EFFECTIVE PERFORMANCE MANAGEMENT

by Admin 1. April 2004 15:05
 

 

In many ways there are no secrets to implementing effective performance management. Performance Management is a process and a process which if implemented effectively should ensure that both employees and managers remain both productive and motivated. The actual process itself should hold no secrets. There are simply a number of steps to be considered within the Performance Management process these being as follows:
  1. Agree roles and responsibilities and the objectives and targets that go with the role. Ensure that both the manager and the employee know what success looks like in relation to each objective. Sales targets are easy to quantify but project objectives may not be so easy to define success.
  2. Ensure the actions needed to achieve the targets and objectives are agreed and achievable.
  3. If some of the actions needed are deemed out-with the capability of the person who has to achieve them, then create a development plan in order that the person is trained accordingly.
  4. Agree a review process by which each individual is coached and supported to keep on track as regards both their objectives and targets together with their development plan.
  5. Mid and Year end appraisals should be simply a “tick box” exercise holding no surprises. If there are then the process building up to the appraisal is not working.
The secrets to Performance Management do not just lie with the actual process but more with the skills and discipline needed to make each of the steps work effectively. And it is the way these skills are used, or not used, that can cause the whole performance management structure to collapse.

At each of the stages there are challenges
  1. Objective and Target Setting – The biggest challenge here is where all the targets and objectives are handed down without any consultation and support. If a manager does not take an employeethrough their objectives and targets then demotivation and in some cases panic can set in. Employees need to understand exactly why they are expected to deliver various objectives and also what the exact manager’s expectations are. The aim of this stage of the PM process is to ensure clarity and focus. Leave people in the “fog” and they get lost! Do not simply “dump” objectives on people.
  2. Once the objectives are set then employees need to be supported in being coached through exactly what they need to do in order to achieve these objectives. Very capable people will need less support than newer employees but all the same, time should be taken to coach them effectively. Again the challenges here are one of the manager putting time aside and also in relation to the ability of the manager to coach effectively. Most managers will advise and direct as opposed to coach and as such they really need to look at their skill level in coaching. Directing is quicker but can be very de-motivational and much less effective.
  3. Training. Everyone pays homage to training and training plans but very few people actually deliver an effective training plan. Managers usually abdicate responsibility for the training plan leaving it to a training department or to the employees themselves. Even though training needs are identified, the only solutions to meet these needs may be the “sheep dip” approach of getting them on the menu of training events supplied by training department. But are they specifically what is actually needed? And what role does the manager take? Do they sit down with the employee and agree learning objectives? Do they monitor progress against these objectives? What about coaching the person post-training enabling them to implement their newly found skills directly into the workplace?
  4. In terms of reviewing an employee’s progress, does the manager spend enough time with the employee? How well are they utilising essential field visit (distant managers) and review skills such as contracting, coaching models such as GROW and OUTCOMES® ; use of the skill/will matrix, behavioural analysis, giving and receiving feedback and of course, motivational models such as MASLOW’S and CARERS™ ? Field visits are not just about going out with an employee for the day to check up how “they are getting on” and sitting in on a few customer calls. There is a lot more to it than that!
  5. The aim of regular reviews and field visits is to ensure that the employee keeps on track with regards their objectives and targets. If the employee enters into an appraisal not knowing exactly what they have done in terms of their objectives and targets or not knowing what their manager is specifically going to say to them in the appraisal then the performance management system has not worked and has to be reviewed to see where the faults have originated. The only surprises that should be delivered are the good ones like an increase in pay that was unexpected or a better car! If employees are “in the dark” about what to expect at their appraisal, then I would hate to be in the shoes of the manager who is conducting the appraisal when it comes to their turn! Performance Management is a simple uncomplicated process but one which needs discipline and a great degree of skill to implement effectively. Get it right then you are on the way to success; get it wrong and you can look forward to a really stressful year end appraisal.

Allan Mackintosh BSc. F.Inst.S.M.M, Professional Management Coach
allan@performance-am.com www.performance-am.com

 

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Medtech Features

The 80/20 Rule

by Admin 1. April 2004 15:04
 

 

The 80/20 Rule

and how it fits into every business

All businesses, whether they like it or not, have to live with the phenomenon called The 80/20 Rule. It is not a "rule" in the sense that someone decreed it. Its formal name is Pareto Principle, after its discoverer, Italian economist Vilfredo Pareto.

