Presentation to East Staffordshire Primary Care Partnership Dr Neil Paul GP

Howbeck Healthcare – A bit about us Who we are - Formed in 2014, we are a management and IT consultancy company; our main business is helping GPs to create and maintain GP Federations. Who we support - South Cheshire and Vale Royal GP Alliance, North Staffordshire GP Federation, and more recently East Staffordshire Primary Care Partnership (we now cover 100+ GP Practices and a population of over 880,000 in total). Our team – We are experienced and innovative with a wide range of skills between us enabling us to support our Federations to: Bid for new income Transform to adapt to the changing NHS Work on joint procurement opportunities Help win service contracts; and Find solutions to improve productivity Our IT solutions - We work with a range of IT companies to provide solutions - either in advising them on how to change / adapt their products or by directly commissioning solutions. We have won over £4 million of new income for our existing clients. Find out more: www.howbeckhealthcare.co.uk

Our principles & how we can help We believe Federations should be clinically led and managerially supported. That local clinicians should be in the driving seat and should be concentrating on clinical things and delivering change, not worrying about the operational running of an organisation. Howbeck Healthcare provides support services for a Federation; including HR contracts, payroll, bid writing etc. Whatever you need or don’t have. We provide access to people and resources that otherwise you might not have access to or be able to afford. We can also provide strategic advice, access to our networks, horizon scanning, experience and examples from other areas of what works and what doesn’t, access to at scale ideas and options. We believe for some projects there are benefits in working with other Federations in a network at Supra-Federation level and we facilitate that.

We have a track record of helping win money & bids Over £4 Million so far

Does Size Matter? Practices –> Federations or bigger? Aims / Goals of a Federation Increase practice income? Reduce practice expenses? Practice survival? Create new structure? Share back office? Salaried service? Representing general practice? Running new services? Provider led commissioning? Delivering ACS? Different levels of scale work best to deliver different aims / goals Practice level Locality level Like minded level CCG / Federation Supra Federation There are different models of how to evolve General Practice = Working at Scale Project – Sue Ikin

Some Advice… Stuff we got wrong to begin with.. Deliver Deliver on things and celebrate your successes Be SMART Have clear reasons and project plans and measures of success – know if you are making a difference – be able to articulate this Communicate COMMUNICATE! With members / practices / partners Governance Have clear roles, accountability and governance – helps to establish credibility and win funding Purpose Have a clear purpose – doesn’t have to be one thing but know what you are about. Understand Understand why people want a federation

A menu of choices Mixed practice / hub extended hours scheme Clinical Trials / Research Buying Group Websites/ Communication manager First Derm Reception competency framework / training package Locum Bank App Lexacom Cloud Physio First Freedom to Speak Up Guardian Alternative solutions – social prescribing scheme Endoscope-i / Medefer AF screening project Mental Health Workers QOF prevalence work – Data Quality Work ICS pharma work Occupational Health Contract IT ideas / projects Inc. IThealthchecks – training – support Diabetes Project with MSD-i Early Visiting Scheme Training Hub PAs and HCP / Nurse training

New Extended hours Scheme £6 / head to replace Ext Hours DES Service is likely to be tendered openly Threats to General Practice of a hub only solution from a 3rd party Lot of money goes into infrastructure / setup Lot of money could go to alt provider / locums etc Lot of fragmented care, workload for practices… your pt was seen last night Poor patient satisfaction

Our proposed model - Primary care delivers both in house & in hub Mixture of hubs open evenings and weekends seeing book on the day work either from practices or 111. Use existing practices if possible Practices open when they can – early mornings – evenings – some weekends – don’t worry about every session. Use own staff where possible but can buy in - preferably with continuity. Utilise marginal costs and economies of scale to keep money in primary care – multiple GPs at once – other staff inc. physios – counsellors – minor surgery – group sessions Could have some practices seeing others pts. Could have GPs from other practices who cant open their own

Mixed practice / hub model Can deliver a lot of activity Can deliver at marginal cost so more money into primary care Patients often prefer own practice - ?own GP Promotes continuity of care Can deliver more capacity in practice Access to more workforce – who might not be free during the day Get paid more to do more! Different ways – share it out – pay the person – hire someone in – skill mix

Summary Using a mixed model including GP practice delivery we believe up to £4 / head can stay in primary care You can utilise your winter pressures hub Patients will prefer it We have a lot of experience running / delivering this

