Practices are faced with clear opportunities with the advent of the new GMS and PMS contracts from 1st April 2004. With demonstrably improved quality of services and possibly an extended range of enhanced services on offer, the opportunity to improve the overall health of both their patient population, and the practice cash flow and income, are clear. As with any period of tremendous change, 2004 also brings with it challenges, and the prospect of winners and losers. The knock-on effect to representatives calling on practices during a time of immense changes will be significant, and again there will be winners and losers here. Representatives who are attuned to the needs of their key practices will be able to work ever closer with them to help achieve mutually beneficial outcomes. Representatives who continue to offer nothing of ‘added value’ and sell only to their own agenda will find increasingly busy practices clamping down on time-wasting activities (such as seeing low-value reps) to refocus on higher value activities.
Quality Practice Development – a key concern for practices
The Quality and Outcomes framework (QOF) in the new contract will encourage all practices to strive to achieve high quality points scores to maximise additional income through this scheme. Achievement of 1000 points is possible for really good practices which will generate an additional £75,000 in 2004/5 then £120,000 in 2005/6 for an average sized practice (5900 patients) – over and above their guaranteed income (‘global sum’).
Given that all practices will strive to maximise their quality points, where do they start and how can you help?
Quality preparation – the story so far……. Quality Preparation Payments
Every practice received a lump sum payment in Q4 2003 to help them prepare for implementing the QOF of £9,000 for the average sized practice. A second payment of £3,250 will be made in April, and a ‘Quality Information Preparation Payment (QuIPP) will be made via a ‘Directed Enhanced Service’ also in April 04 (£2-5,000).
So, what is this quality preparation money intended for? DoH guidance on how to spend it is scant but here are some of the suggestions:
• Upgrading practice IT systems (e.g. with new GMS-compatible software & templates)
• Summarising and ordering notes onto the computer (QuIPP)
• Training staff and doctors on correct use of new Read Codes for the QOF
• Training on use of the computer generally
• Payment of locums to allow staff to attend awaydays on the new contract
• Funding external consultants to facilitate practice business planning around the new contract
The latter point seems logical and between now and the end of the year practices will be either updating their Practice Professional Development Plans (PPDP), or producing their very first PPDP, to ensure they stand the best chance of implementing the necessary changes smoothly. This uses a business planning approach to firstly engage the whole practice in the change implications of the new contract, then following a SWOT analysis, prioritises the issues that need tackling first and creates a SMART action plan to achieve this. This PPDP approach is being actively encouraged by PCTs and LMCs but there is a shortage of professional outside help so your input here may be very valuable. Healthcare Partnership are running a large number of these sessions now at the request of practices, PCTs, LMCs and proactive representatives.
Practice - PCT joint working
Practices are working increasingly closely with PCTs as joint planning for practice and service development is becoming a reality (e.g. the commissioning of ‘enhanced services’). What form will this increasingly close relationship take?
• In many PCTs, Practice Manager groups meet up every month with the PCT Primary Care Development manager to discuss issues and progress.
• Increasingly, these meetings involve an element of PCT-funded training for the Practice Manager group – e.g. Appraisal skills, how to do Practice Development Planning, etc. With the new contract there is a ‘Practice Management Competency Framework’ which provides a standards template for how practices can benchmark their management standards. Future development training for Practice Managers will revolve around this. Know what this entails so you can get involved in training these influential groups (contact Healthcare Partnership for a copy of this Competencies Framework)
• Encouraging production and sharing of Practice Professional Development Plans (PPDP). Good PPDPs help the PCT’s Primary Care Development team allocate ‘develop ment money’ effectively and informs both next year’s Local Delivery Planning and this year’s education and training needs (e.g. what sessions the PCT should be running during Protected Learning Time) as the PPDP identifies resources and training required to support Practice Quality Development.
• Encouraging good practice-based HR and training procedures through PDP and appraisal (see the QOF indicators in this area – contact us for details). This helps the PCT achieve DoH-set targets of NHSwide implementation of integrated planning and HR policies to ensure a skilled and responsive primary care workforce, and should help practices recruit and retain good staff. Strategic Health Authorities will be monitoring this under the ‘Agenda for change’ legislation.
