Practice Management

1. Practice Management Salthill Hotel, Galway

2. Agenda What’s happening and what’s on our horizon? How can we best manage our practices, and prepare for the challenges ahead?

3. Hot Topics in Primary Care • FEMPI cuts on vaccines, Budget 2012 • Pilot project – GPs managing their own GMS lists to a greater degree? • Deregulation of GMS lists • GMS contract renegotiations • Chronic Disease Management in Primary Care • Primary Care Teams • HIQA

4. Watchlist • Late next week – Flu / adrenaline for pharmacists and payments for flu vaccines due • Your Health is Your Wealth: a Policy Framework for a Healthier Ireland 2012 – 2020 (Consultation process 14 June – 30 Sept 2011) • Health Information Bill - To provide a legislative framework for the governance of information in the health sector. • Licencing of Health Facilities Bill - To provide for a mandatory system of licensing for public and private healthcare facilities.

5. Inspections into General Practices • NERA • Health and Safety Authority • HIQA (in future)

6. NERA : • Inspectors have right to • To enter any premises at a reasonable time • To demand sight of records • To inspect records • To take copies of records • To interview and require information from any relevant person

7. Records for NERA Inspection 1. Employer registration number with the Revenue Commissioners 2. Full Name, Address and PPS Number for each employee (full-time and part-time) 3. Terms of employment for each employee 4. Payroll details (Gross to Net, Rate per hour, Overtime, Deductions, Shift and other Premiums and Allowances, Commissions and Bonuses, Service Charges, etc.)

8. Records for NERA inspection (2) 5. Copies of Payslips 6. Employees’ job classification 7. Dates of commencement and where relevant, termination of employment 8. Hours of work for each employee (including starting and finishing times, meal breaks and rest periods). These may be in the form of Form OWT1 (or in a form substantially to like effect).

9. Records for NERA inspection (3) 9. Register of employees under 18 years of age 10. Whether board and/or lodgings are provided and relevant details 11. Holidays and Public Holiday entitlements received by each employee 12. Any documentation necessary to demonstrate compliance with employment rights legislation

10. HSA • Primary focus is preventative and educational • Inspection focus • Risk Assessments • Safety Statement • Safety Representative • Awareness of all staff of their responsibilities • Accident Reporting

11. HIQA • National Quality Standards for Residential Care Settings for Older People in Ireland (Feb 2009) • Report & Recommendations on Patient Referrals from General Practice to Outpatient and Radiology Services (March 2011) • National Standard for Patient Referral Information (March 2011) • Standards for Health Information Governance • National Standards for Safer Better Healthcare

12. Background • Report of the Commission on Patient Safety and Quality Assurance, chaired by Dr Deirdre Madden (2008) investigated a number of serious shortcomings in the health services and called for “Knowledgeable patients receiving safe and effective care from skilled professionals in appropriate environments with assessed outcomes”

13. Safer Better Healthcare Standards 8 “Themes”: • Person Centred Care • Leadership, Governance and Management • Effective Care • Safe Care • Workforce • Use of Resources • Use of Information • Promoting Better Health

14. What to Expect? • Standards to be published: which are general & apply to almost all areas of healthcare • Guidance documentation: to be issued specific to different areas of healthcare • Licencing system: a license will be required to deliver healthcare • Monitoring: Unclear exactly how standards will be monitored (inspection/report or self reporting)

15. Similarities to UK • Care Quality Commission in the UK – licensing legislation passed in 2010 • Out-of-hours providers to register by 2012 • Primary medical services required to register by 2013

16. Lessons from Care of the Elderly • Time & duration • Methods employed: Observation, Record Check and Interviews (patient, family, staff). • Drilling down in specific areas • Overview at end of visit with major issues identified there and then • Right to reply • Report – agreed action plan • Follow up visits

17. Focus of Inspections in Care of the Elderly • Statement of purpose and function • Clear accountable management structures • All relevant policies in place • Risk management (both policy and practice) • Complaint handling and resolution • Finances / accounts • Notification of incidents to HIQA in accordance with regulations

18. How Best to Prepare? • How can we demonstrate that we provide a quality, safe service? • Consider responsibilities and identify the lead person or people in your Practice – both for clinical aspects (Dr / Practice Nurse) and other people in charge (Practice Manager). • These people will need to become very familiar with the standards once published. • Involve all staff through education / practice.

19. How Best to Prepare - Clinical • Structured approach to quality assurance • Conduct any necessary clinical audits & keep the records (BMA guidance, HIQA guidance once published) • Record how you improve your service • Conduct analysis of any adverse events on a regular, defined basis and keep a record of lessons learned from this • Involve staff and patients

20. How Best to Prepare - Governance • Clear supervision structures • Hold structured meetings and record minutes • Have appropriate policies, procedures and guidance documents in place • Make sure these policies, procedures and guidance documents actually reflect practice on the ground • Ensure staff are trained in / familiar with policies, procedures and guidelines • Review documentation regularly

21. How Best to Prepare - Staff • Have a policy on recruitment and induction • Ensure you have CVs, references, background checks, garda clearances, job descriptions all on file • Demonstrate that you have assessed staff training needs • Ensure staff receive all mandatory training • Keep good records

22. Documents You Will Need • Safety Statement • Fire Register • Statement of Purpose • Access Routes • Plans for Dealing with Emergencies • Written complaints process & complaints log • Feedback from Patients • Confidentiality Protocol • HR documentation

23. The Practice Environment • Access to the Practice & security • Housekeeping, general standard of repair • Infection Control • H& S Audit (Risk Assessments) • Keep records of improvements made • Consider having a premises development plan if necessary • Equipment should be safe and suitable, clean and well maintained and staff trained in proper use • Written schedule of maintenance visits

24. Thank You