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

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NPracticeBusiness

novemb

er 2012

Are you doing enough to tackle chronic conditions?

editor’s letterEXECUTIVE EDITORroy lilley

[email protected]

ASSISTANT EDITOR [email protected]

CLINICAL EDITORdr paul lamden

ACCOUNT [email protected]

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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’

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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

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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

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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”.

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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

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08 november 2012

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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.

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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

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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

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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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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

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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

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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

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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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case study

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]

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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

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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

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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

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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.”

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34 november 2012

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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

april 2012


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?

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Keeping schtum Quick ways to improve patient confidentiality

Fighting Fire with Fire One practice recovers after an arson attack


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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?

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november 2012 37

METHODICALMOLLIFICATION

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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

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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

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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

How about a concise weekly digest with expert analysis?

How do you keep up to speed with news and developments that affect your role?

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delivered to your inbox

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

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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 ?

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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

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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

[email protected]


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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?

*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,

Contact

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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

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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

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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


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june 2012






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PRACTICEBUS


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july 2012

MAKING PROVISIONS

GP retirement is o

n the up. Is


A UNITED FRONT


aller

practices su

rvive

THE

MAG

IC N

UMBE

R

The

impa

ct o

f 11

1 on

GP

prac

tices






MAKING PROVISIONS

GP retirement is o

n the up. Is


A UNITED FRONT


aller

practices su

rvive


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

[email protected]


020 7288 6833

[email protected] @


*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/

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Practice Business November 2012

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Transcript of Practice Business November 2012