forget that, too. There are getting on for 75
services that will have to be market-tested under
the requirements of the Any Qualified Provider
provisions.
So, although I was taken aback at the graph,
on reflection, I’m not so surprised. It spelled out
There are more briefcases than stethoscopes running the commissioning agenda, ROY LILLEY finds. He asks: How badly do GPs even want it?
The graph showed three times as many briefcases as stethoscopes and clipboards combined
the fact that GPs are walking away from all this,
big-time. The graph used pictures. Stethoscopes
for GPs, briefcases for managers and a clip board
for ‘others’.
The graph was all about accountable officers.
AOs are important people. They are the people
who are held to account by the Commissioning
Board and (in extremis) the courts. They are
important; they are effectively ‘the boss’.
The expectation was that these roles would
be filled by GPs. Not so. The graph showed three
times as many briefcases as stethoscopes and clip
boards combined.
It seems to me the docs don’t really want to be
in the driving seat, even if they could drive.
ROY LILLEY Roy Lilley is executive editor of Practice Business. He is an independent health and policy analyst, writer and broadcaster and commentator on health and social issues.
prim
ary
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vid
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10 november 2012
PCTs expand Any Qualified Provider Trusts should have been ready to expand the Any
Qualified Provider policy to 39 service areas last
month, the Department of Health has said.
The rollout of AQP started last April after the
DH identified eight community and mental health
services that could be provided under the policy.
AQP providers need to be approved by a
PCT to go onto a list of providers from which
patients are given a choice.
PCTs are due to have
the contracts for the 39
service areas finalised
by the end of October. They will then be able to advertise these contracts on the
Supply2Health website, allowing providers from the private and voluntary sectors, as
well as the NHS, to apply for approval.
The only circumstances in which commissioners can reject providers is if they
reject the price offered, refuse to agree to local standards or to comply with pathways
and referral thresholds, or if they fail quality standards.
A DH spokesman told GP Online: “The choice of service made available for AQP
is by no means ‘top down’. For 2012/13, PCT clusters were asked to offer patients
a choice of AQP in at least three services which were identified as local priorities
through local engagement.
“Of the 39 services listed, only eight were identified as national priorities. These
were proposed after substantial engagement with national patient groups, and had
their strong support.”
NHS in distress, says RCGP Dr Clare Gerada, chair of the Royal
College of General Practitioners, has
spoken out about the “turmoil” caused
by reforms to the NHS and the pressure
services are under to improve efficiencies
while maintaining quality of care.
Speaking at the RCGP’s annual
conference in Glasgow, Gerada said:
“In England, we were in the midst of the
Health and Social Care Bill – and, despite
assurances to the contrary, the NHS is
experiencing the mother of all top-down
reorganisations. In fact, the most radical
in its 60-year history.”
Gerada said that the whole of the
UK’s health services (despite the Health
Act only applying to England) are under a
great deal of pressure to perform.
She described the bill as “longer
than a Tolstoy novel” and as having been
“rushed through at breakneck speed”. “As
a result, our NHS is in distress,” she said
£1.5m allocated for personal budgetsAs much as £1.5m has been identified to
support the potential roll-out of personal
health budgets, according to care and
support minister, Norman Lamb.
A personal health budget pilot
programme is taking place across 60 PCTs,
an evaluation of which is due before the end
of hte year. In order to be ready as soon
as the findings are known, the Department
of Health has identified £1.5m to be made
available to support the first stage of a
potential roll-out.
Lamb said: “We want to ensure more
care is tailored around people’s individual
needs and preferences. Giving those with
complex health needs the control of how to
spend money on their care gives them and
their doctors the flexibility to try innovative
new approaches to achieve better health
outcomes.
“Subject to the results of the current pilot
programme, our aim is to introduce a right
to a personal health budget for people who
would benefit from them most – the scale
and pace of this will be informed by the
independent evaluation.
“We want to be on the front foot as the
results become known – that is why we’ve
identified £1.5m to support the NHS in
the first stage of the roll out as it starts to
implement personal health budgets.”
This is not new money, but NHS money
put in the hands of patients to help them
decide what treatments work best for them.
People with complex care needs and those
with a range of long-term conditions, such
as stroke, diabetes, neurological conditions,
mental health needs and respiratory
problems like chronic obstructive pulmonary
disease (COPD), have been involved in the
pilots so far.
news
Diabetes cases to rise by 700KThe number of people being diagnosed with diabetes is expected to
rise by 700,000, warns Diabetes UK
The research, based on data collected from the Yorkshire and
Humber Public Health Observatory, has revealed that 4.4 million
people in England, Scotland and Wales are predicteded to have the
disease by 2020.
The majority of these extra cases of diabetes would be Type 2,
which is preventable by leading a healthy lifestyle. The charity says
that Type 1 diabetes also appears to be on the rise, however it is
unclear why this is.
Barbara Young, chief executive of Diabetes UK, said: “The
healthcare system is already at breaking point in terms of its ability to
provide care for people with diabetes. The result is that many people
are developing health complications that could have been avoided,
and are dying early as a result.
“Because of this, I have grave fears about the potential impact
of an extra 700,000 people with diabetes, which is almost the
combined population of Liverpool and Newcastle. We face the very
real prospect of the rise in the number of people with the condition
combining with NHS budget pressures to create a perfect storm that
threatens to bankrupt the NHS.”
prim
ary pro
vider
managing LTCs
november 2012 13
Better in the long-term
Around 15 million adults in England
suffer from at least one long-term
condition (LTC) – an incurable
condition that can be managed with
medication and/or therapy. That’s almost
one in three adults. Needless to say, LTCs
cost taxpayers a great deal of money and
so have been at the forefront of many of the
recent changes happening in the NHS. The
Government set up a consultation earlier this
year looking into how long-term conditions
are currently dealt with. It asked people
to share their thoughts on what problems
they face, either living with an LTC, or in
their work affecting people with LTCs, and
how they thought these problems could be
better tackled. It requested that respondents
consider how local services can work
together to make life better for people with
long-term conditions; how people with long-
term conditions can be experts in their own
care and how services can be based on their
individual needs.
Integration, integration, integrationAt the Tackling Long-term Conditions
conference in May, experts discussed what
the future of LTC management in the NHS
could look like. David Behan, director general
of social care, local government and care
partnerships highlighted the lack of joined-up
care as the biggest frustration for patients
at present. He pointed out that for people
with long-term and multiple conditions, their
lives are about much more than health and
social care and that public transport, leisure
and employment are major factors that
Long-term conditions, by their nature, are a drain on NHS budgets and can only be managed effectively if tackled from every angle. CARRIE SERVICE asks if you are doing enough to make things better in the long-term
need more consideration – a more holistic
approach. He also placed an emphasis
on older people and their needs – after all,
they account for 29% of the population and
a massive 50% of all GP appointments. He
pointed out that, “a younger sporadic user
of health services has very different needs to
a frail, elderly person with multiple long-term
conditions and chronic care needs”. With
this in mind, working with local care homes
and community groups to negotiate transport
for regular users of specialised primary
care services within your practice area or
consortium is one way of ensuring that your
elderly patients with LTCs get the support
they need.
Although the buzz phrase ‘integrated
care’ is generally recognised to mean the
integration of care between the primary
and secondary sectors; distilling this
concept and applying it at practice-level
could have a significant impact on how
long-term conditions are dealt with within
your patient population. For example, if you
currently share your services with another
practice in the locality or another surgery
that comes under your practice group,
consider whether your own services are truly
joined-up. If a patient arrives at your surgery
and needs to see someone immediately
for a particular service and you can get
them an appointment at the practice that
provides it, how easy is it for that person
to actually get to that appointment? For
example, will they need a taxi to get them
there? An equally important question is:
When the patient arrives, will the person
managing LTCs
14 november 2012
prim
ary
pro
vid
er
techniques such as telehealth. But it’s
important that they also have support in
implementing telehealth and this is another
area where patient support groups could play
a major role. NHS Yorkshire and Humberside
used money from the Regional Innovation
Fund to develop a local telehealth hub,
offering telecoaching, remote telemonitoring
and teleconsultation to patients across the
region. In addition, a Health Innovation
and Education Cluster was commissioned
to deliver an awareness-raising capacity
and capability programme demonstrating
best practice on new
care models using
telehealth. It is estimated
that in Yorkshire and
the Humber there are
approximately 11,000
new patients per year
suffering from at least
one LTC, who could
benefit from the use
of telehealth at the
time of diagnosis on a
short-term basis, and
about 50,000 patients
who could benefit from it on a longer-term
basis. In particular, this refers to patients with
COPD, chronic heart failure and diabetes. If
telehealth is something that your practice is
implementing, consider whether or not your
patients could benefit from a support network
where they could share experiences and
have access to information and advice. After
all, long-term conditions are here to stay (the
clue’s in the name) so the sooner we get to
grips with managing them, the better.
A younger, sporadic user of health services has very different needs to a frail, elderly person with multiple long-term conditions and chronic care needs
carrying out the treatment have access to
the patient’s notes, i.e. are you using the
same clinical IT system across the practices
and if not, what processes do you have
in place to counteract this so that care
does not become fragmented? Behan also
emphasised in his presentation that “you can
only improve what you measure”, therefore
data analysis and patient feedback is vital to
the progression of a strategic and integrated
approach to LTC management at your
practice. Ramp up your PPG’s activity as
much as possible and always give patients
the chance to feedback, especially if you
are working with another practice where you
may not always witness how they manage
their services first hand.
