1 Identify and reduce excessive workload
All providers of care have suffered from rising workload and financial restrictions. To manage this, many have redefined their core work and reduced their workload by returning this work to the GP. Many practices have reached saturation point and are struggling to meet the needs of their registered population. Partners need to look at how they meet key demands, and audit workload to discover sources that they feel might be inappropriate or excessive. Identify the work that you are not funded to undertake and then discuss whether this can be stopped – always remembering your professional responsibilities to your patient.
Dr Nigel Watson is chair of the GPC’s commissioning and service development subcommittee, chief executive of Wessex LMC and a GP in the New Forest
2 Prepare for a tougher QOF
There are radical changes proposed for the QOF in the 2013/4 contract. It will be much more difficult to achieve QOF under the proposed contract compared with before, and achieving the top quartile will be very difficult. At my practice we plan to keep aiming for a broad range of points, but it will be too difficult to achieve the top quartile – it will mean that we will prioritise work.
We did two things at my practice. We looked at the changes and asked how to achieve QOF points if the contract proposals go through. At our practices we are hoping for a broad spread without aiming for the top quartile in most cases. We also bought an auto blood-pressure machine for the waiting room, which has reduced the burden on staff time in terms of blood pressure readings needed for QOF. We expect it to have paid for itself in the next year or two.
Dr Adam Jenkins is the vice-chair of Ealing, Hammersmith and Hounslow LMC and a GP in Greenford, west London
3 Make a 12-month plan for finances, and start a hiring freeze
Practices should aim to sustain themselves financially. Before April, partners and practice managers should check cash-flow arrangements. Keep cash in reserve if you can, and anticipate any impact from the loss of the MPIG. Staffing is every practice’s major outgoing, so don’t recruit any new staff or partners until April. Long-term commitments leave practices lumbered if income goes down – it is better to be short-staffed for a few months.
4 Negotiate a lease agreement to fix your service charges
In north-east London, a large number of practices operate out of healthcare centres, don’t have a contract with the PCT and have disputed their service charge. Many partnerships have fallen behind on payments. It’s hard to calculate the service charge but even harder to challenge invoices if there’s no agreement. We don’t know how NHS Property Services (PropCo) is going to operate or calculate service charges, but we can’t wait around to find out.
Dr Sella Shanmugadasan is chair of Tower Hamlets LMC and a GP in Shoreditch, east London
5 Make sure staff understand the CQC process
GPC guidance on CQC compliance, which we have been following at my practice, suggests you review policies, make sure all GPs and staff know the policies and use them. Our practice manager takes the lead but we’ve also appointed people as leads in different areas – for example, the nurses lead on infection control. We have also set up an intranet site so that the policies and procedures are in one place. We explained to staff that CQC inspections are part of an ongoing process. Keep reviewing policies regularly and give staff the confidence they’ll need when the inspector knocks.
Dr Richard Vautrey is deputy chair of the GPC and a GP in Leeds.
6 Ensure compliance with CQC standards
By all means take forward your plans for the CQC by updating policies and procedures, training staff, setting up systems for ongoing notifications to the CQC, and so on. But concentrate mainly on ensuring you meet standards. If you are struggling with some of them, prepare plans to tackle problem areas, with a realistic timescale and implementation plan. This will prove to your CQC inspector you are taking the issues seriously.
Dr Sobhi Sadek is a GP in Northampton
7 Help your CCG resource GPs for key work
If local commissioners want to run a new service, GPs should help them plan resources. In our area the CCG wanted to run a new records service for patients in palliative care, so we suggested ways it could be run and resourced by the CCG through general practice. Communication and engagement are key to the success of new initiatives, and the capacity for partners to commit to services outside core work.
Dr Deborah Colvin is chair of City and Hackney LMC and a GP in Hackney, east London
8 Research how your practice will be affected by local cuts and rationing
General practice, as ever, will be expected to pick up the slack – and the bill – when cuts are made. We need to learn to trust what we know and be prepared to fight hard for it.
This means keeping in touch with local commissioning strategies, paying attention to CCG communications and reading commentaries from other agencies. We need to be able to respond to top-down impositions through lobbying, petitioning the public and learning about platforms for public communication. Developing relationships with local, trade and national media and employing PR experts will be key skills. We need also to forge alliances with local councils – as highlighted in the Lewisham hospital campaign where the mayor waded in.
Dr Andy Field is a GP in York. Read more advice on Dr Field’s tip in his CCG insight column.
9 Prepare for cuts to local enhanced services
Keep an eye on what is happening to Local Enhanced Services. Most will fall under the control of CCGs, but some will be commissioned (or paid for) by the local authority, with CCGs or the NHS Commissioning Board involved in their detail. The risk is that funding for some LESs will be stopped. If that is the case, stop doing the work and raise the issue with your CCG and LMC. They may relaunch a LES, or make interim payments for you to continue the work while they decide whether to sustain it.
There is a clear opportunity to renegotiate LESs where they have been poorly funded or run under onerous conditions. But if practices are not robust in their approach to delivery and pricing, they could find themselves delivering more and more for less and less. Do your research and plan which services to launch, lobby for and pitch for.
Dr John Ashcroft is a vice-chair of Derbyshire LMC and a GP in Ilkeston
10 Get to grips with the Any Qualified Provider model
From April 2013 it will be up to CCGs to decide when and where to use AQP as a commissioning tool. Some practices will want to bid for new AQP contracts, but they must be fully aware of the terms.
AQP contracts are based on competition, not price. The award for a successful contract is based on the national tariff. These contracts vary from the LESs. AQP funding is paid retrospectively based on the number of referrals. Even if it’s a good service, if it’s not used there might be less return on your investment. In that respect, they’re unlike LESs where you can plan the finance you’ll get for undertaking them.
Preparing a pitch takes 40-50 hours or longer. You will need to invest in staff, equipment and other resources. You may also need to rely on co-operation with secondary and community care. I’d recommend partners look at what AQP contracts will be available in future, and research the opportunities and risks.
Dr George Rae is a GPC member and a GP in Newcastle upon Tyne
