Our Health Partnership “Show me the money” Sam Dawlatly 16.6.2016 South Birmingham VTS Our Health Partnership making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

What are we going to discuss? Our health partnership What are we going to discuss? Who am I? What are your plans? The bigger picture How this affects you making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

A bit about me University of Birmingham; Jul 2005 Our health partnership A bit about me University of Birmingham; Jul 2005 South Birmingham; VTS 2007 – 2012 Locum and Salaried work; Aug 2012 – May 2013 GP Partner Leach Heath Medical Centre; June 2013 – March 2014 GP Partner Jiggins Lane Medical Centre; May 2014 – present Managing Board Partner; Our Health Partnership Nov 2015 - present making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Other interests Social Media BMJ Blogs Pulse Today blogs BMA News Our health partnership Other interests Social Media BMJ Blogs Pulse Today blogs BMA News Medical Education Creative bits and bobs making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

£7.9bn Currently 7.2% of total NHS expenditure Our health partnership Quiz Question: How much money was invested in general practice in 2014-2015? £7.9bn Currently 7.2% of total NHS expenditure making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Our health partnership What percentage of the NHS budget was invested in general practice 10 years ago? 11% So a reduction of 34% making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Are we doing less work for a smaller slice of the pie? Our health partnership Are we doing less work for a smaller slice of the pie? making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Our health partnership making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Our health partnership making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Our health partnership making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

So we’re getting a smaller share of the budget for doing more work… Our health partnership So we’re getting a smaller share of the budget for doing more work… Where is the we have money going? making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

What are the definitions of the following income streams? Our health partnership What are the definitions of the following income streams? Global Sum MPIG correction factor Premises payments Seniority payments QOF payments DES NES LES Which are being phased out? making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

How much of spending on primary care overall goes on: Our health partnership How much of spending on primary care overall goes on: Funding stream Spend Percentage Global Sum MPIG correction factor Premises payments Seniority payments Total QOF payments Total DES Total NES Total LES Other spend* 40.79% making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Our health partnership https://www.bma.org.uk/advice/employment/gp-practices/focus-on-gp-funding-changes Funding stream Spend Percentage Global Sum £2,306,454,858 28.87% MPIG correction factor £106,751,260 1.34% Premises payments £671,774,253 8.41% Seniority payments £124,101,375/td> 1.55% Total QOF payments £722,393,794 9.04% Total DES £577,496,187 7.23% Total NES £9,664,849 0.12% Total LES £212,470,789 2.66% Other spend* £3,259,216,796 40.79% making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

“Other payments” retainer scheme payments locum allowances Our health partnership “Other payments” retainer scheme payments locum allowances prolonged study leave appraisal-appraiser costs (locums) PCO admin costs (CCGs) IM&T, balance of PMS expenditure non-DES item pneumococcal vaccine/childhood immunisation main programme prescribing fee payments dispensing fee payments reimbursement of drugs making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Our health partnership Added to that is the need for efficiencies in the NHS But perhaps some good news The GP Forward View making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

GP Forward View £2.4 bn extra for primary care over next 5 years Our health partnership GP Forward View £2.4 bn extra for primary care over next 5 years Government at least realise now that there is a problem Too little too late? Conditional – what is needed in return? making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Take home message is: Constantly changing streams of income Our health partnership Take home message is: Constantly changing streams of income Leading to increased bureaucracy for partners and practice managers making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

How does this affect you? Our health partnership How does this affect you? Variable incomes Variable outgoings making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

GP Reg Salaried GP Partner Our health partnership   GP Reg Salaried GP Partner Gross 52200 64000 100000 Pensions (Employer Contribution 14%) 14000 New Gross 86000 Pensions (Employee Contribution 13%) 6800 8320 13000 Taxable Income 45400 55680 73000 Basic Rate Tax (20%) 8000 Higher Rate Tax (40%) 2160 6300 13200 Income after Tax and Pensions 35240 41380 51800 Per Month 3000 3500 4300 making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

It’s not just about the money Our health partnership It’s not just about the money What are the other benefits/drawbacks of partnership, salaried and locum work? making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

What are the effects of the imbalance between income and workload? Our health partnership What are the effects of the imbalance between income and workload? making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

“Triangle of Doom” Our health partnership making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Put another way -> Our health partnership making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Can you come up with any solutions to break this vicious circle? Our health partnership Can you come up with any solutions to break this vicious circle? Discuss in groups of 3-4 and then we’ll discuss making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

We may have come up with some of the following: Our health partnership We may have come up with some of the following: Decreasing workload Decreasing patient demand Decreasing regulation Recruit more GPs Retain more GPs Improve morale … but how? making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Could general practice at scale can offer effective solutions? Our health partnership Could general practice at scale can offer effective solutions? making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

What are the following? What are the differences? Our health partnership What are the following? What are the differences? Federation Super-practice Super-partnership making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

What can be the benefits of working at scale? Our health partnership What can be the benefits of working at scale? Benefits of scale – economy, workload Share challenges and solutions e.g. salaried doctor pool rather than ad hoc locum cover Influence as ‘system player’ – a strong voice to start shifting the emphasis of care provision Potential to develop into broader provider (MCP) Ability to adapt to the political pressure for change and care to be delivered through larger organisations making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

How could future streams of income change? Our health partnership How could future streams of income change? making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

If there is not much more money – how could we be more efficient? Our health partnership If there is not much more money – how could we be more efficient? making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

What are the potential downsides to GP at scale Our health partnership What are the potential downsides to GP at scale making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Not just about the money Our health partnership Not just about the money Workload There is an impending workforce crisis Bureaucracy Shared back office function can decrease this Regulation (CQC) Support and shared registration making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Our Health Partnership as a case study Formed in November 2015 Largest super-partnership in the UK 32 member practices (35 sites) 146 partners, >750 staff 280,000 patients making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Our Health Partnership as a case study making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Our Health Partnership as a case study Strategic management board of 7 elected partners Managing director, Operations director and Finance Director run the business “Profit centre” model – to preserve as much autonomy for practices as possible making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Strategic aims Twin aims: Strong and sustainable General Practice Our health partnership Strategic aims Twin aims: Strong and sustainable General Practice Broader service provision Priorities: Make GP partnership an attractive option for doctors Sustain and improve the local services that patients value Integrate and influence at system level – a strong voice Develop a wider range of services making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Relevance to GP registrars Our health partnership Relevance to GP registrars GP at scale is here to stay Important to understand the flexibility and stability that can be offered Preferred locum list Flexible salaried jobs across sites Partnership The bigger, long term picture making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

What a super-partnership salaried position may look like Our health partnership What a super-partnership salaried position may look like 2 year post-CCT “fellowship Mentor and study budget (£1.5k pa) One day a week at “home site” Flexibility for other sessions Chance to see what practices like, hopefully leading to partnership making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Our health partnership Some final thoughts We believe in the partnership model for general practice (vs. all salaried) To work it needs more people to become partners Could argue that GP at scale is response to poor funding Pragmatic response making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Any thoughts, questions or comments? Our health partnership Thank you Any thoughts, questions or comments? making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

Our Health Partnership Samir.dawlatly@gmail.com www.ourhealthpartnership.com Our Health Partnership making life better for patients and practices, improving resilience and efficiencies, creating development opportunities