The basic rule
as applied to business activity is: 80% of the results come from 20% of one's activities. In business, the 80/20 Rule can be applied in many different ways:

  • INVENTORY – 80% of the business will be done on 20% of the selection of products or services.
  • SALES – 80% of the business will be done in 20% of the time (year, month, week, or day) the business is open to its public.
  • SALES PRODUCTIVITY – 80% of the sales come in from 20% of the sales staff.
  • MAJOR CUSTOMERS – 80% of sales will be done with 20% of one's customers.
  • COMPLAINTS – 80% of the complaints come from 20% of the customers.
  • CUSTOMER BASE – 80% of the customers will come from 20% of the area the business reaches.
  • ADVERTISING – 80% of business from advertising will come from 20% of the advertising.
  • EMPLOYEES – 80% of the work will be done by 20% of the employees.
  • MEETINGS – 80% of the important information/discussions happen in 20% of the meeting time.
  • PROFIT – 80% of the profit comes from 20% of the sales or 20% of the customers.


There is more to these ratios than meets the eye. Having the knowledge of how these ratios affect business can be put to good use. Let's examine how the above variations of the 80/20 Rule can be used to further the business.

INVENTORY – 80% of the business will be done on 20% of the selection of products or services.

The logical thing to say is that if this is so, then why carry or offer things that don't sell often or don't sell at all? The 80/20 Rule is a ratio, so if the total selection is less, the total sales will be less.

For a new business selling products, this means that until one gets a track record it will be necessary to have depth in each item, line, etc. This calls for a very large beginning inventory until the "rate of sale" (or usage) can be established.

Rate of sale is something that has to be tracked very carefully, because one has to keep good selling items in stock at all times and have enough coming in, so that as the popular items sell out, more are coming in to replace them. Replacement time becomes very critical because the depth of inventory needs to cover current sales as well as sales while replacements are on the way.

Not everything sells all the time at the same rate. Each item or style of item will have a high selling period, a slow selling period, and times when it sells somewhere in between. As the saying goes, everything has its "Christmas" selling season, but it may not be in December.

Warning – "logic" would say to get rid of the some or all of the 80% that doesn't sell or sell well. This is "fuzzy logic," because if the overall selection decreases, the ratio still holds true and it will have a negative effect on the 20% that does sell well.

Better, "unfuzzy logic" says to look for ways to increase the sales of things that sell slower or don't sell. If successful, it will help increase overall sales and, since the 80/20 Rule is a ratio, the sales of the better selling products or services will also increase.

SALES – 80% of the business will be done in 20% of the time (year, month, week, or day) the business is open to its public.

Some firms decrease the number of employees on hand during the slow times. This is possible, if looked upon as a yearly or weekly thing (as some days in many businesses are traditionally slow) as long as one has a trained staff or someone that can be called in when needed.

However, there are many tasks in business that get put off when things are busy that need to be accomplished and this is where the "surplus" staff may be put to work doing these activities different from what they usually do.

Trying to boost sales for slow and non-selling products or services and looking for ways to increase profitable sales during slow times will increase gross sales and will cause the busy times to be busier.

SALES PRODUCTIVITY – 80% of the sales come in from 20% of the sales staff. So, fire the ones that are not producing? It may not be the fault of the salesperson. It may be the fault of how the territories are set up, a difference in industries, materials not suited for the potential client base, difficulty in delivery, etc. The question to ask, possibly, is what the sales per customer or order are.

MAJOR CUSTOMERS – 80% of sales will be done with 20% of one’s customers.

It is widely practiced that businesses divide their customers into A, B, and C categories by the amount of business these customers generate. Often, it is the A customers that do the most and are highly targeted by the sales & marketing departments, while B customers are treated half-heartedly and C customers are almost entirely ignored. What is also well known is that in a 10 year period A customers become C customers or go out of business and C customers grow to be A customers.

