1. NAGPC NAGPC National Association of GP Co-operatives Represents & Supports GP Co-operatives & Promotes Quality OOH Patient Care www.nagpc.org.uk Website Sponsored by

2. NAGPC Dr Mark Reynolds MBE NAGPC Chairman Desired organisational characteristics Directors liability

3. NAGPC Last years NAGPC Conference “At the Crossroads ” PIO - CIC - PIC was a popular option PCT merger a safe house

4. NAGPC Patient PCO + Practices Co-operative OOH + Clinical Services Day Support Enhanced Services Nursing Transport A & E Pre Triage? NHSD WIC Access

5. NAGPC A Once in a Career Chance!! But How can we make it happen? Who can make it happen?

6. NAGPC Whole System Approach for a Whole NHS Change

7. NAGPC Key components Motivation Caseload GP Involvement Skill Mix Organisational structure Integration Leadership Contracting Beyond Short term planning, risk sharing? Directors liability

8. NAGPC Making it Happen Unprecedented PCT co-operation Must have an authorised lead Must involve co-design Must trust expertise Can you do this? Does the StHA need to be much more involved?

9. NAGPC Someone must have authority to facilitate and create essential collaboration - where it is not happening

10. NAGPC Remember Date X?

11. NAGPC £££££ Whole System Whole Budget Released GMS not enough in many areas Whole team thinking helps

12. NAGPC Skill Mix- The New Teams No recognised “OOH” qualification Not enough- not yet Senior GPs must help build teams GPs “in team” will manage uncertainty Significant advantage to a team with experienced GP players Examples exist

13. NAGPC Leadership Small empowered team Mandated by committees Chief Executive/Director Primary Care/Medical Director/General Manager

14. NAGPC Beyond short term planning Must look to the future Staff need security NHS needs stability after change Integration will take time Initial structures must be flexible Joint sharing of financial and governance risk? – the payback for “open books”?

15. NAGPC GP Recruitment A new relationship A new and rewarding job A new flexible contracting process BUT - must demonstrate commitment Maybe yearly contracts (at least?) with six monthly rolling renewal Significant career opportunity

16. NAGPC Motivation Para GPs - minimum red tape GPs - conditions, involvement, pay Managers - security, conditions, creativity Staff - local knowledge and expertise

17. NAGPC Integration Patient need first Coincidence of policy + need Careers to be made Chief Execs and SHAs - please! Leadership - influence or power? Intelligent patient journeys Whole system back-up

18. NAGPC Organisational Structure Involve and motivate workers Be NHS/public services motivated Involve all relevant contributors Be able to create change Be stable Be fast moving Be liked by the public Reflect developing skill mix Be independent?

19. NAGPC GP Involvement- Managerial Please use those who know how Complex relationships and clinical consequences Very separate, until now Clinical/managerial expertise - Leaders! Will manage the risk of work transfer to acute sector

20. NAGPC GP Involvement & Caseload 40-60% of OOH Pts presenting to nurse fronted co-ops need a GP (a working estimate) No GPs would result in a major increase in patients to A and E Cost ?

21. NAGPC Contracting What level of detail? –Organisational –Financial Look at what has worked Is PCT process motivating ?

22. NAGPC Directors Liability Essentially; “..Will I be personally liable for the medical consequences of a lack of doctors?” But there must be negligence for there to be liability

23. NAGPC Directors Liability mitigated by Managerial approach Rota planning Sharing the problem, scale, partnerships Opt out planning

24. NAGPC Managerial Approaches Assess caseload Match to clinicians Robust rota Horizon planning

25. NAGPC Rota Planning- for management Commitment- one year ? Include “bad shifts” if necessary Three month planned, nine months hours ? Renewed six monthly on a roll over basis BUT- for clinical owners Flexible Enjoyable Team approach Properly paid Influence on style, content, workload

26. NAGPC Rota Problem Foreseen Share problem with the whole system Back to PCT Whole system reset Skill mix deployment Alter terms and conditions

27. NAGPC Opt Out Planning Structure Establish PCT and SHA criteria Phased ? –Financial –Organisational Advanced clinician planning

28. NAGPC Summary GP directors must not be responsible for the consequences of a national problem outside their control. This approach decreases liability. How is this issue dealt with in a mutual structure?

29. NAGPC Huge new role in sharing good practice and innovation Structures, practical assistance and troubleshooting Implementing REC, assisting the wider vision GP Contracting process and best practice Skill mix integration and education Political representation and lobbying Day service development practicalities, best practice and support N.A. of Urgent Primary Care?

30. NAGPC Summary Finance, think whole budget GPs are needed Skill mix - yes but don’t hold your breath Motivation - involvement and conditions New organisational structures, a choice Rota and opt out planning Integration Directors liability

31. NAGPC A Once in a Career Chance!! “New Integrated service shatters A&E waits!” “Streamlined service saved my sister!” Now to choose a structure that delivers

32. NAGPC NAGPC National Association of GP Co-operatives Represents & Supports GP Co-operatives & Promotes Quality OOH Patient Care www.nagpc.org.uk Website Sponsored by