Knowledge is powerComments published on the Government’s
LTC consultation page suggest that
education and support for patients is very
much at the forefront of people’s minds
when considering how LTC management can
be improved. One wrote: “Each individual
needs right of access to information about
her/his condition and the right to appoint
an agent to act as interpreter of such
information (with right of access to personal
data if such is specified by the individual).”
So educating patients is key – after all, how
can they help themselves if they don’t fully
understand their own health needs? Another
respondent highlighted the importance
of patient groups in achieving this goal:
“Early diagnosis and referral to appropriate
treatment and support can only be fully
achieved if health professionals are aware
of the value that patient groups can provide
in-between appointments. Signposting to
appropriate patient groups for the long-term
conditions initially diagnosed could prevent
a great deal of anxiety for the patient who is
experiencing a life-changing event.” They
added that cost-effective mechanisms could
be put in place if local services developed
good relationships with the voluntary sector
– making things better for everyone in the
long-run: “It could also prevent the patient’s
condition deteriorating to the extent that
they require expensive and invasive
secondary care.”
TelehealthIf patients feel that they have the right kind
of support around them through support
groups and the like, they will have a better
chance of making use of self-management
ANDY SLOANAndy Sloan is sales director
at dbg and is responsible
for increasing the value of
the dbg membership base
through the introduction
of new and innovative
products. With a passion
for marketing and sales, he
has a wealth of experience
working for membership
organisations, and is also
registered with the Institute
of Direct Marketing.
how dbg can help As of July 2012, NHS GP practices across England have been required to begin the process of CQC registration, with inspections expected to commence from April 2013.
With so many regulations for GP practices to consider, and so many different ‘boxes to tick’ it can be hard for practice managers to keep on top of absolutely everything. In many cases when CQC inspectors find a failing, the lack of compliance is normally as a result of lack of understanding on the part of the practice, and not on any grounds of wilful neglect.
This is why it’s so important that as a practice team you fully understand the regulations and how they specifically apply to your practice. Without careful planning and thought, it can be all too easy to miss something out, only to have CQC inspectors pick up on it on inspection day.
Ask yourself, for example: Do you have full records of staff induction training and additional refresher training on all pieces of equipment in your practice? Do you have a suitable infection control policy for your waiting areas? Do you have a full set of up-to-date practice policies and written procedures?
At dbg we can help you address all these questions and more besides, as we work together with you to bring your practice into full CQC compliance. We have over 20 years’ experience working alongside healthcare practices and are ideally placed to meet your practice’s compliance needs. As well as providing membership services to GP practices, we also work closely with dental practices as well. Because dentistry has been under CQC jurisdiction for over three years now, we have built up an incredible amount of experience that we can bring to GP practices, giving you the tools you need to pass your CQC inspection with flying colours.
At dbg, our members’ interests are at the heart of everything we do. Our friendly and experienced team work to provide an excellent level of service and support wherever and whenever you need it, and we will always go out of our way to accommodate your needs. In the world of CQC compliance, we offer a whole wealth of experience, drawn from years of helping practices meet their regulatory requirements. With dbg you can be sure your practice is in good hands.
Following on from your self-assessment, you may wish to work with us further via a full on-site practice assessment to ensure that your responses are accurate and evidence can be validated for a formal inspection. Our expert team can then help you with any areas highlighted and provide a full analysis of any areas where there are gaps in your compliance. The assessment is designed to demonstrate to your practice team, your patients and the regulatory bodies that you are proactively working towards maintaining your obligations and compliance with the ‘Essential Standards of Quality and Safety’, as well as highlighting any potential issues that you will need to manage.
At dbg, our members’ interests are at the heart of everything we do. Our friendly and experienced team work to provide an excellent level of service and support wherever and whenever you need it, and we will always go out of our way to accommodate your needs. In the world of CQC compliance, we offer a whole wealth of experience, drawn from many years of helping practices meet their regulatory requirements. With dbg you can be sure your practice is in good hands. Together, we can help make your practice perfect.
For more information, call dbg on 01606 861 950 or visit www.thedbg.co.uk
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prim
ary pro
vider
marketing
november 2012 17
Shout it from the rooftops
As private business increasingly encroaches on primary care’s remit, it’s time to start marketing your practice
effectively or fall by the wayside. GEORGE CAREY finds out how to get the message out there to your patients
With the likes of Virgin Care and
Serco winning the right to fulfil
massive NHS contracts and
the increased culture of competition in
the commissioning age, practices need
to become increasingly business-like to
survive. This may not have been what
Aneurin Bevan had in mind when the NHS
started, but it’s where we find ourselves.
The harsh reality is that patients are also
customers and quality treatment on its own
isn’t always enough to ensure that they keep
coming through the door. Marketing and PR
are no longer dirty words in primary care
and can make all the difference to patients’
perception of your practice.
Whilst it may seem like a huge culture
change, marketing your practice is based on
common sense; finding out what patients
want, promoting the service, and delivering
marketing
18 november 2012
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it. You may not have thought of it in these
terms before but your practice is a brand,
like any other. Once you have a brand,
keep it in mind for all of your marketing
initiatives. Marketing methods you may want
to consider include: direct mail campaigns,
brochures and leaflets, organising
community events, text reminders or
submitting articles to publications (hint).
Newsletters are a great way of keeping in
touch with your patients and informing
them of changes at the practice, such as
additional services, or new staff. Giving the
material a personal touch, will allow patients
to feel closer to staff and encourage good
relationships in the future.
Distinguishing yourselves from other
practices is crucial, in order to make you
a compelling choice for patients in this
more open environment. Whilst it may
sound elementary, understanding who your
patients are is key to this. Ask yourself, what
kinds of people live in the area and make up
your existing patient list. Are they families
with young children, OAPs or students?
Arming yourself with this knowledge can
allow you to tailor services that will stand
out and stick in people’s minds, fitting a
walk-in clinic or early opening times around
commuter schedules for instance, could be a
way to differentiate you from other practices,
and direct people to you.
Your website is your first point of contact
for the new generation of your community,
and it is very important to use this valuable
tool to communicate with existing and
potential patients. There may have been a
reticence among practices to focus on their
digital offering up until now, because it wasn’t
seen as an important part of their service
offering, but that’s no longer the case. Think
about how you would buy services and the
importance you attribute to the ease and
quality of the website. You automatically
relate that to the service on sale. GP practices
are no different.
Search engine optimisation (SEO) is a
very important part of getting recognised
on the internet and a competing practice
appearing above you on Google’s front
page, can make a difference of a significant
number of patients. Think about what key
search terms your particular demographic
might be using to find you and employ that
to make your site as visible as possible.
Usability is equally important, and a simple
but informative site that is easy to navigate
will be a huge plus point in the eyes of
patients, especially older people, which
The harsh reality is that patients are also customers
make up a large proportion of your patients,
who are not quite as comfortable with digital
discourse. With patients now expecting to
be able to access repeat prescription forms
and make appointments online it is essential
to invest in your digital communications
in order to stay relevant and competitive.
A section of the site dedicated to health
news is a great way to keep your patients
informed and show them that you are up
to date with all the latest issues affecting
healthcare. The time needed to write original
news is, of course, more than most practice
managers and GPs have, but headlines with
links to news agencies is sufficient to get the
message across.
In addition to your practices website,
social media allows you to engage with
patients on a slightly more personal level.
Here you have the opportunity to educate
people, and give them useful advice. There
are concerns about confidentiality and it’s
no replacement for a face-to-face visit but
can still be a useful tool. When it comes to
confidentiality, bear this in mind: If you
wouldn’t say it happily in the middle of the
street, don’t say it on social media. It’s very
simple really. It can be a great way to gain
feedback from patients on your services and
start new conversations about healthcare in
your area. Armed with a shift in perception
and a digital arsenal, it should be possible
to expose your practice to more and more
patients and ensure that your business stays
buoyant and successful.
20 november 2012
prim
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pro
vid
er provision
With private companies threatening to take a portion of primary care provision, how do existing smaller GP practices contracted to the NHS compete? CARRIE SERVICE speaks to public service expert CRAIG DEARDEN-PHILLIPS
The public sector has changed almost beyond recognition in
recent years with private sector companies now playing a
bigger part in service provision than ever before. The state
education sector for example, is now almost indistinguishable from
the independent sector, with academy schools sponsored by large
private companies, opening up all over the country. And it seems
that the health sector is heading steadily in the same direction, with
huge multinational corporations, like the recently censured Serco,
providing services within the NHS. The issue of private provision
in public health is one of great contention, with organisations like
the British Medical Association staunchly campaigning against it.
In fact, it has just been announced as I write this that the BMA is
considering leading a mass patient opt-out from privately-run health
services, which could entail patients being given a ‘patient pledge’
card, allowing them the power to request that they are only referred
to state-run services – in effect a boycott of the Any Qualified Provider
(AQP) scheme.
H E A LT H Y C O M P E T I T I O N
provision
22 november 2012
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What about the little guy?So what does private provision mean for GP
practices contracted with the NHS? Well, if
you are a small practice, you will be only too
aware of what this could mean, and why the
BMA is so adamant that private companies
should be kept well away. The family-run,
one-man-band GP practice is looking
increasingly vulnerable as multinationals step
in, opening sparkling new health centres
and offering every service under the sun.