For any comments on this or any other article or feature in this edition of on target magazine please email the team on:
articles@ontargetmag.com

 

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Medtech Features

the magic monitor

by Admin 1. April 2004 15:02

 

 

 

 

If there were some magical way to predict swings in sales fortune, you might imagine that sales people and sales managers would take advantage of it. After all, according to most of the sales managers I meet, sales people’s forecasts are rarely better than 50% accurate. Sales forecasts provide important information regardless of how accurate they are. In some businesses, 50% accuracy may be the best that can be achieved. People responsible for supply of the forecasted sales, need some sort of indication that allows them to plan. Some company’s aggregate sales forecasts so that the raw data is available to executives. In others, sales managers interpret the forecasts and use a fudge factor to modify each sales person’s input, before supplying a team forecast to management.

Intuition may be the source of a fudge factor and this may unnerve those executives who thrive on precision, however; a little investigation would reveal that the fudge factor takes into account the sales manager’s knowledge of individual sales people. Paying close attention to a sales person’s forecast, even only for a few months, reveals much information about that person’s style and habits. Fudge factors make allowances for the personality, character, and record of accomplishment of each sales person.

I have found that sales people are reluctant to forecast sales in case they are held to account if they don’ t happen. Because all deals that are expected attract a high level of scrutiny, most sales forecasts show only those opportunities that are virtually certain to happen.

As a rookie, I didn’t understand the vulnerability of showing everything on the forecast and merrily filled it with every possibility. Fortunately, Rapid Recall, the company I sold for then, had a sensible forecasting system. It had an ‘ A’ sheet, which was to show the serious stuff, and a ‘ B’ sheet, that you could use for suspects if you wanted to. My naivety didn’t lead to any difficulties, perhaps because I tended to focus on keeping the forecast full of opportunities. In effect, I used the forecast to manage my pipeline.

The magical monitor is a simple way to use the same principles that sales managers use, consciously or otherwise, to come up with fudge factors. At Silicon graphics, my teams forecast sometimes represented less than half the business that we needed to reach the quarterly target. An inquisition wasn’t necessary. Based on trends and past results, I knew that we were likely to make the numbers and forecasted accordingly. I used this approach with good results for seven years at the company.

Putting the magical monitor to work requires a few numbers that you should have easy access to.

First, find out your average order value. All that you need do is divide your total order value for the previous measurement period by the number of orders taken. You can do this as a sales manager or as a sales person. If you are new to the job, you won’ t have any team or personal records to base it on. Call on your accounts department and ask them for the company average. If this isn’t representative, ask for their help to work out a sensible number, just to begin with. Next, divide your target for the next measurement period by your historic average order value. This will tell you approximately, how many orders you must win to achieve your target in the future.

To make the magical monitor work you need another vital piece of information – your conversion rate. Knowing how many suspects, leads, and prospects it takes to win an order gives you the power to look into the future. It is no use guesstimating your conversion rate. For accuracy, you must measure your average over a period. If you don’ t have enough history in your current role, measure the average for the company or your team and begin with that. Count the number of leads that were awaiting follow up at the beginning of each period. Of those leads, count how many became prospects and how many turned into orders. Calculate the ratio for prospects and orders. Make sure you use your definition of a prospect consistently. You should end up with three ratios – one for leads to prospects, one for leads to orders, and one for prospects to orders. For example, leads to orders might be 1:12. This would mean that you need twelve leads to get one order. Prospects to orders may be 1:3. This would mean that you need three prospects, on average, for every order that you need to win. For this example, your lead to prospect ratio is 1:4. Working out your current conversion ratio accurately, is the most difficult part. Once you have numbers to work with, it takes only a few minutes each week or month to collect the new information and update your ratios. All you need is the number of new leads, the number of new prospects, and the number of orders since you last updated your measurements.

It is worth the effort. Armed with your ratios and average order value, you can predict your future performance as far ahead as your average sales cycle. If your prediction indicates that you will fall short of your target, you can identify your vulnerability early, in time to do something about it. Perhaps you don’t have enough leads or prospects to reach your target. It may be that your conversion ratio has slipped. Your numbers will reveal the reason and your will have time to take corrective action.

