Annual Report 2014The patient at the centre of everything that we do

GP Care UK Limited is registered with, and therefore licensed to provide services by, the Care Quality Commission (ID: 1-127835449). Company Registered in England, No. 06517384

Patients seen by GP Care 2007-2014

Who we are

GP Care is a provider of high quality patient services in the community. A federation of 100 GP practices from the Bristol and surrounding areas, we deliver patient care from convenient community settings across the UK.

2013 | 14

2012 | 13

2011 | 12

2010 | 11

ON ISSUE

10pence 2015

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Share Price

Key Financial HighlightsIncome

£2.08m2012/13

£1.90m2011/12

£1.67m2010/11

£2.67m2013/14

Capital Expenditure

£88,155

£5,413

£11,049

£183,254

Growth

9.4%

28.4%

GP Care is a clinician led organisation with a very clear patient focus

Our strategy

Our exceptional people provide excellent clinical care and customer service because we have the patient at the heart of everything we do. We are unique because of the innovative, efficient and responsive pathways that make the patients’ journey safe, quick, straight forward and close to home.

Exceptional People Exceptional Patient CareWhat we said we would do:Increase our range of patient services by seeking out new opportunities to diversify and developing strategic partnerships

Reach more patients by extending our geographical area

Deliver more patient services and better value to the NHS by working with commissioners

Work with our patients to quality control our services by surveying the patients and responding to feedback

Keep our team motivated and patient focussed by using every opportunity to develop and reward them, and to ensure we are recognised as an employer of choice

Develop our relationship with patients and their carers

What we did: We won new NHS contracts to provide patient friendly services in ultrasound, audiology, physiotherapy

We improved patient care by linking the GP with the specialist with our ‘Consultant Link’ service

We won contracts to provide new patient services in Wiltshire, Essex, Walsall, Gloucestershire, Hereford and Guildford

In partnership with Brisdoc, our local Out of Hours provider, we were successful in our bid for the Prime Minister’s Challenge Fund

We have developed a robust patient participation strategy

We created opportunities at a junior management level to motivate our staff and offer them progression

We have developed a highly successful apprenticeship programme in patient administration

What we will do next:We will continually revisit our patient pathways to ensure that we are delivering quality patient care and value for money

We will strive to increase our range of patient services by developing partnerships and expertise that will help us win new contracts

We will actively seek to deliver our existing patient services to CCGs across the country as they come up for tender.

We will bid for a range of contracts for new patient services including sole provider and AQPs

We are in the process of appointing two new Non-executive Directors to strengthen the skills, influence and experience of the Board

We are evaluating the strengths and gaps in our executive team as part of the process to appoint to the top leadership role

‘We only get involved where we can improve the patient experience’ It has been an exciting and interesting year and, significantly, one which has seen us providing services in new areas and working with patients and commissioners as far afield as Walsall and Colchester. We have been successful on a number of fronts particularly winning new NHS AQP contracts in Ultrasound, Audiology and MSK/Physiotherapy. We hope this has been good news for patients too as we strive to ensure our waiting times are low and the quality and consistency of our service is good.

The feedback we receive from patients is always much appreciated and we respond whenever possible to ensure our clinical services ‘hit the mark’ and exceed expectations.

Another key initiative for us over the past year is realising our ambition to work more

collaboratively with other providers. The Audiology contract in North East

Essex and working alongside Action on Hearing Loss (previously known

as the RNID) seemed like two opportunities that were too

good to miss.

After several months of discussion and hard work we are delighted to have set up an excellent service for patients in collaboration with Action on Hearing Loss, who provide the aftercare element of the service at

various locations across Colchester and Tendring.

We are looking forward to other similar ventures where GP Care

can offer added value to patient care by working with other providers

and recognised national charities who are experts in their field.

In April 2014 we started talking to Guildford and Waverley CCG about providing ‘Consultant Link’, a paperless

Advice and Guidance Service for their GPs. After only a few months involving clinicians on both sides, we recently launched the service in partnership with the Cardiologists at the Royal Surrey County Hospital.

We continue to receive significant national interest in Consultant Link and will report on new ventures via our website.

Andrea Robertson Director of Business Development

Our patient servicesNHS UrologyIn the year 2013-14, 2846 patients have been seen and discharged from our urology service.

Patients can attend clinics in any one of seven different locations in and around Bristol, South Gloucestershire & North Somerset.

All patients are seen within 21 days for routine referrals and within 14 days for 2-Week Wait and urgent referrals.