But there is no denying that there is a lot that
can be learned from how private companies
use NHS funds, as Craig Dearden-Phillips,
public sector business expert and founder
of Stepping Out, an organisation that
encourages social enterprise in the public
sector, pointed out in an article for The Guardian, around the time of the Serco
scandal: “Evidence from the world’s most
successful health systems – such as Holland,
France and Germany – suggests that the
most potent way to mitigate the risk of the
NHS silting up under its own cost pressures
is to open up the whole healthcare market to
new entrants.” So how can small providers
ensure that they are part of this provision
revolution, as opposed to one of the victims
of it? When I ask Dearden-Phillips how his
vision of the future may affect primary care
in particular, he says: “The more enterprising
GP practices are saying: ‘Well, ok, we
provide primary care, what secondary care
can we provide?’” He gives the examples of
district nursing, physiotherapy and MSK as
some of the services that forward-thinking GP
practices should be looking to acquire. “The
kind of extra care at home that keeps people
out of hospital,” he says. But it’s not only
the services you choose to provide at your
practice, it’s how you choose to do so that
will determine whether or not you’ll survive.
If the most desirable contracts require
economies of scale, it might be a case of ‘if
you can’t beat ‘em, join ‘em’, he says:“For
example, if I was interested in providing
healthcare services within my patch as a GP,
might I be able to team up with the social
enterprise that might be looking for the
contract on this… I think for GPs, the scale
of the contracting market could well be a
challenge because they are locally focused.
Very little is being commissioned or procured
locally by clinical commissioning groups.”
The futureDearden-Phillips believes that the future of
small providers doesn’t have to be all doom
and gloom – but they will need to take a
different approach to provision if they are to
keep up with their corporate counterparts.
He maintains that although there will always
be a risk of private companies using their
“financial muscle” to push out the little guy,
the emergence of social enterprises in the
health sector could be its saving grace and
GP practices should look to getting more
involved in these. “The NHS’s problem
and challenge is you need a diversity of
providers,” he explains. “The challenge
is that the way they are doing it, they are
going to end up with private players having
a ‘big six’ energy company-type scenario
if they’re not careful, where you’ve got just
a small number of private companies that
block everyone else out of the market – and
the health consumer is faced with very little
choice in reality.” His point is that we are
right to have these fears – because nobody
wants the future he just described. But if we
can make the most of the knowledge and
expertise private companies inject into the
NHS, it could prove an invaluable resource
for primary and secondary care alike: “I
think we all know enough about the way
health services work to know that having
one single unitary that does everything
and is run by the state doesn’t produce
the kind of results we’re all after. What we
need, is a true diversity of provision and the
government playing the role of intelligent
market makers.”
I think we all know enough about the way health services work to know that having one single unitary that does everything and is run by the state doesn’t produce the kind of results we’re all after
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november 2012 25
Planning to expand With expansion in mind, the staff at Creffield
Medical Centre went to work finding and
acquiring a suitable site while developing
a design that would reflect the practice’s
traditional ethos. The reason it took so long
is that most of the time was spent appealing
to the PCT to get permission, since they
paid cost rent. The practice went to a PFI
and interviewed three different companies,
eventually selecting GPG to buy the building
and oversee what would be a £2.5m capital
investment.
The end result is a new medical facility,
which opened in 2011 after four years in the
works. It is hoped this new surgery will serve
the community for years to come. Complex
design features let the building maintain its
listed façade, while providing the capacity
for the practice to develop further services,
like minor surgery. It sets a brilliant example
of primary care provision, warranting a visit
from the Duke of Kent earlier this autumn.
The history and tradition that exists
within the rafters of the Grade II listed
building can now be put to use once again
as something the local community can feel
proud of. Indeed, when I speak to patients
in the waiting room, they are very happy
with their new surgery. Not least the open
reception desk, which, as opposed to the last
practice’s glass-enclosed desk, allows them to
feel a closer bond with the practice staff from
their first point of contact.
The new practice is set over two floors.
This allows for more than one waiting area
to triage the patients. The site also houses a
pharmacy, providing even more services for
patients, while a number of the building’s
original features have been kept intact,
including the original roof trusses, window
openings and external fabric of the building.
The open roof structure provides the
practice with natural light and an automatic
ventilation system that opens when it gets
too warm, while under-floor heating keeps
the space comfortable in the winter. From an
environmental perspective, the new building
received a BREEAM rating of “very good”,
thanks, in part, to a carbon reduction of
nearly 20%.
Inside the building, the practice
operates from 15 GP consulting rooms,
which include training facilities for three
GPs, three nurse consulting rooms and two
dedicated treatment rooms with utilities. In
Colchester is known throughout the
world, thanks in part to Blackadder,
as a garrison town. So it is no
surprise its Garrison Neighbourhood,
converted from old barracks outside the
centre, has become the latest hot real estate
development. Where once the rows of brown
brick played home to cavalry horses and the
thousands of soldiers stationed therein, they
are now abuzz with hammers and cranes
as they prepare for families and young
couples to move in. This is only one part of a
Colchester-wide project to build new homes
and facilities to accommodate the wave of
commuters attracted to the town’s proximity
to London. It is little surprise, then, that
Creffield Medical Centre, a family doctors’
surgery that traces its roots back to the start
of the NHS, would be attracted to the site
when it needed to expand.
Started in 1949 – within months after the
National Health Service was started – The
practice has a loyal following of patients, three
of whom have been on the list since it started
63 years ago. Before Creffield moved to its
new premises last year, the practice occupied
a converted Victorian house, which was the
original home of one of the founding partners.
This Creffield Road surgery was situated near
the town centre. “The place was very higgledy
piggledy,” senior partner Dr Vivien St Joseph
remembers of the previous location. “There
were lots of twists and turns in the corridors
– couple of steps here, couple of steps there,
so very poor disabled access, amongst other
things.” Because it was so central, there were
no dedicated parking spaces for patients
either. “The old surgery was certainly time-
expired,” she adds. “I joined in 1987 and on the
practice minutes from that time, one of the top
agenda items was to move.”
Creffield Medical Centre in Colchester comprises a new-build GP surgery, replacing a former military riding school building with a state-of-the-art primary care facility. As a building it combines complex design features, maintains the listed façade and provides capacity for the practice to develop services such as minor surgery. JULIA DENNISON speaks to senior partner DR VIVIEN ST JOSEPH to find out why the practice is so proud of the scheme
case study
26 november 2012
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addition, there is also a counsellor’s room
and examination rooms alongside the central
waiting area. The practice staff also benefit
from meeting rooms and office space, while
a new car parking area for both staff and
patients as well as covered cycle parking and
good pedestrian links to the town make the
facilities as accessible as possible for patients.
A local yoga instructor even rents the space in
the evening for classes and there are exercise
sessions available for the over-80s. “We’re
in a new development area, and it would be
nice to make it a community facility,” says
Dr St Joseph. She also appreciates the space
the staff now have to gather and exchange
ideas. “Our conference room is the secret of
the success of our practice, I think, because
we have a bank of eight computers and we
all go down there for coffee and to do our
post, results and prescriptions,” she says.
“Obviously, people’s timings differ slightly but
there’s an opportunity to see everybody there
and there’s a huge amount of offloading and
exchanging of [ideas].”
Moving to the new site, it was imperative
for the practice that they kept their identity
as a practice. “One of my drivers was to
move to a site that still had some character, I
actively did not want to move to a brand new,
purpose-built surgery,” says Dr St Joseph.
“We’re just so lucky because what we’ve got
is a building with enormous character that
is basically a shell into which you can put a
purpose-built surgery. So all the advantages
of a modern, new, infection-controlled,
CQC-ready building are all here, but within
a framework that has some historical
relevance.” She’s very happy with the space
too, which she calls “uplifting”. “You come
in on a Monday morning, and it’s not so bad
coming to work.” In short, the new project
benefits the community, the environment
and the practice’s patients and staff who now
have a bigger and better place to work.
Practicalities of designWhen it came to funding the project, the
practice couldn’t do it as a LIFT project,
because it’s a listed building. “Although we
looked initially at funding this ourselves,
firstly it looked really expensive, and secondly,
we’d have to do all the day-to-day running of
the move and the building and the planning
ourselves and we weren’t sure we had the
time or the expertise to do that. And thirdly,
we felt we would end up with a building that
was so valuable that it would be very difficult
to release one’s capital from it,” Dr St Joseph
explains. The cost rent is manageable and the
partners believe the value of the building is
worth every penny.
There was relatively little fallout from
patients who found the previous town centre
location more convenient – only a couple
of hundred out of 11,600 patients. This was
partly down to the stellar job the team did
in informing patients of the big move. “I was
very keen to keep the patients informed, but
also to get their input into what they wanted
from the new building,” says Dr St Joseph.
“Before it became fashionable, we actually set
up a patient participation group four years
ago.” When it came to the new building, they
were very involved – from helping to gather
information to lugging boxes when they
moved. “They like to be hands-on,” says the
partner. “We’ve got our flu day coming up and
they will be on hand with assistance.”
Plans for the futureBy and large, the practice and its staff are
very happy with the new building, with
no current plans to expand the surgery
any further – not that they can within the
confines of its listed shell. Dr St Joseph would
like to see more nursing staff in future, along
with the extra services they would provide.