We call this approach to forecasting, pipeline management. It puts you in control of your results. You will still need a sales forecast that identifies the specific opportunities however; you won’ t be so vulnerable to the uncertainties inherent in predicting individual sales.

This is a simple and effective idea. As ever, action is the key to taking advantage of it. Oliver Cromwell put it this way, “Make the iron hot by striking it”.

If you want to predict the future, find a prophet. To make your future, face the reality of your present.

Clive Miller

Questions and comments to Clive Miller
Telephone +44 (0)118 933 1357
www.salessense.co.uk for free ideas to increase business

For any comments on this or any other article or feature in this edition of on target magazine please email the team on: articles@ontargetmag.com

 

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Medtech Features

ABPI

by Admin 1. April 2004 05:00

Nearly three-quarters of people believe that the NHS spends far more on innovative medicines than the 12 per cent of its budget it actually does, a survey published by the Association of the British Pharmaceutical Industry (ABPI) shows. The survey showed that only 14 per cent of those taking part in the survey estimated the figure approximately correctly, while almost the same proportion - 13 per cent - believed that it took up more than half the NHS budget. “People will be astonished to discover that all the benefits they have come to associate with modern medicines are achieved at such relatively low cost to the NHS,” said Dr Trevor Jones, Director General of the ABPI. The survey also showed that, while an overwhelming majority of people want medicines to be a top priority for scientific research in Britain, 63 per cent do not know that this is already the case. The pharmaceutical industry funds about one-third of the UK’s industrial R&D, amounting to nearly ?9 million every day. In fact, the UK is second only to the USA in discovering new treatments, and a quarter of the world’s top 100 medicines originated here. But there is overwhelming support for the Government taking more steps to help medicines research, and for it to encourage pharmaceutical companies to invest in the country. Both principles attracted about 90 per cent backing, with only three or four per cent of people disagreeing. “People may not understand just how much effort actually goes into medicines research, but these results make it clear that they do understand its importance,” said Dr Jones. “The message is clear that the industry’s ability to innovate and provide world-beating medicines have the support of people in the UK.” Cancer is named by most people as the greatest threat to health. It is the disease for which 62 per cent of people would like a cure and 46 per cent of people are more afraid of contracting it than any other disease. It is also identified, jointly with heart disease, as the nation’s biggest killer. The good news for Britain is that the pharmaceutical industry has also targeted cancer as one of its prime targets for medicines research. It has been estimated that some 500 new medicines are in various stages of clinical trial. “Thanks to researchers working in Britain, including those in the pharmaceutical industry, our understanding of the various types of cancer has increased enormously over the past decade. The result is that cancer is no longer necessarily the death sentence that it used to be, and more advances are in the pipeline” said Dr Jones.

A £76 million research collaboration between a major UK-based pharmaceutical company and Imperial College, London was welcomed by the Association of the British Pharmaceutical Industry (ABPI) as “a tremendously important partnership to benefit patients in Britain”. The unique research collaboration, announced today, will see a new clinical imaging centre built in west London to focus on cancer, stroke, neurological diseases such as Parkinson’s and multiple sclerosis, and psychiatric diseases. “This partnership - here seen on a unique scale - is tremendously important to not only people with these conditions but also to the reputation of the country as a world-leader in imaging technology,” said Dr Trevor Jones, Director General of the ABPI. “It is particularly appropriate that it follows hard on the heels of an ABPI survey which showed that the public see investment in medicines research as a top priority for the country and for the Government.” The survey showed that 89 per cent of people in the UK believe that pharmaceutical companies should be encouraged to invest in the UK, and that only three per cent disagreed. GlaxoSmithKline will contribute funding of ?28 million for the construction of the new Clinical Imaging Centre, next to Hammersmith Hospital. The centre will use and advance the latest technologies in magnetic resource imaging (MRI) and positron emission tomography (PET). GSK will invest a further £16 million in the latest PET and MRI imaging equipment.

