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1. NAGPCNational Association of GP Co-operativesRepresents & Supports GP Co-operatives&Promotes Quality OOH Patient Carewww.nagpc.org.uk Website Sponsored by

2. Dr Mark Reynolds MBENAGPC ChairmanDesired organisational characteristicsDirectors liability

3. Last years NAGPC Conference “At the Crossroads”PIO - CIC - PICwas a popular optionPCT mergera safe house

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

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

6. Whole System Approach for a Whole NHS Change

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

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

10. Remember Date X?

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

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

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

17. 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. 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. 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. 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. Contracting • What level of detail? • Organisational • Financial • Look at what has worked • Is PCT process motivating ?

22. 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. Directors Liabilitymitigated by • Managerial approach • Rota planning • Sharing the problem, scale, partnerships • Opt out planning

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

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

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

28. 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. 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. 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. NAGPCNational Association of GP Co-operativesRepresents & Supports GP Co-operatives&Promotes Quality OOH Patient Carewww.nagpc.org.uk Website Sponsored by