A menu of choices Mixed practice / hub extended hours scheme Apex BI Tool Clinical Trials / Research Buying Group Websites / Comms manager First Derm Reception competency framework / training package Locum Bank App Lexacom Cloud Physio First Freedom to speak up Guardian Alternative solutions – social prescribing scheme Endoscope-i /Medefer AF screening project Mental Health Workers QOF prevalence work – Data Quality Work ICS pharma work Occupational Health Contract IT ideas/projects inc healthchecks – training – support Diabetes Project with MSD-I Early Visiting Scheme Training Hub PAs and HCP/Nurse training

Apex BI Tool

Clinical Trials NHS is really keen on this Huge amounts of money thrown around New income for people / practices Interest outside of day job Brings in skills / knowledge / expertise Variable level of interest / engagement ok – can work at multiple levels

Buying Group Working at Supra-Federation level we can Afford someone to concentrate on this Beat most deals JOIN! Seriously – disengagement appears to ne the only limiting factor.

A federation website (about to go Live) Websites A federation website (about to go Live) Calendar of events Wikipedia / knowledgebase of info – useful resource Info on Aims/Purpose/People Practice websites for those that want them (£200 – cheapest on the market) Helping reduce practice workload - self help - FAQs Supported by a comms manager who reduces practice workload – including running self care campaigns keeping stuff up to date GPASK A Secure “whats app” like group Allows Q&A between clinicians including AHPs, community and secondary care if wanted. Take a look at: One of our other Federation websites: http://www.scvr.org.uk/ One of our practice websites: http://www.sandbachgps.nhs.uk/

First Derm – Tele Dermatology Advising GPs NOT Triaging referrals Take photo on Smart Phone Type in question Get help in 1hour - 1day For difficult cases not everything Get the right diagnosis Advice on Treatment Reduces return visits Reduces Prescription costs Improves patient satisfaction Reasonable cost GP remains in charge and in control its advice not a referral Range of developments possible Find out more: https://www.howbeckhealthcare.co.uk/2017/11/11/first-derm-web-app-rapid-consultant-dermatologist-advice-gps/

HR bundle Working with a training provider to develop a competency framework / assessment tool / learning package for practice staff perhaps including clinicians. Link it to working at scale project – centrally procured HR expertise / standardised contracts / employment / recruitment Size helps – so need to understand level of interest / engagement

Locum Bank App Retired GPs scheme App to link practices to pool of GPs Expanding to cover all locums Bigger pool Developments coming Ability to advertise jobs Other HCPs

Lexacom Cloud Joined up cloud solution that has Bulk savings Advantages from same client in training / support / mobile staff Allows mobile working Ability to move work around the system Links to outsourced typing companies Can link to Speech Recognition and in EMIS / Office apps.

Freedom To Speak Up Guardian Contractual requirement for primary care from September 2017.  Freedom to Speak Up Guardian must be independent of the practice.  Howbeck Healthcare has appointed a small team to lead and manage the scheme across our Federations.  We provide policies and processes to meet the NHS England and CQC compliance requirements for Freedom to Speak Up. Practices can demonstrate: There is a clear positive procedure in place There is support and advice which can be easily accessed to help staff Concerns are taken seriously and clear records are kept Staff are aware of what will happen having raised a concern and will be kept informed

Alternative Solutions: A Social Prescribing scheme Run by Pathways CIC SCVR funded through a pot Very positive feedback from practices / clinicians who are using it Need to think about how to widen its use / uptake / awareness Some work on pre identifying pts to refer rather than waiting for them to come in.

AccuRx Chain decision support Dynamic decision support using NICE, PHE, BNF and local guidelines Chain Workup provides advice on management of a given diagnosis, based on medical record and clinician input Dynamic questions Patient specific guidelines EMIS notes automatically generated Coded entry, red flags documented Chain Formulary identifies appropriate prescription, checking record for contraindications Contraindications pre-answered from EMIS Clear view of record search Guideline drug recommended Access to source guidelines Chain Advice sends and prints self-management advice, automatically tailored to the patient Patient receives SMS message with a link Specific comments can be added to the advice Advice tailored to patient Clear safety netting

AccuRx Stream Comprehensive package to enable safe and effective skill mix shift Currently in development in Oxfordshire Stream Reception

There’s more…. our AIM is to help you find the money to do these PROJECTS as well as helping you deliver them