The announcement of the Government’s increased commitment to science and innovation has received strong support from the country’s most innovative and research-based industry pharmaceuticals. The Chancellor has promised to protect the large funding increases for science announced in the last Spending Review and pledged increased investment in future years. The Association of the British Pharmaceutical Industry (ABPI) is delighted by this commitment to make Britain a world-class centre for science, technology and innovation. “The UK-based pharmaceutical industry funds onethird of the UK’s industrial research and development and has a proud tradition of innovation that has made a major contribution to the country’s health - through new medicines - and to its wealth - through its tremendous export success,” said Dr Trevor Jones, Director General of the ABPI. “We very much welcome the support of the Chancellor in maintaining and increasing this vital endeavour and look forward to co-operating with the proposed consultation.” The Chancellor’s announcement follows hard on the heels of an ABPI poll published this week that shows overwhelming support for the Government to take more steps to support medicines research, and for it to encourage pharmaceutical companies to invest in the UK. More than three quarters of people in the UK (78 per cent) think that research and development of innovative medicines is a top priority for investment. “Clearly the public will be as delighted as we are to see the Government supporting innovation. Every day the pharmaceutical industry invests nearly ?9 million in research and development with the result that the UK is second only to the USA for discovering and developing new medicines. The public depend on us to develop new and innovative medicines to treat the diseases that worry them most,” said Dr Jones. The ABPI survey showed that the public would most like to see a cure found for cancer (62 per cent), highlighting the importance of continued scientific research. The good news for Britain is the pharmaceutical industry has already targeted cancer as one of its prime areas for scientific research, with an estimated 500 new medicines in various stages of clinical trial. Surprisingly, more than a third (36 per cent) of the public believe that Britain has a poor record for discovering and developing new medicines to fight diseases when, in fact, a quarter of the world’s top 100 medicines originated here, including treatments for cancer, diabetes and asthma. The survey also showed that nearly three-quarters of people believe that the NHS spends far more on innovative medicines than the 12 per cent of its budget it actually does. Only 14 per cent of those taking part estimated that the NHS invested less than 15 per cent in medicines - and 13 per cent believed that it took up more than half the NHS budget. “People are surprised to discover that all the benefits they have come to associate with modern medicines are achieved at such relatively low cost to the NHS,” said Dr Jones. “But the message is clear that the public want medicines to be a top priority for scientific research in Britain.”

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Features

Leading the modern practice the ever-expanding role of the Practice Manager

by Admin 1. April 2004 05:00

A year ago, the leading editorial in the British Medical Journal heralded the opportunities for improving health outcomes with the new GMS contract but predicted that the transition would not be smooth. The new contract begins this month but some important questions remain unanswered. In this article Paul Midgley highlights the help Practice Managers need to seize the opportunities that the new contract presents, in the knowledge that this will boost your access and sales.

BACKGROUND The four key aims of the General Practitioners Committee when they entered negotiations on this contract 2 years ago were:

  • Improve (GPs’) working lives
  • Attract extra funding into General Practice
  • Improve recruitment and retention
  • Improve services for patients

The success of the contract from a GP’s point of view will be judged against these aims. Practice managers have a crucial role in managing change in their organisations and will find many opportunities within the new contract to improve things for both patients and staff, and increase income.

KEY CHANGES COMPARED TO THE OLD CONTRACT The fundamental changes are listed here.

  • Practice-based contract with PCT - individual lists will cease
  • Funding based on patients not doctors
  • End to 24 hour responsibility
  • Choice of services to offer
  • Quality-based incentive scheme
  • Enhanced services shifting services from secondary to primary care
  • Predictable higher monthly income = improved cash-flow = better business planning

The final point is perhaps the most important driver of change, as the running of the practice business should be facilitated by PREDICTABLE monthly inflows of EXTRA cash. This stability allows for better, longer – term business planning around services, people and premises.

NEW SOURCES OF FUNDING FOR PRACTICESThis is an important chart as it clearly emphasises where changes are most likely to occur – where the greatest amount of new money is available. This highlights the huge importance of the Quality Framework (QOF) to practices. QOF’s value to the practice could rival income from the Global sum once they achieve high QOF points levels. It also highlights the importance of using the Quality Preparation payments and QuIPP payments (for summarising notes) to re-design internal processes to maximise QOF points. These payments are not there to top up the GPs’ income!  Some existing funding pots have been increased significantly (Seniority and pensions for GPs). There is some re-branding of existing monies (Directed enhanced services, Local Enhanced Services). Other new sources of funding other than QOF include a small amount for National Enhanced Services (many PCTs have not commissioned these this year!).

