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

2. 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

3. 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 present
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

4. 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

5. £7.9bn Currently 7.2% of total NHS expenditure
Our health partnership
Quiz Question: How much money was invested in general practice in ?
£7.9bn
Currently 7.2% of total NHS expenditure
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities

6. 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

7. 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

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

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

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

11. 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

12. 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

13. 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

14. Our health partnership
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

15. “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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

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

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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. Our Health Partnership
Our Health Partnership
making life better for patients and practices, improving resilience and efficiencies, creating development opportunities