To further improve access and convenience for our patients we are trialling evening clinics every week and extending some Saturday clinics to offer more appointments.

We are also pleased to report that GP Care is trialling a process with North Bristol Trust as a referrer for CT scans which is an extension to our current service.

NHS DVTThe GP Care DVT Service has been operational for over 6 years now and during that time over 7500 patients have been referred, 4600 scans have been performed and over 1100 patients have been successfully anti-coagulated within the community.

The biggest change this year has been the introduction of the Rivaroxaban pathway following NICE approval for DVT treatment in July 2012. The DVT Team worked closely with the CCGs, the treatment centres, the Thrombosis Committee at North Bristol Trust and the manufacturer Bayer to create a new and safe pathway for patients as an alternative to treatment with Warfarin.

The aims of introducing the new Rivaroxaban pathway were:1 Benefits to patients; Greater treatment choice

Less impact on daily life More independence Less time at GP surgeries

2 Increased cost benefits to the NHS;

3 Further development of our already excellent workingrelationships with primary and secondary care.

Since the pathway went live in April 2013, 85% of the patients we have treated for confirmed DVT have chosen to be treated with Rivaroxaban.

Patients told us:

“Getting a DVT came as a great surprise to me. I didn’t want all the to-ing and fro-ing to

appointments to get my Warfarin level right so I chose Rivaroxaban

which has been very, very good, nothing short of excellent.”

“The staff were polite and informative. I was very impressed and I would recommend the

service very highly.”

“ I’m very happy with Rivaroxaban. It’s one

tablet a day; it’s easy.”

Following feedback from the acute trusts and in line with NICE guidance we took the opportunity to add the assessment and prescription of compression hosiery for patients on either the Warfarin or Rivaroxaban pathways.

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NHS AudiologyNHS patients registered in Bristol and South Gloucestershire, North East Essex and Herefordshire can be referred to the service by their GP.

GP Care’s Audiology Service provides free of charge hearing assessment and hearing aid fittings at convenient community clinic locations for NHS patients aged 50 and over who are suffering from gradual hearing loss.

We offer a personalised service for patients; we talk to patients and deliver excellent clinical care in a way that is friendly, convenient and well administered. We always offer a choice of clinic locations and agree a convenient appointment time.

Each patient has a lengthy hearing assessment when the audiologist will not only test hearing levels using a state of the art portable audiometer but also discuss with the patient the specific situations in which they have difficulty hearing.

An Individual Management Plan (IMP) captures all of this information. The patient is offered the hearing aid fitting and the audiologist will explain the realistic outcomes of wearing the aid.

Patients have a telephone number to call should they need any after care or more batteries. Telephone lines are open from 8.00am to 6.00pm with all calls being answered by a member of the GP Care admin team. During 2012 our average time to answer calls across all of GP Care’s services was just under 8 seconds.

We provide patients with immediate verbal reports and written reports where appropriate at the end of their appointment.

We pride ourselves on giving patients the best option in terms of technologically advanced hearing aids. Unique innovations include WhistleBlock technology which cancels any feedback to increase audibility to provide a natural sound quality. Another advantage is NoiseBlock processing which automatically detects and supresses background noise.

We are particularly delighted to be working with the national charity Action on Hearing Loss to maximise the benefits we can offer to people with hearing loss.

NHS UltrasoundThe Ultrasound team have had a very busy year with the rapid expansion and success of the new NHS contracts in Gloucestershire and Swindon.

The number of patients that we have looked after has grown hugely in the last year. We’ve welcomed a number of new clinical and administrative staff to support this growth in patient numbers.

Our Picture Archive and Communication System (PACS) has been developed to support the administration of

the clinics - now spread across 40 sites ensuring local access for all our patients.

We launched image sharing with other providers through the Image Exchange Portal, cementing relationships with Secondary Care teams and furthering our integration with the NHS. This has been very well received and helps us to ensure our patients’ treatment is seamless, as well as delivering a cost saving to the NHS in terms of avoiding repeat scans.

Our patient satisfaction surveys earned us Commissioning for Quality and

Innovation (CQUIN) payments from both Gloucestershire and Swindon

CCGs. Patients have commented how good it is to be able to go to

a GP Practice rather than a hospital and many have avoided the hospital environment entirely.

Our private ultrasound services Our private service is offered at several locations in the Bristol area and continues to be popular. Along with Abdominal Aortic Aneurysm Screening and Pregnancy Reassurance Scans, we launched an IVF package of 3 scans which has proved popular and successful.