Know what enhanced services your local PCTs have commissioned. Ask any practice manager!

There are new schemes to help repay grants, rent etc on premises. Practices will pay less on IT (responsibility for maintaining and upgrading IT now rest solely with PCTs). If you want to know more about practice funding under the new contract, read the Statement of Financial Entitlements (http://www.bma.org/ap.nsf/Content/Hub+GPC+contract) so you are clear.

END RESULT - Practices who continue to offer their existing range of services should therefore benefit from an increase in annual income and more predictable monthly income.

WHICH SERVICES WILL PRACTICES OFFER? Practices have agreed with the PCT which services the practices will provide over and above the basic requirements of Essential services in 2004/5. Their PCT will have confirmed which of the Enhanced services the practice will be commissioned to provide in 2004/5. Practices should already be thinking ahead to 2005-6, and discussing internally, and with the PCT, which National Enhanced Services (NESs) to provide in 2005/6, as PCTs will look to increase the range of NESs that are offered in year 2 as they shift funds away from hospital providers.

If your drug can help practices provide Enhanced Services, start discussions with the Practice Manager/partners/leadership team to identify the extra services they could offer, examine the required Quality specification and estimated income, and decide which if any would be worthwhile helping the practice bid for should the PCT find the funds to commission these services from within primary care. For more information about the range of enhanced services, see the BMA website (address above).

KEY ROLE FOR PRACTICE MANAGERS – CHANGE MANAGEMENT AROUND QOF A key NEW role for practice managers is to lead the practice to achieve the maximum points possible under the QOF because points mean prizes! Some practices (paperless, ex-fund holding or early wave PMS for example) really do expect to achieve maximum points in 2004-5 and larger practices will benefit from six-figure boosts to their income. A practice’s big incentive to strive for maximum points in 2004/5 is the link to year two’s monthly ‘aspiration payment’. 60% of year one’s ACTUAL points value will be paid monthly over year two at the much-increased pounds per point rate. Even average sized practices, performing to a high level (over 850 points) will benefit from six-figure boosts in income in year two.

Many of the changes required to maximise QOF need a multidisciplinary approach, so full buy-in is needed from the practice team. Practices should invest their ‘Quality Preparation Payments’ and ‘QuIPPS’ into training, protected time, and extra hours for summarising during 2004 to help get the team informed, plans developed and skills developed.

Healthcare Partnership’s most popular training workshop this year has been ‘Maximising Practice Income through your Practice Development Plan’ and we expect this to continue throughout 2004.

QOF PAYMENT All QOF points convert into cash. Achievement payments will be paid to practices in April 2005 from a DoH master computer system (QMAS) which reads from all the major practice IT system suppliers (e.g. EMIS, Torex, Vision). This means that practices will only get paid for what QOF work has been done if their IT system faithfully records and reflects this work.

A key role for Practice Managers is to get everyone up to speed on IT – a failure to do so means their practice will earn less QOF money than it should.

Details of consultations with patients occurring outside the practice also need to be entered onto the practice computer – currently many are not. You could help here – why not provide paper copies of the relevant templates for doctors/nurses/health visitors doing domiciliary visits so they can collect the necessary information relevant to the patient’s condition for the QOF? Finally, for the 10 chronic diseases, the pounds per point will also be determined according to the practice’s disease prevalence compared to national data. Once QMAS goes live (August 2004), practices’ disease registers data will be collated across the UK, and then by dividing the register by the list size, to give disease prevalence. Practices with relatively high disease prevalence compared to national average will need to work harder to achieve the targets set in QOF so will get higher payments per point; those with lower than average prevalence will receive less per point.

LEADING ON LEARNING UNDER NEW GMS – FUTURE OF PHARMA SPONSORSHIP A practice’s ‘Global Sum’ now covers ‘protecting’ time for PDP, PPDP and appraisal preparation. PGEA NO LONGER EXISTS! PCTs may continue to provide Protected Learning Time sessions – if they do, practices will fight to use this time for practice-based sessions wherever possible, though clearly PCTs will still want to run localitywide sessions where essential briefing and training is required.

