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General practice organisations explained

Posted by Blogs, The General Practice BlogNo Comments

If you don’t know a PACS from an MCP or if you are unsure of the difference between a Super Practice and a Federation then look no further! Click here to see Ockham Healthcare’s interactive guide to the confusing world of general practice organisations. The guide will take you through the eight main general practice organisations with links to the relevant guidance. The guide will open in another window. If you find this guide useful, or if you feel there are any other areas of general practice that would benefit from a similar approach – why not let us know in the comments section above.

 

 

 

 

 

 

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What the “Next Steps on the NHS 5 Year Forward View” means for General Practice

Posted by Blogs, The General Practice BlogNo Comments

Ben Gowland was excited by the promises made in the General Practice Forward View (GPFV) last year but, in this blog at the time, he expressed concern about the lack of any kind of accompanying financial plan. Now the government has published a “next steps” document which outlines the key priorities for the NHS over the next two years; and those concerns appear to be well founded.

There are 6 things general practice need to know about this document:

1. There will be £1bn less investment into General Practice than expected

In a cunning sleight of hand, the document reveals in a graph on p18 the promised £2.4bn additional expenditure into general practice uses a start point of April 2013, not the publication date of the GPFV (April 2016).   As well as leaving a bad taste in the mouth, it means the “extra” from 2016 is closer to £1.4bn, with the rate of growth of increase slowing from 2017 (now) onwards.

2. “5000 additional GPs” will become “the highest number of GPs in training ever”

Instead of saying there will not be an additional 5000 GPs and fronting that out, the document trails what will undoubtedly be the line the government and others will take in future that there are more GPs in training than ever before.

3. Extended Access is all

The one part of the GPFV the government really does care about is extending GP access. “By March 2018, the Mandate requires that 40% of the country will benefit from extended access to GP appointments at evenings and weekends, but we are aiming for 50%. By March 2019 this will extend to 100% of the country” p19. The additional funding for access, meanwhile, does not kick in until April 2019 and April 2020, a fact the document makes no attempt to address.

4. QOF will go, and be “reinvested”

Any practice bruised by the recent PMS reviews or removal of MPIG may be nervous to read the following, “We will seek to develop and agree with relevant stakeholders a successor to QOF, which would allow the reinvestment of £700M a year into improved patient access, professionally-led quality improvement, greater population health management, and patients’ supported self-management, to reduce avoidable demand in secondary care”. GPs are rightly nervous of the term “reinvestment”, as it generally means expecting them to continue doing what they are doing now, as well as undertaking additional activities to earn exactly the same amount of money, or even less if some of that “reinvested” money is siphoned off into networks, hubs, or CCG financial positions.

5. 30-50,000 is definitely the magic number

Most practices are seeing the writing on the wall that getting to this population size is going to be necessary one way or the other, but this document clearly reaffirms it. Badged as encouraging practices to work in networks or hubs, it clarifies (underlined) “the model does not require practice mergers or closures” (p21), while at the same time promising funding incentives to accelerate the move to reach this magic population number.

6. GP-led CCGs will be usurped by more powerful STPs

The whole section on STPs is crafted as a work around legislation to take responsibility away from CCGs and give it to STPs, and in some cases turn them into something called Accountable Care Systems (ACSs). These “will be an evolved version of an STP that is working as a locally integrated health system. They are systems in which NHS organisations (both commissioners and providers), often in partnership with local authorities, choose to take on clear collective responsibility for resources and population health” (p35).

Nearly exactly one year on from the publication of the GPFV it feels like we have just moved two steps backwards from the forward steps of last year. Then it felt like the current plight of general practice was recognised, whereas now that recognition feels absent once again, replaced instead with a simplistic view that operating at scale is a straightforward solution and an almost blinkered focus on extending GP access.

29
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Putting the pride back into general practice

Posted by Blogs, The General Practice BlogNo Comments

In his second guest blog for us, mergers expert Robert McCartney argues that general practice will best thrive where there is a good balance of strong leadership and co-operation coupled with independence and the freedom to innovate.

The old expression of ‘herding cats’ was used when I first told people that I would be moving into primary care and working with GPs. Moving from the structures of an NHS trust the initial impression of primary care did feel like this.

Processes would be agreed and targets set but whether they were actioned felt like it depended upon the whim of the individual. As they hold significant power regardless of the position within the practice it was difficult to influence and change this mind set.

It dawned on me that traditional management structures and processes, particularly those largely learnt within the NHS were not appropriate for working with GPs. They are partially based on the belief that teams do need to be controlled and directed as a ‘herd’. Although this does have its place, particularly in larger teams needing to pull in the same direction it is less efficient with smaller groups were individuality is held at a greater value.

When considering the nature and reasons many doctors decide to specialise as GPs it was evident that the analogy of the cat remained relevant. Both are independent, don’t like to be interfered with, enjoy opportunities to explore new avenues whilst always being loyal to their home.

These are strong characteristics and have both positive and negative affects if they are not identified and managed appropriately.

If there are these similarities, then instead of thinking about the ‘herd’ we should be thinking about the ‘pride’. Within the ‘pride’ there is strong leadership, a close-knit family feel to the group and clearly defined roles emphasising the importance of co-operation. They allow independence and encourage exploration, especially of the younger members, whilst ensuring that they work together for the common purpose.

By recognising these qualities and purposes we can improve the structures and relationships needed to continue the success of primary care. Within most practices the traditional partnership model allows this structure to exist. It allows the retention of freedom and independence, whilst clearly defining the boundaries to ensure it ultimately helps the common purpose.