Of course, there are more side interests
she would like to pursue, but she believes
“it’s enough of a challenge to continue to
provide cracking good clinical care”. When
asked to summarise her practice’s ethos, Dr
St Joseph felt it was the best of both worlds:
“We like to describe ourselves as providing a
modern, forward-thinking clinical practice
within a traditional family base.” The listed
building with a modern core symbolises this
philosophy perfectly.
Practice Creffield Medical Centre
Partners 6Clinicians One salaried GP, up to three
registrars, one nurse practitioner, two
treatment room nurses, one healthcare
assistant
Patients 11,600
fast facts
Introducing LMC ConnectLMC Connect is a special range of telephone call tariffs provided solely by Atech Network Services - the only approved LMC Buying Group telecoms supplier. The LMC Connect range offers the potential for outstanding savings and is available exclusively for GP practice members of the buying group.
Save money: On average doctors surgeries save more than 35% on telephone calls and line rentals when switching to Atech.Hassle free: Atech would be responsible for all your line rental and call tariffs. Billing is carried out monthly, directly by Atech giving you complete peace of mind. Atech’s support and billing departments are manned by fully trained engineers and can be contacted directly by you.Keep all existing numbers and lines: You do not need to worry about numbers changing, engineering visits or loss of service when switching to Atech as being direct Openreach WLR3 partners, Atech will work with Openreach to provide a smooth transfer for you.Easy to switch: Transferring across to Atech is cost free and simple. The transfer process can be as fast as 14 days from date of order placement.
LMC Patient ConnectOne of the latest applications to hit the market, especially designed for GP practices, and allowing you to integrate your existing CRM system, such as EMIS, Vision or SystemOne is called LMC Patient Connect.
Available from Atech, LMC Patient Connect will greatly increase practice efficiency in a number of ways. Primarily, by reducing the amount of time spent finding patient records on incoming calls and ‘trapping’ the callers number to be tagged against patient records thus ensuring up to date contact information is maintained.
If you also decide to purchase the fully encrypted call recording and call reporting applications that are available from Atech as a bundle pack with LMC Patient Connect software, then you would also be able, amongst many things, to store call recordings against individual patient records - and add notes against each recording.
The call reporting will enable you to monitor line and extension usage over time and produce bespoke reports that can be automatically generated based on many variables, such as time of day, extension number, call duration etc, etc.
Contact AtechFor further information, contact the LMC
Buying Group sales team at Atech
0844 854 0054 [email protected]
TERMS & CONDITIONS* Practice Business magazine is free for the first six months to first-time subscribers who qualify: finance, practice and business managers at surgeries and practices. For those who do not qualify: annual fee is £68.
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28 november 2012
case study
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case study
Just over a month ago, Harbours Medical Practice in Cockenzie, East Lothian became one of the first practices in Scotland to introduce a new system to improve patient experience. JULIE PENFOLD speaks to practice manager JANE JOHNSTON to find out more
Patient Access was formed as a social
enterprise in 2011 from a community
of over 40 GP practices around the
UK. The movement now serves over 350,000
patients and continues to grow. The enterprise
discovered a way to improve patient access
to GPs and reduce waiting times, making
clinicians, practice staff and patients much
happier in turn.
Practices using the system use a simple
process of direct communication between
the GP and patient. When a patient wants to
make an appointment, they simply call the
practice as usual; the receptionist takes their
details and the GP then calls them back at a
convenient time. Via this system, the GP is
able to determine whether they need to see
the patient or can diagnose and advise them
over the phone. Participating practices have
found, on average, only one in three patients
actually needs to be seen. Jane Johnston,
practice manager at Harbours Medical Practice
in Cockenzie, East Lothian is the latest surgery
to use the system.
Could you describe how the previous appointments system worked?We offered appointments in advance and kept
a number aside every day to be booked one
or two days before. Patients could also call on
the morning for appointments that day. We
also introduced steps, such as having GPs offer
phone consultations in between appointments
and having a duty doctor every day for
emergencies. However, the problem of never
having quite enough appointments available
to meet patient demand always remained.
The lines were really busy and it was very
difficult for patients to get appointments as a
result. Patients were furious with the situation.
We also had patients who would queue at the
surgery to try and secure an appointment. By
the end of summer, we had over 40 patients
queuing at the surgery. The demand for
appointments was higher than what the
practice was able to offer. Our receptionists
had to say no to patients and would have
no alternative other than to ask them to call
back the next day. Some of our patients were
also able to work out that they could play the
system and gain access to a GP by being added
to the duty doctor’s list for that particular day.
What impact did this have on the practice?We were concerned for our patients and were
looking for a solution that would prevent
them having to call at 8.30am each morning
to try and secure an appointment for that day
or later that week. We had instances of older
patients who were feeling ill that were calling
for appointments and been told there were
none left for that day, they would not push the
situation at all. Instead they would just keep
trying to book appointments day after day;
Changing the System
case study
30 november 2012
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this would sometimes go on for a week until
they could book one. We really felt we had
to do something to combat the demand for
appointments and the frustration experienced
by our patients. We needed a solution where
an ill patient who needed to be seen that day
could have contact with the GP. The daily duty
list was just getting longer and longer. It was
getting out of hand the amount of names on
the list for the duty doctor to triage on top of
their normal surgery.
What interested the practice about moving to the Patient Access system?One of the doctors had seen previous articles
about Patient Access and we had tried various
other appointments system methods in
the past, such as introducing two-days-in-
advance appointments and the day in advance
appointments too. These changes did not work
out as we hoped. By moving to the Patient
Access system, we knew we would be able
to deal with the demand for that day on that
day. We had seen the Patient Access system in
action and witnessed how it works in a practice
setting. Harry Longman, the social enterprise’s
chief executive, also came to visit us to provide
an overview of how the system works. As we
had seen how it had worked in other practices,
we found it was easier to explain to patients
that we were moving to a completely different
appointments system that had benefitted
patients elsewhere.
What were the aims of the changeover to the new system?Our main aim was to provide a better service
to our patients; this would enable patients to
be advised or seen on the day and remove the
wait for appointments, which could stretch
to up to ten days in particularly busy periods.
We also hoped the new system would help
with patient and GP continuity, as patients
can request to be called back by their GP. With
the old appointments system, appointments
were in such demand that patients would
take an appointment with any doctor that was
available. We’re hoping the new system enables
our patients to always deal with the same GP
wherever possible.
How did patients react to the new system?There was actually a very short timescale
to enable us to let patients know we were
moving to the new appointments system.
We only decided to make the switch three
weeks before the Patient Access system went
live. Patients were advised of the change
via the local press, leaflets in pharmacies
and messages printed on prescriptions. In
addition, reception staff were also handing
out leaflets to patients coming into the
practice. Word of mouth also helped to spread
the news. We decided just at the beginning of
September that we would go live with the new
system three weeks later. Our Patient Access
system went live on Monday, 24 September.
Although the practice only introduced the system very recently, how are staff and patients finding the changes?Most of our patients appear to like the new
system and really appreciate receiving a call
back from the GP on the same day; this is
usually within one-and-a-half to two hours
from the patient calling. We’re still currently
experiencing a surge in calls at 8.30am each
morning and are letting patients know when
they contact us and also via our website that
they can now call at anytime during the day.
Most patients are happy to give details of the
reason for their call to the reception staff as
this helps us to assess urgency. For patients
who find it difficult to make and receive calls
while at work, we are trying to resolve this by
asking the patient to let us know a suitable
time where they can take a call and asking the
GP to call at that convenient time. The new
system is certainly better for patients.
We also feel it is better for staff as although
they are still busy taking calls and requesting
details, they no longer have to say no to a
patient. That in itself is making it easier.
Instead of our receptionists having to look up
how long it will be for an appointment, they
can now take details and have a GP contact
the patient the same day. In our first week, it
was a little quieter than usual and we feel this
was as a result of patients perhaps waiting a
little while longer to call as the system had just
launched. The second week was busier and
more like usual.
We have found many patients can be
advised and dealt with over the phone which
lessens the need for patients to come into the
practice to be seen. If a patient is required to
see the GP, they can now be seen at a time that
is convenient for them.
Our main aim was to provide a better service to our patients
Practice Harbours Medical Practice
Patients 9,870
Clinical staff Seven GP partners,
four practice nurses and a healthcare
assistant. Health visitors and district
nurses are also attached to the practice.
Non-clinical staff 9.5
PCT Lothian
fast facts
Talk to a specialist…
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We can provide the full package of cover, and adapt your policy to suit you. Why not see the in-depth guide to locum insurance on our website or speak to your local Financial Consultant?
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Arrange a no-obligation appointment with an expert
Quote reference 45664
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22386 Practice Business HPV 277x92.indd 1 18/10/2012 15:13
Those who work in the medical profession know that anyone can be struck down with illness or injury out of the blue. In GP surgeries hiring a locum is often the only solution if one of the doctors falls ill.
Here are some of the most frequently asked questions about locum protection.
Q: What are typical rates for a locum?A: Locum prices can vary dramatically across the country. A Medeconomics UK Survey of locum rates for 2011 showed the daily rate can range between £770 in London and £150 in South and East Wales. Over long periods it will become an expensive resource and it becomes clear that taking out locum insurance is essential.