What do you need to do to continue to support learning events?Work closely with PCT education and training leads, GP tutors and PLT organisers so you know what events are planned for the year ahead. Work closely with Practice Managers in target practices to ensure you know the practice’s learning needs, and support their inhouse training sessions. Help them put together their PPDP (or work with an external supplier, e.g. Healthcare Partnership) so you can really understand their needs and identify solutions. Practices will use their practice-based PLT to plan ahead, to train staff in line with their PDPs, or the practice together on its PPDP/joint learning (e.g. Significant events audits). These events offer sponsors a great opportunity to really understand customers better and develop close joint working.

LEADING IM & TResponsibility for IM&T maintenance, and purchasing of new kit (hardware and software) becomes the responsibility of PCTs under the new contract. For IT-literate practices, this may be viewed as hugely constraining, but for the majority of practices, this will reduce costs significantly and SHOULD still provide as good if not a better level of IT support service. PCTs will enter into pan-PCT service level agreements PHARMACEUTICAL FIELD ISSUE 4 2004 33 Contact Healthcare Partnership on 0870 2413506 or by email at enquiries@healthcarepartnership.com for details of our training and development services, for testimonials from our extensive list of satisfied customers and for opportunities for sponsorship in your area. Copies of the Practice Management Competency Framework can also be obtained from Healthcare Partnership. with IT suppliers providing better service than would be possible for individual practices. For practices with poor IT, this is very good news as they won’t have to pay for a shiny new GMS compliant system. IT is important for 2 reasons – firstly achievement of QOF points depends on it, secondly, as a stepping stone to Patients Electronic Health Records by 2010. Practices are being encouraged to move paperless as soon as possible hence the funding support for summarising through QuIPPS and the target of 60% by 31st March 2005 for a QOF payment.

LEADING RECRUITMENT AND RETENTIONPractice managers face a huge challenge to recruit and retain good staff. With more and predictable monthly income, practices can afford to employ more or better paid staff. This involves a people capability review. Are the right people doing the jobs most suitable to their skills? In the past, it was a catastrophe if a GP left the practice and they couldn’t recruit as it affected practice income. This drove many practices into PMS. Now, this is no longer an issue, and retirements and resignations present an opportunity to review how the same level of service can be provided by utilising other professionals (e.g. nurses) to take on the bulk of minor illness and routine chronic disease management, and freeing up their time by recruiting or training up administrative staff to perform basic health checks, taking blood pressures, etc. Many (PMS) practices in difficult recruitment areas have been forced to innovate along these lines and have developed successful models for a broader-base of service provision. Clearly this requires that there are nurses to recruit or a willingness to be trained, and the funds and training available. Practices need help with this training – PCTs don’t have much funding so it either comes from Global Sum, or an alternative source – Pharma! Are you ready for this?

LEADING PRACTICE MANAGER AND TOP TEAM DEVELOPMENT The new contract heralds the way for a more complex practice organisation with a greater income stream, more staff, certainly more regulated and IT based. nGMS Annex C (practice management competency framework) recognises the pivotal role played by Practice Management team. This framework will help practices benchmark their current performance to systematically plan to develop the skills required to move the practice towards a more corporate business approach. It will help identify what new skills are required in new recruits to senior positions. An integrated management team may involve the practice manager at the centre providing vision and momentum to the rest of the senior managers (which may well include GPs, senior nurses, IT managers and possibly others in a large practice). Clearly, this will be a challenging transition for many practices and external facilitation of Practice Management Competency development is advisable. It also provides an opportunity for you to help. If your company is unable to provide this for practices, contact Healthcare Partnership for help. The importance of non-GP members on the practice leadership team is recognised in the new contract allowing non-GPs to co-sign the contract alongside at least one GP. Some PMS practices are already led by non-GPs – the new GMS Contract allows GMS practices to provide parity for indispensable non-GPs , opening the way to them becoming partners.