1203 patients

2013|14

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2012|13

6740 patients

100005000

Minor Surgery Patients have loved our Minor Surgery Service this year and we have seen more people than ever for removal of lesions that are not available on the NHS. The service has gone from strength to strength in the last year with the highest patient volumes seen so far and enquiries continuing to increase.

Our experienced minor surgery clinicians have offered additional capacity and increased locations for GP Care patients which has kept waiting times within a week or two for consultation and procedure, all within a half-hour appointment.

The feedback we receive is excellent and the questionnaire sent to patients now includes the friends and family test which prompts more written comments than we have received previously, such as those below.

“I was very impressed with the whole service and the speed with which I was seen. I am very happy with the results. The doctor and call centre staff were lovely. I would not hesitate to use GP Care again myself or recommend you to friends/family. Thank you!!”Patients can be treated by GP Care’s Minor Surgery Service clinicians at 6 different GP practices across the Bristol area.

Physiotherapy The new Private Physiotherapy Service has now been running successfully for just over a year and has treated an increasing number of patients who have either self-referred or were referred by their insurance company, and with our high quality service, we continue to get busier. Meet the physiotherapists:

“Your skill as a therapist and ability to motivate has resulted in ‘better than expected’ results in my shoulder pain and function. This has restored my lifestyle which is SO important to offset the demands of my working life and the ravages of time. Many many thanks.”

Danny Brown Physiotherapist

Matthew Snell Physiotherapist

Nicole Jones Physiotherapist

GP Enterprise Awards 2014 winners: Best Use of Media and TechnologyThe GP Enterprise Awards are organised by GP magazine and GPonline, in association with the RCGP and sponsored by the MDU. The GP Care Consultant Link Service won ‘Best Use of Media and Technology’.

The Judges said:

“This is a very innovative service, which every GP would want to have in their area. The almost instant access to a consultant is so impressive. ”

NHS DVT – an award winning serviceIn February 2014 GP Care was recognised for the improvement to patient care and the cost benefits to the NHS of the Rivaroxaban pathway.

The service was awarded 3rd prize at the Thrombus Innovation awards.

“GP Care is always looking for ways to improve care pathways.”

Our people2013/14 has seen a real step change in the development of the GP Care organisation with the headcount now over 60! We take great satisfaction from the fact that we have managed to secure the services of some excellent clinicians and administrators who share our passion for excellent community based patient care.

We are very proud of our very robust recruitment and selection processes which have ensured that we are well placed to deliver top quality services and patient care, both in the Bristol area and in those areas where the business has geographically expanded. All new employees attend a thorough induction process during which time is spent in ensuring that everyone appreciates the Company’s values and passion for providing consistently excellent care for all our patients. We believe that it is this “personal touch” that sets us apart from other community based providers and this opinion is clearly supported by very positive patient participation survey feedback.

The continuing professional development of our team continues to be of paramount importance. Individual training needs are identified during the annual appraisal process and we regularly hold professional development days for clinicians and deliver patient focused training for our Health Care Assistants who support the delivery of our services. Monthly team meetings and the annual GP Care Staff Away Day are valuable sources of information sharing with the team and we continue to set great store by the feedback we receive from our bi-annual “Happiness at Work” survey.

A report from our apprenticesSince joining GP Care, we have been working on our NVQ

qualifications but the best aspect of our job has been the work we have been doing and the daily contact with

patients. Since starting at GP Care our first lesson has been about putting the patient first and at

the centre of everything we do. Our knowledge has grown about patient confidentiality and what happens behind the day to day running of our patient services. We have also expanded our skills on Microsoft programmes.

As well as completing our NVQ Business Admin Level 2 we have gained many

qualifications which include Maths, ICT and English and we have been appointed as

permanent patient co-ordinators. Patient feedback is important to us as it reflects how hard we work to

make sure patients are satisfied.

Patient feedback

“What a friendly local service. I was immediately put at ease by staff in the ultrasound clinic. The procedure was explained clearly and carried out with no sense of rushing and an overall feeling of real care and understanding.”

“A very relaxed atmosphere. Staff were very professional & kind and explained everything as they went along. I knew exactly what was happening & was therefore happy throughout the whole procedure.”