Changing role of the Practice Manager In modern Primary Care, a highly skilled and well-resourced Practice Manager is a must for the efficient running of the practice. PCTs see practice managers as a key way to influence GPs and their practices most quickly. Why? Practice Managers have the ‘HR’ role in the practice, see all the issues in practices (especially around teamwork, skills, and education) and have a responsibility to maximise practice income (and now quality). Practice Managers play a pivotal role in practice communication – a key issue for PCTs as their messages may not always be welcomed by already overstretched GPs, and may not be communicated to the staff without the Practice Managers’ support.
Modern Practice managers need to be a hybrid of business manager, HR manager and IT specialist in most practices – plus negotiators between the GPs, staff and PCT! They are tasked to run increasingly complex, multi-million pound organisations with (usually) insufficient staff and inadequate training (and often with inadequate support from the GP partners), so time, money and skills are in short supply. They need help! Although PCTs are gearing up to provide more support, resources will be limited, so this is where you can come to their rescue! Even if you are not tasked with a call rate on Practice Managers, it can’t have escaped your notice how influential these people are, so time spent getting to understand their needs better, and the needs of your target practices, will be time well spent. If you already working a system of coverage and frequency on key target practices as opposed to call rate, then you will no doubt already be doing this.
Find out what the practice is focussing on for Quality development
You want to spend more time in key practices, selling your products to relevant healthcare professionals. They feel they have no time for ‘nice to do’ things – e.g. seeing reps – indeed they may see your visit as not only a drain on their time but also possibly jeopardising their drug budget. So, how do you address the needs and concerns of the practice, in order to address your needs to see the right customers and spend time selling to them?
Find out what is of concern to the practice. Then see if you can help support them in some way. You, your organisation, or people in your network of contacts may well be able to provide valuable assistance in key areas where help is needed. If so, you have found your way to become a valued resource to the practice. Provide the support (make a commitment to keep up your support, not just a one-off), build a relationship, and reap the rewards of improved access to sell more often to the key practice stakeholders.
Areas of Quality Development in Practice management and chronic disease management are clearly laid out in the QOF template (see headings below and points per area). If you are serious about understanding your key practices better, discuss the QOF with your practice managers and find out where they need help to improve their scores. It may be in relevant clinical areas, but it might just as easily be help in developing the administrative side that is their real need. Be alert to the whole range of possibilities, and first, be aware of areas where you can help them. If you don’t have a copy of the full QOF indicators, contact us for a copy which we can email you. This will allow you to make as many copies as you need to take to your target practices, to show your genuine interest, to find out what they really need, to identify what help you can provide, and to identify opportunities to get a business return.
Areas of ‘Quality & Outcomes Framework’ and potential points
Chronic Disease management
CHD & LVD - 121
Hypertension - 105
Diabetes - 99
Stroke or TIA - 31
Hypothyroidism - 8Epilepsy - 16
Asthma - 72
COPD - 45
Mental Health - 41
Cancer - 12
Records and information - 85 (also QuIPP DES)
Patient communication - 8
Education and training - 29
Practice management - 20
Medicines management - 42
Length of consultations – 30
Patient survey – 70
Cervical screening – 22
Child Health Surveillance – 6
Maternity services – 6
Contraceptive services – 2
Access - 50
What should I do now?
1. Look at the areas of running a quality practice above. Obtain a copy of the detailed QOF indicators from us. In which areas do you or your company have personal competence? Could you train or mentor a member or members of staff? What about areas where your colleagues, manager, or head-office based staff are skilled in – could they help out?
2. What about bringing in external resources, e.g. clinical speakers, management training consultants, financial advisers, law experts? If you are worried about the cost of doing so, you could share it – e.g. with colleagues, non-competitor companies, the practice (who have had Quality Preparation Payments) or even PCT?
3. Consider supporting the PCT’s ‘Practice Managers Forum’ meetings – again, provide help as well as resources e.g. food/room hire if possible.
4. Use your business plan to document which practices will get your focus of time and budget, get the help you need and watch those sales grow!
Clearly, the better your network of contacts, the better able you will be able to help your key practices, and the better your customer access will be. Not only will you sell more but you’ll also be spending your resources on something that your customers really want that will gain them extra income and their patients a higher standard of quality care– a genuine win-win outcome!