Q: Who is liable for locum costs?A: All GP practices are required to provide cover for absent doctors for up to 12 months and the responsibility of who meets these costs is usually determined by the practice’s partnership agreement.
Typically, this agreement creates a mix of shared business liabilities for partners, including salaried GP and other staff costs, and personal liabilities. Many agreements make paying for locum cover the personal responsibility of the partner and it will be their individual decision whether or not to take out locum insurance.
Q: Who should pay the premiums for any cover?A: This again is usually dictated by the partnership agreement and what liability is being covered. Insurance premiums for shared business liabilities are usually met by the practice, but premiums for personal liabilities are generally met by the individual Partners. A single plan can cover all of your practice’s shared business liabilities for locum cover, role replacement cover and sick pay, as well as the Partner’s individual personal liabilities.
The kind of insurance taken out, either an individual or group policy, shouldn’t be decided by any of the practice staff as it is a key part of the family income protection planning for most GP partners.
Q: What should be included in a policy?A: Whoever takes out the locum policy needs to ensure it suits their needs and circumstances.
• Check the policy includes an ‘own occupation’ definition. This ensures there will still be a payout even if they can still do other types of work based on their knowledge and experience.
• Confirm the terms and conditions are permanent throughout the entire term of the policy, no matter how many claims are made or if their condition deteriorates.
• Ensure the plan comes with guaranteed options so they can increase the cover without having to provide further medical evidence.
• Check the length of the ‘deferred’ period. It may be cheaper to have a longer period between the date they’re taken ill and the date that payments are made, but it may not always be the best option. Ideally, the deferred period ties in with their circumstances and how long they can cover payments.
ConclusionAs a practice manager you will want to ensure the surgery runs smoothly and remains in good financial health. If you’re not clear, check the practice agreement to see who is responsible for providing cover and ensure cover is in place, up-to-date and meets the needs of your surgery.
Talk to a financial adviser who has experience of working with GP practices to make sure the right cover is in place to protect both the business and your Partners.
The above does not constitute financial advice and is for general information only.
Making plans for locum cover
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32 november 2012
Property woesTo rent or to own? With PCTs being abolished in April and properties being handed over to a new property services company, is it time to bite the bullet and buy your practice? And if you’re renting, what can you expect when ownership is handed over from the PCT to the new owners? CARRIE SERVICE takes a look at rent and property issues for GP practices
managem
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november 2012 33
Deciding when is the right time to buy
your GP practice can be tough, but
in less than five months’ time you
could be forced to make a decision whether
you like it or not. Come April 2013, PCTs will
be no more and any GP practice buildings
that are currently owned by the PCT will be
taken over by the NHS Property Services
company. Recent reports in the press have
suggested practices could be at risk of
massive rent increases when the it takes
over from the PCT. GP magazine recently
put in a freedom of information request, to
which 132 PCTs responded and 104 admitted
to not having signed lease agreements for
all the GP practices they currently lease
to. The GPC raised concerns that there is
insufficient information available about the
NHS Property Services company, leaving
many practices in fear of extortionate
rental increases. However, PCTs have now
been tasked with producing the correct
documentation before April and ensuring
that a signed lease is in place for all practices
renting their property. As straightforward
as this may sound, there are a still number
of issues that practices should think about
before they sign their lease. Issues such as
the rent level you will be expected to pay and
whether this will be reimbursed; how and
when your rent can be reviewed; the length
of the lease; restrictions around what the
property can be used for and whether the
building is compliant with health and safety
regulations, should all be clarified before
you sign.
To buy or, not to buy?With all the ongoing issues to consider
around rent, is it worth practices just taking
the plunge and buying their premises?
“Unlike the wider commercial property
market, i.e. office, retail and industrial, we
have seen healthcare rents continue to rise
since the economic downturn,” says Ben
Willis, partner at law firm Veale Wasbrough
Vizards. Demand for clinical buildings
currently exceeds supply due to a number of
factors, including an ageing population and
an increase in secondary care treatments
being moved over to primary care. Therefore,
rental prices are continuously on the
increase. “The rental value of a property is
key to determining the market value of a
property,” says Willis. “So if rents continue
to rise, then the price of healthcare property
will also continue to rise – so now may be the
time for GPs to buy their surgeries.”
property
34 november 2012
man
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Of course, buying your practice may also
require securing a loan, resulting in greater
liability and capital outlay in the short-term
– but it could be worth it in the long-run, says
Andrew O’Dowd, director at GP Surveyors:
“Owning gives greater flexibility to alter,
change use and redevelop, and the freedom
to make building management decisions
without reference to a landlord. There are
also the benefits of possible appreciation in
value to the benefit of the partners – together,
of course, with a risk that values may fall.”
He also points out that by leasing to third
parties, such as pharmacies, there is the
potential to produce an additional income.
Willis agrees with this in principle: “You have
complete control over the building and can
therefore develop the building to continue to
meet the needs of the practice, and adhere to
current regulations and standards, without
having to go through a landlord.” However, he
advises that despite the fact that GP surgeries
are seen as good solid investments, there
are now very few lenders prepared to put
forward 100% of the transaction costs and
can also restrict partnership changes where
there is a requirement to buy in. It’s worth
remembering, too, that ultimately you will
have full responsibility for the building, so its
current state of repair is definitely something
to take into consideration, says O’Dowd:
“Most PCTs have not operated full planned
preventative maintenance schedules for their
properties and many are in disrepair, not
compliant with statute or CQC requirements
and may well contain asbestos.” A full survey,
as well as a valuation and identification of
liabilities, is vital.
Timing is everythingIf you are going to buy, time it well, taking
into consideration your current situation,
says Willis: “Tactics and timings are very
important when considering purchasing your
surgery. Of particular importance is how long
you have left to run on your current lease.”
If you only have a couple of years left, you
are much more likely to be able to purchase
the building from your landlord without any
issues than if you still have, say, 15 years left.
Another area to consider is which
ownership structure you will be choosing.
“Most buy through the operating partnership
and own the property as partnership
property,” explains O’Dowd. “Separate
investment vehicles – company or limited
liability partnership – to own the property
with a lease back to the operating partnership
are also often considered and very often
the drivers on structure will be tax lead.
These schemes can be complex and proper
advice should be taken to ensure they are tax
efficient and ‘fundable’, i.e. acceptable to the
lending bank.”
The changing shape of general practiceWith more practices now taking on services
that would normally only be available in
secondary care, general practice now needs
to equip itself for a whole other calibre of
patient. A small converted town house might
have sufficed when the practice consisted
of one or two GPs and a couple of thousand
patients. But if you are hoping to provide a
bigger range of services, perhaps including
district nursing or minor surgery for instance,
then you will need more than a couple of
consultation rooms and a small waiting area.
As property management changes come into
play, think about how fit for purpose your
building is and whether it’s worth moving into
a more suitable property before you decide
to buy or renew your lease. If you think that
the building is just in need of a few repairs
and improvements, grants are available
from some PCTs to help with refurbishment,
however it will depend on your locality
whether or not these are available to you. If
you would like to continue renting for the
time being but are coming to the end of your
lease and are looking for something else, have
you considered joining forces with a larger
practice or health centre? This could provide
you with the facilities you require to provide
additional services and also give you the
economies of scale you need to procure the
best contracts.
Unlike the wider commercial property market, we have seen healthcare rents continue to rise since the economic downturn
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november 2012 37
METHODICALMOLLIFICATION
managem
ent
complaints
Whilst receiving complaints can be a demoralising experience, they are inevitable and can improve your practice in the long-run.
GEORGE CAREY looks at the best way to deal with them
Complaints have hit the headlines in
recent months, in particular, a report
published in September by the
General Medical Council showed that one in
64 doctors now face the possibility of being
investigated by the regulator, as complaints
rose by 24%. This also has to be viewed
in the context of a study carried out by the
Medical Defence Union last year, which
shows that doctors believe patients are more
likely to go to the media with a complaint
about their treatment compared to five years
ago. So is it the case that the standard of
treatment in primary care is falling, or are
patients simply becoming more vocal about
Mike Farrar, chief executive of the NHS
Confederation, says: “Patient feedback is
an invaluable part of improving care. It is
essential doctors listen to their patients’
experiences – good and bad – to improve
professionally. And it is crucial that the right
systems are in place to learn from occasions
where things go wrong.” He opines that the
rise in complaints may simply be down to
more vocal and assertive patients, although
does not rule out the possibility that it could
be down to more serious issues, concluding:
“Every patient should be given the necessary
time to discuss healthcare concerns which
can often be complex and upsetting.”
smaller issues? As usual where the headlines
are concerned, the suspicion is that the truth
lies somewhere in the middle. And when one
of your patients has a complaint, what’s the
best way to deal with it in a timely and pain-
free manner for all concerned?
Positive outcomesAs all but the most despotic of us would
agree, complaint is generally a necessary
part of any service and is an essential part
of establishing where improvements need
to be made. It is, in the end, a force for
improvement and, when done correctly,
should result in positive outcomes. As
complaints
38 november 2012
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already will not have their opinion improved
by being made to wait for a response. As part
of this, the practices complaints procedure
should be made readily available or, better
still, be displayed so that those with a
complaint know what to expect and have
an idea of the time scales involved. It’s also
important to record everything that occurs,
in case things cannot be resolved quickly
and amicably. Emails are particularly helpful
in this event, but if that is not the medium
of discourse, then the witnessing by a third
party of correspondence would be of use.
