Practice Managers – a new breed
Dr Neil Turton
Chief Executive
16th October 2013
What is a Practice Manager?
Dr Turton’s remarkably unscientific analysis of The Practice Manager!
First Practice Management
Responsibilities of the post of 'Practice
Manager
NHS Careers
Collins English Dictionary
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Someone who is called a
Practice Manager!
You can ask for it to be created
Practice Manager Salary & Bonus Survey 2012
Who is running this business?
•
•
•
•
•
•
•
About £9bn per year
40,000 GPs (30,000 FTE)
75,000 practice staff (FTE)
8,100 practices
We are!
99% of population
300m + consultations per year
90% of NHS contacts
What about the challenges ahead?
Political
Economic
Social
Technical
Legal
Environment
Commissioning
Financial
pressures on
NHS
Flat
investment
Changes in
GP jobs
market
Rise in
demand
Increased
patient
expectations
Growing
population
with more
complex
needs
Increasing
prevalence of
long term
conditions
Aging
population
Ability for
community &
home based
care
Online access
Telephone
consultations
Skype
CQC
Inspection
Procurement
and
competition
law
Medico-legal
Premises
Sustainability
New GP
contract
Integration
8-8 7/7
working
It’s a big challenge!
How will we get there?
Gentlemen
amateurs?
Highly
organised &
trained
professionals?
What’s the future of General Practice?
A sustainable system of general
practice requires increases in
scale, scope and organisational
capacity, while preserving the
local small-scale points of
access to care that are highly
valued by patients.
Case Study: Salford Health Matters CIC
A social enterprise born in 2007
Community Interest Company
One of first wave NHS ‘spin-outs’
15,000 patients
3 purpose built premises across Salford
Multi-disciplinary team (44 staff)
Specialist homeless service
Ground-breaking children’s A&E avoidance project
(GP Awards and HSJ Awards finalists)
Social prescribing in partnership
Our Achievements 2007 - 2013
5 former PCTMS practices
1 Practice over 4 sites + homeless,
We now run…
children’s, and social prescribing
We inherited…
Secured on-going
PMS contract
Co-ordinated
Initial 5 year APMS contract
Fragmented
11,500
patient
15,000 patients
TUPEd
staff from separate teams
Uncoordinated
Low staff morale
Costly
Poor satisfaction
All salariedMore
staff inefficient
one organisation
Investors in
People
/ good morale
Cost
effective
6 hard years!
High patient satisfaction (mostly!)
Minimal patient involvement
Multi-disciplinary
Patient Forums
at each site
No trainees
GP, Nurse & social worker training
Poor
performing
Vision
+ Emis
server based systems
Common web-based IT platform
64% QOF
Primary
Care
96% QOF, CQC
compliant
Cost PCT £1.9m / year
Services
Cost £1.5m / year
(on £2m turnover)
No return on investment
Reinvested £120,000 in services
Inefficient
Practices
High performing
Our Structure
Board
Chief Executive
Clinical
Governance
Reporting
CBU
Senior Team
Leader
Clinical Director
(Ops & GP)
Team Leader
Clinical Lead
Team Leader
Clinical Lead
Team Leader
Clinical Lead
Clinical Director
(Nursing Lead)
Operational
delivery Team
Our business model
Site 7
franchise
Site 5
SHM Model of
Primary Care
Site 1
Salford
Site 4
Service
B
Site 2
CBU
Site 3
Service
A
New area,
e.g, Trafford
Site 6
Standard
Practice Costs
Our Central Business Unit (CBU)
The CBU provides the corporate infrastructure
1. Corporate Governance
Chief Executive
2. Finance
1.0 WTE
3. Human Resources
4. Quality Standards
5. Contract Management
Personal Assistant
/ Communications
6. IM&T
Lead
7. Estates
0.5 WTE
8. Health & Safety co-ordination
9. Business Continuity co-ordination
10. Communications & Engagement
Senior Team
Finance & HR
Leader
Manager
11. Project Management
1.0 WTE
0.5 WTE
12. Business Development
13. Central Administration
Contracts
Performance
Manager
1.0 WTE
Learning Points
Clear focus provided by company mission and values
Focus on quality – set high standards, invest in staff, PDR & training
Specialised roles – Finance, HR, Contract Performance, Business Development
Establish common systems and process (adopted a ISO9001 approach)
Necessity is the mother of invention – £100k year on year contract value reduction
Be consistent and systematic… but also shake it up – restructure, new roles, etc
Learn from mistakes and celebrate success - staff contributions, awards, etc.
It’s bloody hard work and we’re not there yet…
Where next? Our Business Strategy
Short-term: business improvement & consolidation
Investment in Leadership
Improve patient experience - add value at each stage in patient pathway
Further develop homeless, children’s & social prescribing services
Medium-term: organic growth
Steady list increase
Explore staff ownership model
Develop a new multi-agency health centre
Deliver integrated care services
Extend access
Practice acquisition and / or shared services
We are up for
the challenge…
…Are you?
Thank you
salfordhealthmatters.co.uk
neil.turton@nhs.net
0161 212 5818
07824 505 217