NAGPC National Association of GP Cooperatives Represents

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NAGPCNational Association of GP
Co-operativesRepresents Supports GP
Co-operativesPromotes Quality OOH Patient
Carewww.nagpc.org.uk
Website Sponsored by
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Dr Mark Reynolds MBENAGPC ChairmanDesired
organisational characteristicsDirectors
liability
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Last years NAGPC Conference At the
CrossroadsPIO - CIC - PICwas a popular
optionPCT mergera safe house
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Patient
PCO Practices
Co-operative OOH Clinical Services
Day Support
NHSD WIC Access
Enhanced Services
A E Pre Triage?
Transport
Nursing
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A Once in a Career Chance!!ButHow can we make
it happen?Who can make it happen?
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Whole System Approach for a Whole NHS Change
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Key components

• Motivation
• Caseload
• GP Involvement
• Skill Mix
• Organisational structure

• Integration
• Leadership
• Contracting
• Beyond Short term planning, risk sharing?
• Directors liability

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Making it Happen

• Unprecedented PCT co-operation
• Must have an authorised lead
• Must involve co-design
• Must trust expertise
• Can you do this?
• Does the StHA need to be much more involved?

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• Someone must have authority
• to facilitate and create essential collaboration
  -
• where it is not happening

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• Remember Date
• X?

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• Whole System
• Whole Budget
• Released GMS not enough in many areas
• Whole team thinking helps

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Skill Mix- The New Teams

• No recognised OOH qualification
• Not enough- not yet
• Senior GPs must help build teams
• GPs in team will manage uncertainty
• Significant advantage to a team with experienced
  GP players
• Examples exist

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Leadership

• Small empowered team
• Mandated by committees
• Chief Executive/Director Primary Care/Medical
  Director/General Manager

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Beyond short term planning

• Must look to the future
• Staff need security
• NHS needs stability after change
• Integration will take time
• Initial structures must be flexible
• Joint sharing of financial and governance risk?
  the payback for open books?

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GP Recruitment

• A new relationship
• A new and rewarding job
• A new flexible contracting process
• BUT - must demonstrate commitment
• Maybe yearly contracts (at least?) with six
  monthly rolling renewal
• Significant career opportunity

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Motivation

• Para GPs - minimum red tape
• GPs - conditions, involvement, pay
• Managers - security, conditions, creativity
• Staff - local knowledge and expertise

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Integration

• Patient need first
• Coincidence of policy need
• Careers to be made
• Chief Execs and SHAs - please!
• Leadership - influence or power?
• Intelligent patient journeys
• Whole system back-up

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Organisational Structure

• Involve and motivate workers
• Be NHS/public services motivated
• Involve all relevant contributors
• Be able to create change
• Be stable
• Be fast moving
• Be liked by the public
• Reflect developing skill mix
• Be independent?

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GP Involvement- Managerial

• Please use those who know how
• Complex relationships and clinical consequences
• Very separate, until now
• Clinical/managerial expertise - Leaders!
• Will manage the risk of work transfer to acute
  sector

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GP Involvement Caseload

• 40-60 of OOH Pts presenting to nurse fronted
  co-ops need a GP (a working estimate)
• No GPs would result in a major increase in
  patients to A and E
• Cost ?

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Contracting

• What level of detail?
• Organisational
• Financial
• Look at what has worked
• Is PCT process motivating ?

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Directors Liability

• Essentially
• ..Will I be personally liable for the medical
  consequences of a lack of doctors?
• But there must be negligence for there to be
  liability

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Directors Liabilitymitigated by

• Managerial approach
• Rota planning
• Sharing the problem, scale, partnerships
• Opt out planning

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Managerial Approaches

• Assess caseload
• Match to clinicians
• Robust rota
• Horizon planning

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Rota Planning- for management

• Commitment- one year ?
• Include bad shifts if necessary
• Three month planned, nine months hours ?
• Renewed six monthly on a roll over basis
• BUT- for clinical owners
• Flexible
• Enjoyable
• Team approach
• Properly paid
• Influence on style, content, workload

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Rota Problem Foreseen

• Share problem with the whole system
• Back to PCT
• Whole system reset
• Skill mix deployment
• Alter terms and conditions

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Opt Out Planning

• Structure
• Establish PCT and SHA criteria
• Phased ?
• Financial
• Organisational
• Advanced clinician planning

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Summary

• GP directors must not be responsible for the
• consequences of a national problem outside
• their control.
• This approach decreases liability.
• How is this issue dealt with in a mutual
  structure?

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NAGPC

• Huge new role in sharing good practice and
  innovation
• Structures, practical assistance and
  troubleshooting
• Implementing REC, assisting the wider vision
• GP Contracting process and best practice
• Skill mix integration and education
• Political representation and lobbying
• Day service development practicalities, best
  practice and support
• N.A. of Urgent Primary Care?

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Summary

• Finance, think whole budget
• GPs are needed
• Skill mix - yes but dont hold your breath
• Motivation - involvement and conditions
• New organisational structures, a choice
• Rota and opt out planning
• Integration
• Directors liability

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A Once in a Career Chance!! New Integrated
service shatters AE waits!Streamlined service
saved my sister! Now to choose a structure
that delivers
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NAGPCNational Association of GP
Co-operativesRepresents Supports GP
Co-operativesPromotes Quality OOH Patient
Carewww.nagpc.org.uk
Website Sponsored by