@robertvarnam #GPdev @NHSIQ

Releasing time in general practice

Dr Robert Varnam PhD MRCGPClinical lead, CCG transformational change delivery, NHS Improving Quality

Head of general practice development, NHS England

GP, The Robert Darbishire Practice, Manchester

robert.varnam@nhs.net

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@robertvarnam #GPdev @NHSIQ

Releasing time in general practice

The issue The Productive General Practice Examples Deployment Top tips

@robertvarnam #GPdev @NHSIQ

Releasing time in general practice

The issue The Productive General Practice Examples Deployment Top tips

@robertvarnam #GPdev @NHSIQ

The issue

£

@robertvarnam #GPdev @NHSIQ

@robertvarnam #GPdev @NHSIQ

Releasing time in general practice

The issue The Productive General Practice Examples Deployment Top tips

@robertvarnam #GPdev @NHSIQ

The Productive General Practice

VisualManagement

@robertvarnam #GPdev @NHSIQ

The Productive General Practice

@robertvarnam #GPdev @NHSIQ

The Productive General Practice

Comprehensive lean-based redesign

for busy general practices

Practical, guided, supported

@robertvarnam #GPdev @NHSIQ

The Productive General Practice

@robertvarnam #GPdev @NHSIQ

The Productive General Practice

@robertvarnam #GPdev @NHSIQ

The Productive General Practice

• 12 modules packaged in a box set• Manageable, easy to follow, self-directed modules• A large range of supporting resources – spreadsheets, documents,

eLearning and guidance films

@robertvarnam #GPdev @NHSIQ

The Productive General Practice

@robertvarnam #GPdev @NHSIQ

The Productive General Practice

• Support packages from expert teams• Options for sharing & collaboration between practices• Aligned with strategic commissioning priorities

@robertvarnam #GPdev @NHSIQ

Typical results

• Extra nursing capacity identified, providing extra capacity worth £11k

• More accurate staff planning resulted in the cancellation of planned appointment of staff – avoiding £15k of staff expenditure year on year

• Time taken to retrieve prescriptions requests reduced by 82%, releasing 12.5hrs of staff time per week

• Turnaround time for medical reports reduced by 43%

• 14% reduction in stationary costs

• 57% reduction in blood test resource costs

• 82% reduction in nurse sickness and absence

@robertvarnam #GPdev @NHSIQ

‘I seem to manage to get home on time much more often than I used to … It makes a big difference to my work-life balance.’Dr Knut Schroeder, Bristol

“Led to changes that were really life changing for me. Improvements mean I do not stay late evenings and this means I am not making mistakes because I am tired.” Dr Angela Bradley, Leamington Spa

Our list size has started to grow for the first time in a good while … the practice is more efficient, friendly, flexible and productive. Dr Paul Cook, Bolsover

@robertvarnam #GPdev @NHSIQ

Releasing time in general practice

The issue The Productive General Practice Examples Deployment Top tips

@robertvarnam #GPdev @NHSIQ

Examples

1. Reduced hassle & time

2. Better care & reduced costs

3. Improvement & transformation

@robertvarnam #GPdev @NHSIQ

eg 1. Reduced hassle & time

Sort

Set

Shine

Standardise

Sustain

Remove non-essential things

Organise necessary thingsAssign each object a place

Regularly clean & maintain the area

Develop procedures, arrange similar areas in similar ways, use colour codes

Use regular audits and embed 5S in the everyday routine

@robertvarnam #GPdev @NHSIQ

eg 1. Reduced hassle & time

Sort

Set

Shine

Standardise

Sustain

@robertvarnam #GPdev @NHSIQ

eg 1. Reduced hassle & time

Sort

Set

Shine

Standardise

Sustain

@robertvarnam #GPdev @NHSIQ

eg 1. Reduced hassle & time

Sort

Set

Shine

Standardise

Sustain

@robertvarnam #GPdev @NHSIQ

eg 1. Reduced hassle & time

Sort

Set

Shine

Standardise

Sustain

@robertvarnam #GPdev @NHSIQ

eg 1. Reduced hassle & time

Sort

Set

Shine

Standardise

Sustain

@robertvarnam #GPdev @NHSIQ

eg 1. Reduced hassle & time

@robertvarnam #GPdev @NHSIQ

eg 2. Better care & reduced costs

Handling of repeat prescriptions• source of “near-constant frustration for

staff”• already looked at several times

small, short-lived improvements

@robertvarnam #GPdev @NHSIQ

eg 2. Better care & reduced costs

PGP Prescribing Module saved 12 hours of receptionist time per

week• ‘script hunt’ reduced from 118 to 21 seconds• less time waiting for GPs• happier staff, less stressed

75% reduction in interruptions for GPs• happier GPs, feeling safer

50% drop in ‘urgent’ requests• less sense we’re working ‘on the brink’ all the

time

@robertvarnam #GPdev @NHSIQ

eg 3. Improvement AND transformation

Improving today’s practice

Process redesign• “given us a structured approach to

making improvements”

reduced the number of calls GPs have to make by 80% and released time for an extra 2 patients to be seen each day

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eg 3. Improvement AND transformation

@robertvarnam #GPdev @NHSIQ

eg 3. Improvement AND transformation

@robertvarnam #GPdev @NHSIQ

eg 3. Improvement AND transformation

Shaping our future practice

Radically re-thinking & transforming• focus on self-care, group

consultations, technology

patient-led design approach segmentation of high profile patient

groups proactive multiple LTC review clinics

@robertvarnam #GPdev @NHSIQ

Releasing time in general practice

The issue The Productive General Practice Examples Deployment Top tips

@robertvarnam #GPdev @NHSIQ

Deployment

• Appealing & relevant to wide variety of practices

• Most are doing PGP in collaboration with others

• Attractive in supporting CCGs’ system transformation strategies

• Time & commitment are essential

• Support is highly valued

• Additional training in improvement tools is helpful

@robertvarnam #GPdev @NHSIQ

NHS England’s strategic framework

Aug 13• Call to action on general practice.• Strategic framework for commissioning general practice. • 9 workstreams.

Mar 14• Emerging Findings

Apr 14• Phase Two

Learning networks

4. Business developmentLegal

Financial

Management

3. Capability-buildingService improvement

Leadership

1. Innovation spreadPeer networking

Innovation hub

National Coordinating Centre

Development advisers

Strategic leadership

Development advisers

National guidance

PMO support Evaluation

2. Release capacity

Bureaucracy

Clinical ‘clutter’

Internal productivity

General practice development programme

Release capacity

BureaucracyAdministrative pressures on practices originating within the NHS, particularly through contracting.

Clinical ‘clutter’Potentially avoidable demand for consultations created outside the practice.

The Productive General PracticeImproving efficiency in practice systems and processes.

@robertvarnam #GPdev @NHSIQ

Releasing time in general practice

The issue The Productive General Practice Examples Deployment Top tips

@robertvarnam #GPdev @NHSIQ

Top tips

Prepare, engage, explain, collaborate, support

@robertvarnam #GPdev @NHSIQ

@robertvarnam #GPdev @NHSIQ

Top tips

Create strategic alignment Create a values-based shared purpose

Do it collaboratively Engage, engage, engage

Be realistic about time commitment Build local support resource Use it as it is meant to be used

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@robertvarnam #GPdev @NHSIQ

www.nhsiq.nhs.uk/capacity-capability/productive-gp.aspx

enquiries@nhsiq.nhs.uk

robert.varnam@nhs.net

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