Practice Management
Salthill Hotel, Galway
17th September 2011
Agenda
What’s happening and what’s on our horizon?
How can we best manage our practices, and
prepare for the challenges ahead?
17th September 2011
Hot Topics in Primary Care
• FEMPI cuts on vaccines, Budget 2012
• Pilot project – GPs managing their own GMS lists to a
greater degree?
• Deregulation of GMS lists
• GMS contract renegotiations
• Chronic Disease Management in Primary Care
• Primary Care Teams
• HIQA
17th September 2011
Watchlist
• Late next week – Flu / adrenaline for pharmacists
and payments for flu vaccines due
• Your Health is Your Wealth: a Policy Framework for a
Healthier Ireland 2012 – 2020 (Consultation process
14 June – 30 Sept 2011)
• Health Information Bill - To provide a legislative
framework for the governance of information in the
health sector.
• Licencing of Health Facilities Bill - To provide for a
mandatory system of licensing for public and private
healthcare facilities.
17th September 2011
Inspections into General Practices
• NERA
• Health and Safety Authority
• HIQA (in future)
17th September 2011
NERA :
• Inspectors have right to
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To enter any premises at a reasonable time
To demand sight of records
To inspect records
To take copies of records
To interview and require information from any
relevant person
17th September 2011
Records for NERA Inspection
1. Employer registration number with the
Revenue Commissioners
2. Full Name, Address and PPS Number for each
employee (full-time and part-time)
3. Terms of employment for each employee
4. Payroll details (Gross to Net, Rate per hour,
Overtime, Deductions, Shift and other Premiums
and Allowances, Commissions and Bonuses,
Service Charges, etc.)
17th September 2011
Records for NERA inspection (2)
5. Copies of Payslips
6. Employees’ job classification
7. Dates of commencement and where relevant,
termination of employment
8. Hours of work for each employee (including
starting and finishing times, meal breaks and
rest periods). These may be in the form of Form
OWT1 (or in a form substantially to like effect).
17th September 2011
Records for NERA inspection (3)
9. Register of employees under 18 years of age
10. Whether board and/or lodgings are
provided and relevant details
11. Holidays and Public Holiday entitlements
received by each employee
12. Any documentation necessary to
demonstrate compliance with employment
rights legislation
17th September 2011
HSA
• Primary focus is preventative and educational
• Inspection focus
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Risk Assessments
Safety Statement
Safety Representative
Awareness of all staff of their responsibilities
Accident Reporting
17th September 2011
HIQA
• National Quality Standards for Residential Care
Settings for Older People in Ireland (Feb 2009)
• Report & Recommendations on Patient Referrals
from General Practice to Outpatient and Radiology
Services (March 2011)
• National Standard for Patient Referral Information
(March 2011)
• Standards for Health Information Governance
• National Standards for Safer Better Healthcare
17th September 2011
Background
• Report of the Commission on Patient Safety
and Quality Assurance, chaired by Dr Deirdre
Madden (2008) investigated a number of
serious shortcomings in the health services
and called for “Knowledgeable patients
receiving safe and effective care from skilled
professionals in appropriate environments
with assessed outcomes”
17th September 2011
Safer Better Healthcare Standards
8 “Themes”:
• Person Centred Care
• Leadership, Governance and Management
• Effective Care
• Safe Care
• Workforce
• Use of Resources
• Use of Information
• Promoting Better Health
17th September 2011
What to Expect?
• Standards to be published: which are general &
apply to almost all areas of healthcare
• Guidance documentation: to be issued specific
to different areas of healthcare
• Licencing system: a license will be required to
deliver healthcare
• Monitoring: Unclear exactly how standards will
be monitored (inspection/report or self
reporting)
17th September 2011
Similarities to UK
• Care Quality Commission in the UK – licensing
legislation passed in 2010
• Out-of-hours providers to register by 2012
• Primary medical services required to register
by 2013
17th September 2011
Lessons from Care of the Elderly
• Time & duration
• Methods employed: Observation, Record Check and
Interviews (patient, family, staff).
• Drilling down in specific areas
• Overview at end of visit with major issues identified
there and then
• Right to reply
• Report – agreed action plan
• Follow up visits
17th September 2011
Focus of Inspections
in Care of the Elderly
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Statement of purpose and function
Clear accountable management structures
All relevant policies in place
Risk management (both policy and practice)
Complaint handling and resolution
Finances / accounts
Notification of incidents to HIQA in
accordance with regulations
17th September 2011
How Best to Prepare?
• How can we demonstrate that we provide a
quality, safe service?
• Consider responsibilities and identify the lead
person or people in your Practice – both for
clinical aspects (Dr / Practice Nurse) and other
people in charge (Practice Manager).
• These people will need to become very
familiar with the standards once published.
• Involve all staff through education / practice.
17th September 2011
How Best to Prepare - Clinical
• Structured approach to quality assurance
• Conduct any necessary clinical audits & keep the
records (BMA guidance, HIQA guidance once
published)
• Record how you improve your service
• Conduct analysis of any adverse events on a regular,
defined basis and keep a record of lessons learned
from this
• Involve staff and patients
17th September 2011
How Best to Prepare - Governance
• Clear supervision structures
• Hold structured meetings and record minutes
• Have appropriate policies, procedures and guidance
documents in place
• Make sure these policies, procedures and guidance
documents actually reflect practice on the ground
• Ensure staff are trained in / familiar with policies,
procedures and guidelines
• Review documentation regularly
17th September 2011
How Best to Prepare - Staff
• Have a policy on recruitment and induction
• Ensure you have CVs, references, background
checks, garda clearances, job descriptions all
on file
• Demonstrate that you have assessed staff
training needs
• Ensure staff receive all mandatory training
• Keep good records
17th September 2011
Documents You Will Need
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Safety Statement
Fire Register
Statement of Purpose
Access Routes
Plans for Dealing with Emergencies
Written complaints process & complaints log
Feedback from Patients
Confidentiality Protocol
HR documentation
17th September 2011
The Practice Environment
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Access to the Practice & security
Housekeeping, general standard of repair
Infection Control
H& S Audit (Risk Assessments)
Keep records of improvements made
Consider having a premises development plan if
necessary
• Equipment should be safe and suitable, clean and
well maintained and staff trained in proper use
• Written schedule of maintenance visits
17th September 2011
Thank You
17th September 2011