Transcript Private trader at Work

GENERAL MEDICAL SERVICES
GENERAL PRACTICE MANAGEMENT
Learning Outcomes
UNDERSTAND:
 The Scope of General Practice Management
 The various means by which GPs are contracted
 Key features of the Contractual and Partnership
Agreements and the Business Plan
 General Practice funding streams
Important History of General Practice
1948: Lord Beveridge, NHS is established, providing free health care for everyone
1952: College of General Practitioners is founded
1966: Family doctor charter facilitates payments for nursing staff and buildings
1976: Primary Care Act requires general practice principals to do vocational training
Mid 80s: Cost /Notional Rent Scheme, Practice Nurses and Practice Managers started
to appear
1990: General practice contract – Health Promotion Clinics. Fundholding introduced
1997: New contract enables general practitioners to choose to be salaried rather
than self employed Personal Medical Services. Money ran out
1999: Fundholding is replaced by Primary Care Groups and Trusts
2004: nGMS Contract - Doctors are allowed to stop providing out of hours care
Private trader at Work
Before the 20th century general practitioners worked as private traders,
treating patients only if they had the means to pay
Yesterday v Today
2 groups
GENERAL PRACTICE IS A BUSINESS
General Practice is a small people-centred
business
The business
partnership
is
owned
by
GPs are “independent contractors”
the
practice
WHAT DO YOU EXPECT
THE PRACTICE MANAGER
TO KNOW
AND BE
CAPABLE OF DOING?
NES GPMVTS MENU for LEARNING
LEARNING NEEDS ANALYSIS D
General Medical Services Contract (2003) Annex C:
Competency Framework For Practice Management
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Practice Operation and Development
Risk management and assessment
Partnership Issues
Patient and Community Service
Finance
Human Resources
Premises and Equipment
IM&T
Population Care
“IN A TIME OF TURBULENCE AND CHANGE, IT IS MORE TRUE THAN EVER THAT
KNOWLEDGE IS POWER”
Sir Francis Bacon and
J F Kennedy
IMPORTANT DOCUMENTS
to know about and use
• Practice GMS Contract
• Statement of Fees and Entitlements (SFE)
• NHS Circulars
• Partnership Agreement
GENERAL PRACTICE CONTRACTING
ARRANGEMENTS
LOCAL ADMINISTRATION LEVEL:
◦ Scotland – PCO ◦ England - PCT HB ◦ Wales -
Primary Care Organisations
Primary Care Trusts
Local Health Boards
4 CONTRACTUAL METHODS:
◦ General Medical Services Contract (GMS) – (a new GMS contract has been
in place since April 2004)
◦ Personal Medical Services agreements (PMS)
◦ Alternative Provider Medical Services (APMS), and
◦ Primary Care Led Medical Services (PCTMS).
A CONTRACT BETWEEN WHOM?
• Contract between a practice and a PCO
– all practice partners will enter contract with PCO
• Individual practice contractual terms come
from national “menu”
A PARTNERSHIP AGREEMENT
• A contract between the partners and should be kept up to date at all
times in order to be valid and thus effective.
• Although an oral partnership is a valid one, it is not to be recommended.
• In a PARTNERSHIP AT WILL, relations between partners are governed by
the Partnership Act 1890, unless some agreement to the contrary can be
proved.
• The Partnership Act was designed to cover all partnerships and does not
meet the specific needs of individual professions.
Partnership Act 1890.
Some consequences of being a partnership 'at will';
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Any partner may dissolve it at any time with no formal procedure
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Death or bankruptcy of a partner will automatically dissolve the partnership
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No partner(s) has the right to expel another for any reason
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No partner(s) has the automatic right to carry on the partnership
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The assets will be frozen immediately on dissolution
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Staff will be made redundant on dissolution
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All partners are entitled to an equal share of the assets
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All partners have equal liability for the debts
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No new partner may be appointed without a unanimous decision
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All partners may take part in the management of the partnership
Partnership Agreements
Document Hierarchy
The GMS Contract
Contractual and
Statutory Requirements
Practice Policies and
Procedures
GMS CONTRACT
Practice Based Lists
• Patients Registered with Practice not GP
• New Patient Right to See GP of Choice
»
Wait longer
• New Rules on Registering Patients
»
Clinician can refuse (violent patient)
»
Refer to another clinician if doesn’t provide service
»
New Rules Removing Patients
WHO are our PATIENTS?
Must provide primary medical services to the
following:
REGISTERED PATIENTS & TEMPORARY RESIDENTS
• provide appropriate ongoing treatment/care
• including provision of advice re patients health
(including health promotion) and referral to other
services.
