In Cornwall and the Isles of Scilly we are lucky as we have some outstanding practice managers. Our aim is to work with the LMC to support every practice manager so that they are equipped with the tools, support and information that allows them to manage their practice business effectively and efficiently. We know that the current environment is extremely challenging and we have a number of practices who might need extra support. We have two senior practice managers who serve as Non Executive Directors on our Board.
If you are struggling:
Where practices feel they need immediate help, we have developed an arrangement with expert partner organisations who can conduct a rapid 2-day intensive review and from this we can work completely confidentially with commissioners and the LMC to define a tailored support package. Our partners who will carry out the intensive support team visit have expertise in property, prescribing, back office efficiency, mergers, partnership working, relationship management, employment law and contracting. We also host a local 'Change Manager' who works directly with practices who need support or who are vulnerable.
Prior to seeking help we urge all practices to complete the local RESILIENCE ASSESSMENT TOOL as it gives a clear picture of practice stability. A guide to completing the Resilience Assessment Tool can be found >here . Practices are requested to send a copy of the final 'report' tab to KH CIC for confidential use so that we can start a conversation about designing a support package. We DO NOT need full sight of your financial data. All information will be treated confidentially.
Working at scale:
Our support partners can also help in exploring working together at scale to share resources or work towards common objectives and we can appoint a relationship manager to help you on this journey. KH CIC is your Company and we are set-up to deliver services on your behalf, which may specifically be in your cluster or locality. For example, we can help you explore employing and deploying a shared clinical pharmacist across your patch or exploring how you can work collaboratively at scale towards common aims and objectives. This might be in a primary care home or MCP type arrangement.
What to do next:
Funds are available locally to support our struggling practices and also to support initiatives for working clinically at scale. See our offer here> Contact the office, or the LMC, if you feel you need help and support. Please use this form to contact us if you need support >here
The sections below are specifically there to help point very busy practice managers to practical examples of schemes that have worked in other parts of England. NHS England (NHSE) has made a number of funding streams available primarily through the General Practice Forward View (GPFV) to support certain initiatives; for a full list of details of Nationally funded schemes click here; to see details of the case studies and practical hints and tips click on the schemes below.
The GPFV instructed CCGs to fund and make available access to online consultation systems . The systems allow patients to access information on a range of illness to help them self-diagnose as well as receive pharmacy advice, contact NHS 111, submit an e – consult to their GP and make use of other administrative services. This has the possibility to free up GP time by directing patients to the most appropriate service first time as opposed to giving every patient an appointment regardless of their concern. Kernow Health CIC (KHCIC) is currently running a trial within a cluster of practices in mid-Cornwall. Providers of these services include Emis and askmygp amongst others. Hopefully funded by the CCG from April 2017.
The migration of patient data online has been proved to save staff time with varying degrees of success based on the practices current administrative methods. Moving partial patient records online, as well as test results and other admin services can streamline the routine tasks that typically take up a lot of staff time. Currently TPP , Emis , INPS and Microtest all offer (free) software to aid in achieving the above tasks.
The GPFV has asked CCGs to plan and support the delivery of national expertise and support for groups of practices. This is a long term strategy designed around the 10 High Impact Actions (case studies can be found by using the link) such as Productive work flows and Personal productivity which NHSE say will release 10% of GPs time. The CCG will invite bids from practice clusters in due course.
As part of the GPFV CCGs will offer funding to provide training to receptionists in order to remodel their role as ‘care navigators’. This involves using the receptionists as a first port of call to direct patients to the most relevant source of information or person to deal with their issue first time. Pilots have shown that this could save £10,000 in GPs time per average sized practice per year.
The funding also includes training for clerical staff to help the GPs deal with clinical administrative tasks. Following in-house protocols, the member of staff would process letters, enter patient data into their records and book appointments if necessary. Pilots have shown a reduced number of errors and an average saving of £6,800 per GP per year. Funding for both these schemes will be distributed via the CCG and allocations will be made in November/December this year.
As part of the GPDP outlined in the GPFV funding will be made available for practice manager development training in 2016/17 and over the next three years. More details about funding from the CCG will be available this autumn.
NHSE have announced a second wave of funding to get 1,500 clinical pharmacists into general practice. The clinical pharmacist will work with a group of practices to resolve day-to-day medicine issues and consults with and treat patients directly. This includes providing extra help to manage long-term conditions, advice for those on multiple medications and better access to health checks. KHCIC has successfully supported the Penryn Federations’ bid for wave 1 funding. KHCIC are willing to help clusters of practices to bid now for further funding. Pilots have shown a mixed but positive result, reducing the number of GP appointments by 20-30%.
The GPFV (page 47) suggests that there will be funding for a service that allows patients to see a physiotherapist for musculoskeletal problems without having to see a GP first. The physiotherapist would be based in a single practice or shared between a number of practices. Pilots show that approximately 20% of appointments are for musculoskeletal complaints and that a cost and time saving of over 20% per patient seen can be achieved. The CCG has announced that it will in 2016/17 re-procure all adult MSK physiotherapy services for both AQP and non-AQP.
It is not yet clear how the GPFV ambition for more physiotherapists fits with the CCG commissioning intentions.
There will be funding for practice nurse development, including support for return to work schemes, improving training capacity in general practice for nurses, increases in the number of pre-registration nurse placements and other measures to improve retention. For more information click here.
As part of GPFV a number of sites have employed paramedic practitioners which can provide care within the practice to relevant patients and do home visits with full access to GP records. Current pilots have had success with both these aspects, whereby the scheme pays for itself. This scheme would have to be self-funded by the practice or cluster.
The GPFV highlights that making full use of the volunteer sector by social prescribing frees up GP time and allows them to do things that only they can do. There are two types of interface between general practice and the volunteer sector; a receptionist navigator or a volunteer link person and separate agencies which organise care once patients have been referred to them. Cornish practices are successfully running schemes with Age UK and there are a number of other successes around the country. The Bromley by Bow Centre is a good case study. This is a practice self-funded scheme.
Several general practice IT system providers have software that can provide a demand-led appointment system, whereby the number of available appointments is related to the demand. This software can be used in conjunction with a staff rota system to associate the number of staff available to the number off appointments filled.
This prevents wasting GP time by having them sit through empty appointments and stops understaffing in busy periods. Pilots have shown a reduction in DNAs by 70-80%. This will be made available to every practice from 2017/18, likely for free or via the CCG.
There will be support for future MCPs, PACS and acute care collaborations, linked to the next phase of sustainability and transformation planning. We expect money to be released to support this through NHS Kernow and linked to the NHSE Resilience Programme money. Details to follow with also, hopefully, guidance as to how to access it. It will be aimed only at practices working together / collaborating clinically at scale along the lines of the NAPO Primary Care Home sites.
DNAs are a common feature of general practice, with a positive correlation between how long an appointment was booked in advance and DNAs.
There are a number of cost efficient and easy ways to reduce DNAs; providing a rapid way for patients to cancel appointments, text message reminders (10% reduction), getting the patients to write their own appointment cards (18%), getting the patients to read back the details of their appointment (4%), reporting positive attendances (14%) and reducing ‘just in case’ bookings (80%). Implementation for most of these methods will be self-funded by the practice.
However the CCG will provide funding through the GPIT budget for the messaging services.