Other professionals who often work in this ‘pride’ mentality include lawyers, IFAs and accountants and they frequently work in variations of the partnership model. Working at scale can and does work with this model.

Partnerships are under-pressure and there are many different alternatives being explored but as long as the principles of strong leadership offering independence with controls are applied these models can succeed.

I would recommend that when GPs, practice managers, commissioners and anyone else look at how primary care can be provided at scale that they do not forget the frequently shared personal traits and ensure new structures maximise the benefits these bring.

Robert is Managing Director of McCartney Healthcare Associates Limited. He is an expert on practice mergers and this is the second in a short series of blogs he will be writing for Ockham Healthcare. If your practice needs a helping hand with its fledgling relationships, you can contact Robert via e-mail at rm@mccartneyhealth.co.uk or call 0203 287 9336.

15
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The Six Stages to Effective GP Recruitment

Posted by Blogs, The General Practice BlogNo Comments

In this week’s Blog, guest blogger Nick Mattick demonstrates that GP recruitment cannot be rushed as he outlines the key stages to effective recruitment and spells out the common mistakes practices often make.

It’s a common misunderstanding in GP recruitment that spreading the net as wide as possible and throwing money around will solve the problem. But, in the current recruitment crisis where there are simply not enough GPs to go round, this is unlikely to be the case.

The reality is that your GP vacancy is only likely to appeal to certain people and to attract those people, you need a clearly defined strategy which outlines who they are and how you can target them. The lack of a strategy, or an ill-defined process may not only fail to deliver you any appropriate candidates – it could even lose you applicants who walk away in frustration.

In this blog I am outlining the six key stages to developing such a strategy. They are:

1.Define your candidate – What does the practice want and who is most likely to apply? Focus on who your candidates are likely to be dependent on the type and location of the job on offer. For instance candidates with young families are most likely to want facilities, infrastructure and flexible hours. Whereas those a little longer in the tooth, with the kids off at university, maybe downsizing and wanting to get away from the busy city.

What qualities might a successful candidate possess and how does the practice make itself more attractive to those candidates? Here, you need to consider how the practice will respond to issues such as work/life balance, portfolio roles, specialist training and, perhaps, opportunities to work with other practices to offer more exciting or innovative roles etc.

2.Candidate Attraction – This means getting your defined applicant to see your advert. Your advert is an excellent way to demonstrate what you have to offer candidates. But too often I see lazy adverts which say something bland like; “we’re a friendly team, this is our list size, our IT system and our opening times – come and work for us.” But adverts like those could be for any practice, anywhere in the country. You must find your unique selling point (your USP) and get applicants to become interested in the story you tell about yourself.

For your advert to stand out amongst all the others, you will need to advertise where your defined applicants are likely to be looking, so consider using Google AdWords, LinkedIn and Facebook; these have great tools to really focus on selling your job to the right people.

3.Candidate Handling – How do you deal with applicants once they have expressed an interest? Communication is key. Always acknowledge a CV and give a timeline for your process. Tell applicants what documents you will want from them, and ask them what they want from you.

Have ready all relevant documentation that applicants are likely to need including, as a minimum, the current Job Description and a Person Specification. But also consider CQC reports, Ofsted reports about local schools etc. Offer applicants informal visits and be prepared to help with estate agents or organising house viewings. And don’t forget to ensure your practice website is up-to-date.

4.The Interview – The interview is not just about candidates selling themselves to you; it is your chance to sell yourself to candidates. So be organized on the day and pre-plan questions; agree who will ask what questions when.

A clean, uncluttered, open and light room will put your candidate at ease. Try going informal – don’t sit behind a desk. Offer a tour of the practice and introduce them to colleagues – but most of all, however you do it, make them feel welcomed.

5.Negotiation – Once you have found your candidate you are aiming to achieve a Win: Win. You probably won’t get exactly what you are looking for and you probably aren’t exactly what the candidate is looking for either; so consider how you will “close the deal” and get both parties as close as possible to what they are looking for. Agree in advance what are “red lines” and what’s up for discussion. Many people, when recruiting, think it’s all about the money – but in most cases it isn’t. Find out what’s really most important to a candidate.

6.On-boarding – This is about getting your candidate to the start line and to hit the ground running. It’s more difficult in GP recruitment because of the long notice periods that lock GPs into jobs – usually for 3-6 months; so make sure you continue to engage with your candidate during this time.

Invite them to practice meetings or social events, offer help with finding somewhere to live, get all the paperwork and compliance done in advance and offer them an induction session before starting. Keep up the communication and start forming relationships early.

If you’re looking for an urgent start consider “buying them out” of their notice period. On Day One make sure you are ready for them to start with email and log-ins available, a list of who’s who and housekeeping issues clear such as how the phones work and how to get refreshments; and even think about, as a particularly nice touch – a welcome gift!

In essence then the key lessons for GP recruitment are:

Recruitment is not something that can be done over a sandwich at your desk – it requires a lot of effort, work and planning.

  • Don’t expect to place an ad in the BMJ and have candidates queuing at the door; you have to work for them.
  • It will take some compromise.
  • Don’t be locked into a mindset of replacing like for like recruitment is an opportunity to change, to freshen things up.
  • Recruitment is all about up-front planning, a clear process, adapting and communicating.
  • Above all – you need to sell, sell, sell!

Nick Mattick is an expert in Clinical Recruitment & Recruitment Strategy. Nick has worked for NHS and private healthcare service providers and recruitment agencies. You can contact Nick:

Call 029 2051 2517 or email Nicolas.mattick@me.com

 www.OliverRose.net

 Recruitment strategy, planning, help, support, advice & experience in all things Clinical Recruitment. We’re not an agency – we help you to avoid having to use one.

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