IMMEDIATE NECESSARY TREATMENT
Must also provide primary medical services
required in core hours for any person (to
whom the practice has been requested to
provide treatment) owing to accident or
emergency at any place in practice area
This includes any medical emergency not just
services provided under this contract.
THE CONTRACT “MENU”
FIVE TYPES OF SERVICE
“Normal”
services:
1. Essential
2. Additional
“ Supplementary”
services:
1. Directed Enhanced
2. National Enhanced
3. Local Enhanced
ESSENTIAL SERVICES - MANDATORY
Practices must provide the following services during core hours
(8am-6.30pm)
Management of its registered patients & temporary residents
(TR) who are:
(a) ill, or believe themselves to be ill, with conditions from
which recovery in generally expected
(b) terminally ill
(c) suffering from chronic disease
delivered in the manner determined by the practice in
discussion with the patient.
ADDITIONAL SERVICES
• Normally expected of all practices but OPT-OUT possible
• These will mainly include services which are preventative:
– CHS
– Non-IUD contraception
– Non-intra partum maternity
– Childhood vaccinations and immunisations
– Cervical screening
– Curettage, cautery and cryocautery
OPTING-OUT
Either:
• temporary (emergencies)
• permanent (long-term problems)
PCOs and practices working together
Maximum 9-month process
Alternatives – other practices, PCO, other providers e.g. walk-in centres
Money removed from practice global sum
Patient access to services protected
LIST CLOSURE process
DIRECTED ENHANCED SERVICES
• OPT-IN for practice
• Obligatory for each PCO
• National specifications
• No one practice has to do but someone has to
– Services to violent patients
– Childhood vaccinations and immunisations financial
incentives
– Minor surgery
– Flu immunisations
NATIONAL ENHANCED SERVICES
OPT-IN - national terms and conditions
e.g.
Anticoagulant monitoring
Sexual health
Drug and alcohol misuse
Depression
Intra partum care
Near-patient testing
Immediate/first response care
IUCD
MS
Terminally ill
Learning
disabilities
Minor injuries
Homeless
LOCAL ENHANCED SERVICES
OPT-IN
• Response to specific local requirements
• Local terms, conditions and standards
• Possibly, innovative services for piloting and
evaluation
Payments
How can the practice income be increased?
Seniority & Other Payments eg
maternity, sickness
Quality & Outcome Framework
Enhanced Services
Global Sum or
Minimum Practice Income Guarantee
3
GLOBAL SUM
ESSENTIAL
&
ADDITIONAL
PREMISES
PROTECTED
TIME
QOF - ASSURED
QUALITY
MONEY
UNIFIED BUDGET
FUNDS
DIRECTED AND
NATIONAL
ENHANCED
PCO
£
PCO-MANAGED
LOCAL
ENHANCED
GUARANTEED
FUND(S)
IT
PRACTICE
ALTERNATIVE
PROVIDER
2011-2012 GMS CONTRACT AGREEMENT
Practice Expenses
For 2011-12, in order to reduce the risks of a further net pay cut for GPs,
we have agreed to an increase to the overall value of GMS contract payments
by 0.5 per cent, to support practices in meeting the costs of increased
expenses, including the pay award for employed staff with a full time
equivalent salary of less than £21,000. This increase will be delivered in
through a 2.53 per cent increase in the value of a QOF point from £127.29 to
£130.51.
This increase in the value of a QOF point is intended to deliver the full 0.5
per cent expenses increase agreed with NHS Employers.
Increased expenses – no reimbursement for Commercial waste disposal
BUSINESS PLANNING
“Alice's Adventures in Wonderland”
Alice comes to a fork in the road and asks the cat:
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“Would you tell me, please, which way I ought to go from here?”
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“That depends a good deal on where you want to get to”, said the Cat.
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“I don't much care where”, said Alice.
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“Then it doesn't matter which way you go”, said the Cat.
Rudderless, haphazard, reactive, poor communication and teamwork
BUSINESS PLAN
Needs:
• People – Personnel & Patients
• Organisational
• Operational
Plan:
• Vision and the Mission
• Practice Profile
• Running the Business
• Finance
ACTIVITY
The Practice Merger
The Task
 In groups of 5-6, consider the scenario
 Before commencing the exercise, nominate a spokesperson and a scribe.
 You have 20 minutes to brainstorm the issues
 You are not expected to solve the problems but to identify the issues
 The issues may be suitable tutorial topics