1. Presentation to East Staffordshire Primary Care Partnership
Dr Neil Paul GP

2. 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:

3. 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.

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Apex BI Tool

14. 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

15. 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.

16. 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:
One of our practice websites:

17. 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:

18. 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

19. 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

20. 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.

21. 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

22. 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.

23. 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

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

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