The best way to ensure that complaints
are kept to minor grievances and
suggestions, rather than angry diatribes is
to encourage feedback at every opportunity.
It’s when patients are left to stew on their
opinions that problems become exacerbated.
This is where patient discussion groups can
be invaluable as well. Having regular open
discussions with patients will show them that
you are trying to improve any circumstances
they are not happy with and that their
opinion is valued. A regular report on agreed
objectives and progress against those will
serve to reinforce your status as a practice
that listens to and, more importantly, acts on
their suggestions for improvement.
The hope would be that complaints can
be resolved without taking up even more
time from the busy days of GPs and practice
managers, but occasionally it is the personal
approach that will make all the difference.
While email’s are an efficient and convenient
way to answer problems, a five-minute
meeting could save your practice a lot of
time in the future. Dealing with complaints is
a lot like weight loss, we all know the right
way to do it in theory but adhering to that
best practice at all times is the challenging
part. At the end of a long day it’s far easier
to have a takeaway than prepare a healthy
meal, just as it’s tempting to leave an email
of complaint until the next morning rather
than deal with it straight away. A speedy
and objective response to complaints
should usually be enough for an acceptable
resolution for both sides. Stick to those
principles and you should have the recipe for
a more streamlined and happier practice, for
patients and professionals alike.
We are all prone to procrastination
to some degree and when it comes to
complaints, it is the worst possible course of
(in)action. Sir Donald Irvine is former president
of the General Medical Council and urges
practices to deal with problems sooner rather
than later, as he advised the Medical Protection
Society: “For both the patient and the doctor,
complaints are best resolved early on and
at a local level. We know from experience
that things go wrong when they are not. The
underlying reality is this – that complaints,
when resolved quickly and sincerely, help all
of us to provide better quality service. The
more that we as doctors become accustomed
to dealing with and responding positively to
comments and criticisms from members of
the public and our peers, the better.”
A listening earOpenness and accountability are important
when dealing with complaints. While
resolution of the complaint may not be quick,
it’s important to acknowledge receipt of any
complaints as soon as possible. Anyone
annoyed at the service they have received
For both the patient and the doctor, complaints are best resolved early on and at a local level
QOF
40 november 2012
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Hypertension Everyone has blood pressure; without it blood
would not circulate. It is the force exerted
by blood on the walls of the arteries when
the heart beats. The blood pressure rises when
the heart contracts, forcing blood into the arteries
(systolic pressure), and falls when the heart relaxes
and fills with blood again (diastolic pressure). For
most people, a blood pressure of 140/85mm of
mercury pressure is desirable. Blood pressure
varies normally, rising during exercise and falling
during sleep. It also increases with age. When
blood pressure is persistently raised, it is called
hypertension and affects about 16 million Britons.
Raised blood pressure increases the risk of a
heart attack, stroke, kidney disease and dementia.
It is usually without symptoms and there is often
little warning of the damage it does to vital organs.
For this reason, it is important to have the blood
pressure checked on a regular basis so that it can
be treated if raised.
No cause is found in over 90% of patients
who develop high blood pressure (essential
hypertension). In the remaining cases, a variety of
factors, such as kidney disease, thyroid disease,
A generous amount of QOF points are available for GPs who monitor and treat hypertension. For example, six points can be obtained if the practice can produce a register of established hypertensive patients. PAUL LAMBDEN explains what ‘hypertension’ means and how to avoid ‘white coat syndrome’
hormonal abnormalities or drugs, such as the oral
contraceptive pill, may be responsible.
It is now recommended that an ambulatory
blood pressure monitor is used to establish
whether the blood pressure is raised or whether
treatment is effective. Using the technique
eliminates ‘white coat syndrome’ and often helps
identify problems like nocturnal hypertension.
The device consists of a cuff, which is fitted round
the upper arm, connected to a small pump and
monitoring device usually fitted to a waist belt. The
device automatically measures the blood pressure
every 15-30 minutes during the day and every
30-60 minutes during the night for 24 hours. The
patient should do normal activities (except bathing
or showering!). The device is removed after 24
hours and the results analysed by computer. The
technique gives reliable BP readings and variances.
A large number of QOF points are available
for GPs. Six points can be obtained if the practice
can produce a register of established hypertensive
patients. The other points available are distributed
across a number of clinical areas and demonstrate
the importance of good blood pressure monitoring
and management (see table).
If the blood pressure is raised, it needs to be
reduced to a normal level. This can be done by
pursuing a healthy lifestyle and a number of simple
actions can be of great value:
n Do not smoke
n Eat a healthy diet, low in saturated fats
n Keep to the ideal weight
n Reduce salt intake
n Do not exceed recommended levels of
alcohol intake
n Exercise regularly
n Reduce stress.
If simple measures do not reduce blood
pressure, the hypertensive patient may need to take
medication. There are a range of different types
that work in different ways. Patients often need two
or three different ones to control blood pressure
effectively. All may produce side effects and it may
DR PAUL LAMBDENis a practising GP and a qualified dentist. He has been a GP for 35 years, over 20 of which have been in practice. He has previously worked as an NHS trust chief executive, principal of a medical defence organisation, LMC secretary and Parliamentary special adviser. He is a writer and broadcaster.
QOF
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practicebusiness.co.uk
It is now recommended that an ambulatory blood pressure monitor is used to establish whether the blood pressure is raised and sometimes whether treatment is effective
take time to find the right drug or combination for an individual.
There are several different types of medication for hypertension.
Diuretics, e.g. bendroflumethiazide or furosemide, help the body
remove water and salt. They make the patient pass more urine
and consequently are usually taken in the morning. ACE Inhibitors
(ramipril or enalapril) prevent the creation of the hormone angiotensin
II and therefore open blood vessels. They may cause a troublesome
dry cough in some people. ARBs (losartan or candesartan) block the
angiotensin receptors and work in a similar way to ACE inhibitors.
Calcium channel blockers (amlodipine) open blood vessels through
a direct action. They may cause swollen ankles. Beta blockers
(atenolol) slow the heart by blocking adrenaline and they open blood
vessels. Alpha blockers (doxazosin) block blood vessel receptors,
lowering blood pressure.
These days, home blood pressure monitors are very reliable
and cheap to purchase (a suitable one can be bought for £10 at a
supermarket). Checking BP in the comfort of your home, in a relaxed
atmosphere, gives an accurate reading of the true pressure and,
increasingly, doctors are accepting patients’ readings rather than
taking the BP in the surgery. A machine is worth the investment. n
Table INDICATOR POINTS PAYMENT STAGES
BP4Record of BP in the preceding nine months
8 50-90
BP5Patients with BP of 150/90 or less in preceding nine months
55 45-80
CHD6Percentage of patients with CHD with BP of 150/90 or less in preceding 15 months
17 40-75
Stroke6Patients with history of stroke or TIA with BP of 150/90 or less in preceding 15 months
5 40-75
CKD2Patients on CKD register with record of BP in preceding 15 months
4 50-90
CKD3Patients on CKD register with BP of 140/85 or less in preceding 15 months
11 45-70
DM30Patients with diabetes in whom last BP was 150/90 or less
8 45-71
DM31Patients with diabetes in whom last BP was 140/80 or less
10 40-65
PAD3Patients with peripheral arterial disease with BP of 150/90 or less in preceding 15 months
2 40-90
legal
42 november 2012
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and is still treating patients properly and so on,
then unless there is a green socks clause the
others are left with very little recourse, and the only
way to achieve a departure is to negotiate it. That is
never a pleasant process and inevitably involves a
cash settlement.
Even if a green socks clause is present, care
should still be taken if the partner has any ‘protected
characteristics’. Usually, the power of a green socks
clause lies in the fact that nothing actually need be
‘proven’ against the partner for it to be activated
– usually notice can be
served merely because the
business relationship isn’t
working out. However, all
partners have a right not to
be discriminated against,
and if a green socks notice
were served because a
partner were disabled, then
the partnership could find
itself on the wrong end of a
discrimination claim.
Particular difficulties
can arise if the ‘problem’ partner goes off work with
stress (which can count as a disability). It is then very
difficult for the other partners to serve notice without
risking being accused of discrimination – liability for
which is uncapped.
It is therefore important to deal with any
performance issues as they arise, and to ensure that
your partnership deed allows you broad rights to
expel if necessary.
A sockable offense Don’t like the cut of your fellow partner’s jib? VEALE WASBROUGH VIZARDS says make sure a ‘green sock’ clause is in place
A couple of feuding partners’ dispute led to one of them crashing his car into the other’s car in the car park
Partnership is a relation closer than marriage,
and the fallings out can be just as acrimonious.
We recently heard of a falling out involving a
couple of feuding partners (not VWV clients) whose
dispute led to one of them crashing his car into the
other’s car in the car park. It goes without saying that
having any involvement in a partnership dispute is an
unpleasant experience.
It sometimes comes as a surprise when partners
find they do not have an automatic right to expel
a partner that they have fallen out with. The rights
that they do have will
depend on what is in the
partnership agreement –
so a partnership deed that
does not give the partners
the necessary protection
can be a serious problem.
I usually recommend
that a ‘green socks’
clause be inserted in
partnership agreements
– these allow for partners
to be given six months’
notice to retire, without the need to prove fault on
either side. The ‘green socks’ clause is so called
because it could be served merely because a
partner comes in wearing green socks every day,
and the others couldn’t bear it.