Away day This year’s Away Day saw a mix of clinical and administrative staff, along with some of the directors, spend a full dayat Westonbirt Arboretum in Gloucestershire to review our services and re-establish our goals and aspirations to make GP Care the leading healthcare provider for patient experience. It was a full and busy day that delivered many valuable outcomes and ended with a treasure hunt around the grounds and an award ceremony for outstanding performance in the workplace.

“Everyone associated with GP Care should take great pride in the huge commitment and enthusiasm of a team that is determined to keep the patient at the heart of everything we do”. Linda Chick HR Director

1 We don’t use answer phones – patients can always speakto a person immediately on phoning. The average call response time is 8 seconds;

2 We give patients clear and useful information about what toexpect of their investigations or treatment with us. And we keep them informed at every step of the way;

3 We ensure our clinics, which include some at weekends, run totime and we make every effort to ensure they can flex to extra demand when needed;

4 We see all patients as promptly as we can, usually wellinside our contract time limits – for them, the sooner the better;

5 We link GPs and specialists through our ‘Consultant Link’advice & guidance service to give primary care the confidence to continue to hold clinical responsibility, saving patient journeys to hospital and enhancing continuity for them;

6 We provide care from a network of quality-assuredprimary care premises saving patients time-consuming and costly visits to hospital sites but still with the appropriately skilled clinician providing the clinical intervention;

We get information back to the referring GP practice immediately so that if the patient needs a follow-up discussion their GP has the information to hand;

We evaluate constantly how the services are being received and act on that feedback.

Now the ‘One Care Consortium’ specifically will focus on:

Availability of the electronic patient record wherever that patient needs it to be;

Developing a ‘front-end’ to general practice that supports self-help or accessing community or primary care services;

Working cooperatively to streamline that access where that’s necessary over the whole 7-day week; and

Harmonising IT in primary care, facilitating its use by doctors and maximising its benefit to patients. We give our best efforts to redesigning and modernising care using every 21st century tool available to us. The centrality of the patient to us is an indicator of the degree of our professionalism - let’s keep them at the heart of everything.

Annie Kelly Operations Director

Dr Phil Yates Chairman

A message from the ChairmanIt’s tough to keep putting patients at the heart of everything. We all aspire to this but as budgets get tighter and margins reduce there’s a danger that we cut our cloth accordingly and reduce our level of service. The challenge for us is to be a ‘facilitator of the system’, someone that gets the components of medical care in the right place at the right time for the customer. It requires dedication and diligence to constantly consider how services would feel if we were experiencing them and remodel them accordingly.

Working hard to improve the ‘logistics’ around the patient experience is something close to us all. This year, with the launch of the One Care Consortium, local practices’ response to the Prime Minister’s Challenge Fund in association with Brisdoc and GP Care, we have some resource to fund some new initiatives.

Here’s a sample of initiatives GP Care has developed in approaching this:

Operations Director Annie Kelly talks about improving the patient experience and outcomes As part of NHS contract requirements we were obliged to implement the Friends and Family Test in our Gloucestershire and Swindon Ultrasound services during 2013/14. We took the decision to implement this across all our service areas and have been collecting data across the year. We are delighted to report that we achieved the targets set by the Commissioners and that 87% of patients surveyed would be “extremely likely” to recommend us to their friends and family and 100% of staff would too.

Changes to our exclusion criteria in our community DVT service now allow us to see more patients in the community. This relieves pressure on secondary care and gives patients the choice of 5 convenient community locations.

Our Rivaroxaban pathway is now very well established and over 80% of patients with positive DVT diagnosis are choosing this drug over Warfarin as it has fewer restrictions on diet, simpler dosing regime and does not require such frequent visits for monitoring purposes.

We have recently introduced weekday evening clinics within our community urology service which are proving very popular with patients who do not need to take time off work to attend appointments.

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The comments from patients were overwhelmingly positive and demonstrated how much they appreciated being able to be seen in a GP Practice that was local to them. They also highlighted how friendly and efficient our members of staff are.

87%Extremely likely to recommend to friends and family

12%Likely to recommend to friends and family

1%Neither likely nor unlikely

GP Care Friends & Family Survey Results

servicesdesigned around

the patient

we showkindness, dignity

and respect

we keep theGP informed

we talk tothe patient

high clinical quality

close to home

efficientcari

ng the patient

GP Care UK Limited, Christchurch Medical Centre, North Street, Downend, Bristol BS16 5SG

T 0117 9562100 0845 649 2100 F 0117 9562224 0845 649 2101 E info@gpcare.org.uk www.gpcare.org.uk

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