While no one would ever expel someone for
something so trivial, it does illustrate the point: If a
partner has become difficult or impossible to work
with, but is not in outright breach of the agreement
Does your partnership deed include a green socks clause? VWV will be happy to carry out a free review of your current arrangements.
Please contact [email protected] or at 0117 314 5429.
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44 november 2012
Thinking of becoming partner at your practice? CARRIE SERVICE looks at the risks involved for PMs and how to navigate the change of role
P a r t n e r s h i p : i s i t f o r y o u ?
wo
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november 2012 45
For a practice manager, achieving partner
status might feel like the icing on the cake
and the perfect recognition of your efforts at
the practice. The prospect of earning more money
– 40% more than non-partner PMs according to a
recent survey – and having greater influence over
business decisions sounds like a win-win situation,
right? But as the old saying goes, with great power
comes great responsibility and it is not a decision
that should be taken lightly. Practice manager
partnerships are a bit of a rarity, with just 3.75% of
PMs in the UK having partnership status to date, so
if you’ve been approached to become partner at
your practice, you must be doing something right.
Steve Morris, general manager of First Practice
Management and an ex-practice manager, advises
PMs not to get blinded by flattery and keep a level
head. “Manager partnerships are not for everyone,”
he says. “You need to be clear on your personal
motives and do your homework thoroughly – and
in advance.”
Losing your rightsBecoming a partner will ultimately mean losing
many of the basic rights you have as an employee
at the practice, as you will effectively become
self-employed. You will therefore need to decide
whether your relationship with the other partners
is strong enough for this to not become an issue.
If you have worked at the practice for a number
of years – which is probable if you are looking
to become partner – then it is more than likely
that any potential conflicts have already arisen
and been resolved by this point. But if you are
relatively new to your current practice, be sure to
think it through before you sign on the dotted line.
You may all be getting on like a house on fire at
the moment, but things could look very different
when reality sets in and you come to realise that
your partner’s actions directly affect your own
investment in the practice – and vice versa. It’s
also worth bearing in mind that you will no longer
be able to bring unfair dismissal claims and may
advice
46 november 2012
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not be covered for constructive dismissal (when
an employee is forced to quit their job against their
will because of their employer’s conduct).
Till death do us partIf the partners broached the idea of partnership
with you rather than the other way around, ask
what the motives for their proposal are and what
they hope to gain from the partnership. Aside
from the fact that they believe you are worthy
and capable of the role, they are probably keen
to secure your presence at the practice for the
foreseeable future. Ask yourself if you are ready
for such a commitment and clearly lay out what
you hope to get in return. “You will have your
own agenda that may include greater autonomy;
wider authority; parity of status, equity, risk and
reward; and the full agreement of all of the existing
partners,” says Morris. “You will also need to
commit time, your long term career, and your
emotional well-being. Be sure that the move is right
for the practice and right for you. Instructing your
own specialist solicitor and accountant to act on
your behalf is absolutely essential.”
Identity crisisBe aware that your new position will bring a
change in dynamics at the practice that not
everybody will see as positive and being the only
non-clinical member of the partnership
could cause issues for some. In a case
study on the First Practice management
website, practice manager Dr Ann
Burntonwood (PhD) writes about her own
somewhat fraught personal experiences
of becoming a partner at a GP practice
in south Wales. Although the final
decision to appoint her as partner was
unanimous, one partner had wavered
on their decision because they had
reservations about having a non-clinical
member in the partnership; worrying that
she might start to manage some of the
clinical aspects of the role. Also, as she
has the title of Dr Burtonwood like her
clinical counterparts, concerns were raised about
confusion from patients about her being a GP.
These reservations played on Burntonwood’s mind
and made her feel as though she perhaps hadn’t
earned the full confidence of the other partners.
It’s easy to see how this could affect relationships
within the partnership if not fully resolved, as
Morris reiterates: “Less than a full agreement
from the partners may result in a residual element
of resistance and possibly a negative effect on
confidence and perceived standing. Consequently
there is a danger that the manager is placed in
something of a limbo – not part of the staff group
and not feeling a full partner either.” If you are
part of a larger management team, there is a
chance they might view your becoming a partner
as ‘changing sides’ potentially creating a feeling
of segregation within the team. With this in mind,
something to get clear from the offset is how your
job role is going to evolve with your new status –
how will your duties in management change – if
at all? What will your new job title be? If you do
decide to take partnership, think about how this
might affect other members of your team and
let them know how you will be divvying up your
time from now on. If the practice will be taking on
someone new to assist with extra duties, ensure
that staff know where this person sits in the
practice hierarchy. Keeping people as informed
as possible could help avoid the same feelings of
isolation that Burntonwood suffered.
Financial risksYou are making a huge financial commitment
that will affect the rest of your life – be it for
better or for worse. So seeking independent
legal and financial advice from a professional
outside of the practice is essential. Some even
suggest appointing a ‘next friend’ to help you stay
completely objective. It may even transpire that
the other partners are unable to offer you what
you want from the partnership, so make your
expectations and demands clear from
the beginning. “One certainty is that you
will be looking for a personal benefit for
you and that this must therefore be at
the expense of the partnership,” explains
Morris. “So the partners will need to be
certain that a manager-partner is best for
the practice in the long-term, and that the
risks, benefits and costs to the practice
have been properly assessed as part of
a solid and well-researched business
case.” Burntonwood opted for a fixed-
share partnership with full premises buy-
in on an equal sharing basis – something
that takes time to calculate as there are
many influencing factors. “The fixed
share was agreed by working back equivalent
employment costs – salary, NI and other on-cost
amount – agreeing uplift in income plus cost rent
etc., then converting this sum into a percentage,
based on the last accounts,” explains Morris.
“Over the years other expenses and other sources
of income have been added into the equation.”
Considering the complicated issues involved
in becoming a partner, it’s easy to see why so
few practice managers have chosen to do so.
But with proper research, planning and a good
open relationship, becoming a partner could be
the secret ingredient your career is missing.
There is a danger that the manager is placed in something of a limbo – not part of the staff group and not feeling a full partner either
If you are looking for new staff uniforms this autumn, take a look at the bright new blouse options from company clothing specialists, Meltemi. Pink and cerise are now very popular colours both on the high street and in corporate clothing, and colour predictions suggest they are here to stay. Their new blouses create a modern, smart and distinctive image for staff and offer options in cool polycotton or crease-free CoolWeave fabrics.
In developing the new range, Meltemi solicited feedback from those working in practice. Now, in addition to the new colours, their Ella blouse range is available in both semi-fitted and loose-fit blouse shapes to help provide a choice of style and shape to meet staff preference.
Get a bright new look in the surgery…
For full information on the new blouses, or for a brochure detailing garments for your medical teams, please visit www.meltemi.co.uk, call 01603 731332 or email [email protected]
020 7288 6833
www.practicebusiness.co.uk/subscribe/
@
april 2012
Practice Business is an approved partner with...
Reduce and deliveR
Working with CCGs to cut back on
emergency admissions Patients aRe youR viRtues
Chair of the National Association of
Patient Participation speaks uplife afteR PctsWhat will happen to your practice
after the PCT goes?
practicebusinessinspiring business solutions for practice managers
+
april 2012
june 2012
Practice Business is an approved partner with...
Let the games beginHow the Olympic Games could impact your practice
Keeping schtum Quick ways to improve patient confidentiality
Fighting Fire with Fire One practice recovers after an arson attack
practicebusinessinspiring business solutions for practice managers
+
june 2012
practice
Practice Business is an approved partner with...
PRACTICEBUS
INESSinspiring business solutions for practice managers
+
july 2012
MAKING PROVISIONS
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A UNITED FRONT
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UMBE
R
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THE
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IC N
UMBE
R
The
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Subscribe nowreceive
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As more care moves into the community,
general practice faces a time of great
opportunity and much challenge: increased
competition, greater accountability and
a need for strategic, top-quality business
management. Practice Business supports
practice managers with information-packed
articles, the latest news analysis, best
practice interviews and easy to read guides to
all aspects of your role. All this can be yours
free for six months - how’s that for best value?
*TERMS & CONDITIONS In order to qualify for a free subscription, the recipient must be a first time subscriber and be a finance, practice and/or business manager with purchasing authority at surgeries and practices in the UK or Ireland. For those who do not qualify log on to our website to subscibe for half price. For details or to subscribe contact Natalia Johnston on [email protected] or visit www.practicebusiness.co.uk/subscribe/
As more care moves into the community,
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DO YOU KNOW ABOUT OUR COMMISSIONING MAGAZINE?
While we will still cover commissioning-related topics from a primary care provider point of view, practice managers heavily involved in clinical commissioning will want to refer to our bi-monthly commissioning magazine, Commissioning Success. For a free copy, email your details to [email protected] with the subject line “Commissioning Success”.
comment
48 november 2012
wo
rk/li
fe
SAY IT TOMY
FACEWith more communication done via technology, the lines are blurring between what is and what isn’t acceptable to discuss
via e-mail and phone. We know effective communication is vital to good business practice, so why do we still avoid those face-to-face conversations in the workplace? HR coach JULIE
COOPER discusses why you need a good conversation
wo
rk/life
comment
november 2012 49
If you want to get a point over, doing it the way that suits you may not best fit with the other person
There are many times in our working
lives when we need to talk to each
other. Of course, this should be
easy, right? We are all capable of holding
a conversation. What else is there to it?
If only life were that simple. People are
complex beings, with different personalities,
opinions, perceptions, values, beliefs
and experience.
Add to the mix the many reasons there
may be for talking to someone, including
both your agenda and theirs, and it becomes
apparent that there are many different
directions a conversation can take. Much
of the time we get the results we want, but
other times we come away wishing that the
outcome had been different, or with that
nagging feeling that we haven’t done as well
as we hoped we would.
Let’s not underestimate how important
this is. Speaking to someone face-to-face
(as opposed to pinging a quick email, for
example) is the cornerstone of building
effective relationships. Now, you may not feel
you need a good relationship with the people
you work with. You are there to do a job. But
here’s the ‘but’ – and it’s a mighty big ‘but’ –
people perform better when they have a good
relationship with their line manager. Recent
studies have shown a strong correlation
between this relationship and the degree
to which an employee is actively engaged
in their work. Engaged employees not only
perform better, but they also have less time
off sick, have less accidents and are prepared
to go the extra mile for you. In simple terms:
Good face-to-face skills = good
relationship = engaged staff = productivity +
extra mile.
It’s not rocket science, but is so often
overlooked as a critical element of staff
management, and is instead thought of a
luxury we don’t have time for. Let’s get this
straight right now. In your brain, file ‘good
working relationships’ under ‘essential’ not
‘when/if I have time’.
I’m sure you can see the flaw in the
otherwise simple plan – if the one-to-one
discussion is not handled well, the opposite
applies and you could have disengaged,
disinterested ‘jobsworth’ clock-watchers,
which will just make your job even harder.
So how do you make sure your one-to-one
meetings are effective? Start by being aware of
your own personal style, then think about how
you can adapt it to better match the style of the
other person. We all have personality traits and
ways of learning that have an impact on how
we best absorb information. If you want to get
a point over, doing it the way that suits you
may not best fit with the other person.
You may also think you know how to
listen. Many people hear what they want to
hear, don’t acknowledge the other person’s
view, and don’t explore issues to uncover
the real reasons behind issues. Consider
this: In my opinion, you are not in a position
to comment until you understand the full
picture. If you use the ‘listen – respond –
propose’ model in a conversation, you will
find yourself moving elegantly out of many a
tricky situation:
1. Listen until you understand where the
other person is coming from
Gather all the facts, feelings and
circumstances. Try to get to the bottom
of the other person’s interests and
motivation. Let them know you have heard
and understood.
2. Respond – say what you think and feel
about the situation
Describe how the situation has an impact
on you, using appropriate language.
Do not use ‘but’. Be open, honest and
straightforward. Assign your feelings/
problem to behaviour or events – not the
other person.
3. Propose – say what you would like
to happen next, considering the
consequences for yourself and the other
person
Be clear and specific about your needs –
dropping hints or assuming may not work.
Give the other person an opportunity to
do the same. Be realistic. Define roles, time
scales, etc. Be prepared to meet the other
person half way. Offer a joint solution.
If you have a one to one meeting coming
up, you can prepare by considering the
following:
n Outcome Also known as beginning with the end in
mind. What specifically is it you want?
n Think ahead Sometimes the planning is simply
getting organised, at other times there
are deeper questions to consider, so
allow yourself thinking time. How
might the other person respond? How
much flexibility do you have? What
questions will get to the heart of the
matter? What order is logical to discuss
things in?
n Steps Knowing the steps you need to take
during a discussion can make a difficult
meeting much more straightforward.
Have an ordered checklist to help keep
you on track.
n On the hop Of course, we don’t always have the
opportunity to plan for conversations,
but as a general rule of thumb, the
more important the conversation, the
more thought should go into thinking
how to handle it. If you find yourself
caught ‘on the hop’, don’t feel you
have to respond right away. You can
still acknowledge the other person,
thank them for raising the issue, and
say you will get back to them within
the hour, or tomorrow – whatever you
need to stop yourself making snap
decisions that you might regret later.
It’s a fact of life that the busier we
are, the more we tend to rush in with
insufficient thought.
Make your conversations good ones,
for both parties involved. Treat face-to-
face skills like any other ability you want to
develop; learn, reflect on your performance,
improve. You will see the rewards sooner
than you think.
This is an extract from Face to Face in
the Workplace, available for £20 from
FacetoFaceintheWorkplace.com
diary
50 november 2012
wo
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fe
Practice diary
I’m not a fan of paper, so it was a terrible shock
when I took my first job in primary care to find
so much of it still in circulation. Despite some
electronic alternatives already being available,
paper remained the primary media for many
practice processes. This hard-wired attachment to
endless A4 sheets and sticky notes was a trusted
way of working, and so a strong resistance to
electronic alternatives existed.
The catalyst for change came through us
signing up for the information management and
technology DES, a major component of which
was achieving ‘paper light’ accreditation. We put
together a team of clinical and administrative
staff and arranged to meet regularly to discuss
opportunities to reduce paper-based processes
and investigate what we could achieve with our
existing hardware and software packages.
It was agreed that incoming post was a
source of many issues and that we should focus
on what we could do to improve this. Our initial
step was to look at reducing the volume of post
being received and to investigate if electronic
alternatives were available. We contacted local
hospitals and screening services and found that
many alternatives already existed. New interfaces
were created that enabled secondary care systems
to ‘talk’ directly with our own. Not only did this
significantly reduce the amount of post being
IT manager GRANT BURFORD discusses the process to becoming ‘paper-light’ and how it has benefited his practice
Gone are the days of frantically searching through in-trays and files looking for discharge summaries
received, it meant important patient information
was available much sooner than before. And a
smaller pile of post was a welcome site for the
admin team. What’s left of our incoming mail is now
scanned on arrival and distributed electronically
using our document management system. It allows
us to maintain a record of where a document is and
any actions that have been taken. Gone are the
days of frantically searching through in-trays and
files looking for discharge summaries.
With our initial project complete and everyone
agreed that electronic records offered so many
advantages both internally and to our patients, the
momentum for change was now present. Our most
recent project saw the transition of our practice
survey into an online format. We were able to
collect substantial amounts of feedback in a very
short timeframe, with the results all collated for us.
We now intend to run more regular surveys which
will assist greatly in our preparation for the patient
participation DES.
We’re noticing more and more services are
now available through electronic means and are
always keen to exploit them wherever possible.
With a bold statement this week from the NHS
Commissioning Board national director of patients
and information, Tim Kelsey, pledging to make the
NHS ‘paperless’ by 2015 there’s a lot still to be
done to make this a reality. It’s time to fling your
fax machine, put away your pen and paper and
embrace the changes.
GRANT BURFORDis IT manager of the Imperial College Health Centre
Practice Business welcomes a different columnist each month to share their experiences and provide their view from the practice manager’s desk. If you would like to contribute to the diary page, please get in touch by emailing [email protected]
april 2012
Practice Business is an approved partner with...
Reduce and deliveR
Working with CCGs to cut back on
emergency admissions Patients aRe youR viRtues
Chair of the National Association of
Patient Participation speaks uplife afteR PctsWhat will happen to your practice
after the PCT goes?
practicebusinessinspiring business solutions for practice managers
+
practice
june 2012
Practice Business is an approved partner with...
Let the games beginHow the Olympic Games could impact your practice
Keeping schtum Quick ways to improve patient confidentiality
Fighting Fire with Fire One practice recovers after an arson attack
practicebusinessinspiring business solutions for practice managers
+
practicebusinessinspiring business solutions for practice managers
+
Practice Business is an approved partner with...
PRACTICEBUS
INESSinspiring business solutions for practice managers
+
july 2012
MAKING PROVISIONS
GP retirement is o
n the up. Is
your practice prepared?
A UNITED FRONT
How federating helps sm
aller
practices su
rvive
THE
MAG
IC N
UMBE
R
The
impa
ct o
f 11
1 on
GP
prac
tices
Practice Business is an approved partner with...
Practice Business is an approved partner with...
Practice Business is an approved partner with...
Practice Business is an approved partner with...
Practice Business is an approved partner with...
MAKING PROVISIONS
GP retirement is o
n the up. Is
your practice prepared?
A UNITED FRONT
How federating helps sm
aller
practices su
rvive
Subscribe nowreceive
months free
As more care moves into the community, general practice faces a time of great opportunity and much challenge: increased competition, greater accountability and a need for strategic, top-quality business management. Practice Business supports practice managers with information-packed articles, the latest news analysis, best practice interviews and easy to read guides to all aspects of your role. All this can be yours free for six months - how’s that for best value?
020 7288 6833
www.practicebusiness.co.uk/subscribe/
020 7288 6833
www.practicebusiness.co.uk/subscribe/
*TERMS & CONDITIONSIn order to qualify for a free subscription, the recipient must be a first time subscriber and be a finance, practice and/or business manager with purchasing authority at surgeries and practices in the UK or Ireland. For those who do not qualify log on to our website to subscibe for half price. For details or to subscribe contact Natalia Johnston on [email protected], +44 (0)20 7288 6833 or visit www.practicebusiness.co.uk/subscribe/
practicepractice
PRACTICEBUS
INESSinspiring business solutions for practice managers
+
Contact
us today
quoting
refe
rence
“PBSUB6”
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ualify