PRACTICE MANAGER EDUCATION Practice managers have a big responsibility to develop themselves. PCT-provided protected time, for example for monthly Practice manager forums, should become a standard commitment in their diary. Increasingly these meetings may be extended to incorporate specific training to develop key areas around the competency framework. PCTs, the Modernisation Agency and NHS University will all provide more qualification-based learning opportunities for those practice managers keen to development themselves (but not the funding!). Ambitious practice managers will seize this with both hands and develop themselves. This will increase their bargaining power at salary review and could prompt an invitation to become a partner in the business if they really excel.

CONCLUSION – WHAT HELP DO PRACTICES NEED FROM YOU?Practice managers never have been busier, so if you understand their priorities, you will know where you can help your key practices most. Where should you think about helping?

  1. Sorting out IT software, ardware and training. Do you or your company have knowledge or skills in this area?
  2. QOF Help the practice decide how they will achieve the QOF points they have aspired to. Can you support an away-day ideally leading to an updated PPDP? Can you help them develop Chronic Disease Management clinics?
  3. What staff job changes will they required to run new or better services? Help them put a recruitment and training plan into action (PPDP is a good place to start). Your company’s experience around recruitment and training could be useful.
  4. What are their management team’s competencies and skill gaps? Support them to take some time out as a management team to work through the competency framework to establish a baseline and key areas for development. Use this to define recruitment and training needs and areas for future support that you can provide them. If they need to expand or move, can you help them put a business case proposal together so they put their case in the most persuasive way possible? Perhaps your Healthcare Development manager can help with writing a business case.

There has never been a better time to work collaboratively with key customers as their needs change and opportunities beckon. Get help from internal company resources to keep your costs down, but be aware that some practices may have a problem with ‘getting into bed’ with one company, and indeed may not be happy for company personnel to facilitate their business planning due to the sensitive nature of issues that may arise. If this is the case, an external agency such as Healthcare Partnership may be preferable. We can also help your budget stretch further by involving other sponsoring companies to cover the cost. Contact Healthcare Partnership on 0870 2413506 or by email at enquiries@healthcarepartnership.com for details of our training and development services, for testimonials from our extensive list of satisfied customers and for opportunities for sponsorship in your area. Copies of the Practice Management Competency Framework can also be obtained from Healthcare Partnership.

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Features

Revving up for the Adenoviral-P53 Gene Therapy

by Admin 1. April 2004 05:00

 By Curt Herberts, Research Analyst, Frost & Sullivan, North America

While gene therapy has been on the scientific horizon for a few decades, only in the last couple of years has it really taken successful strides in climbing the ominous oncology clinical trial ladder. Despite some serious setbacks, involving the death of one patient and the development of leukaemia in another three, gene therapy has continued to make progress and now has a New Drug Application (NDA) under review at the FDA, and many more in clinical trials. Within the next two to seven years, gene therapy could break the activation energy to finally make it the next big thing in cancer treatment regimes.

IN THE PAST, cancer treatment has involved a mélange of different choices including surgery, radiation, chemotherapy, hormonal therapy, and biologic therapy. However, new discoveries have led to promising technologies within the realms of anti-angiogenesis, monoclonal antibodies, vaccines, and gene therapy. Gene therapy is defined as an “approach to preventing and/or treating disease by replacing, removing or introducing genes or otherwise manipulating genetic material.” Researchers and drug companies alike see this technology as a potential effective therapy to treat different diseases in areas such as: haemophilia, cystic fibrosis, cancer, cardiovascular, pulmonary, neurological, and infectious disease. Gene therapy is applicable across so many different disease states because of its ability to target specific molecular targets on particular cell types within the body. This allows the therapy to directly affect the site of disease, while eliminating extraneous side effects associated with forms of systemic therapy. Currently, there are a number of different techniques to deliver desired gene therapy regimens into specific targeted cells within the body. Some of them include viral vectors, liposomal vectors, ex vivo cell transfection, artificial chromosomes, matrix vectors, genetically engineered cells, gene activators, naked DNA, bacterial vectors, chemical and physical methods, regulation of gene expression, and gene repair.

It has yet to be decided which of these techniques will prove most effective in delivering a specific treatment to the desired location within the body. Many biotechnology and pharmaceutical companies have found significant barriers to commercialisation when trying to develop a gene therapy product. The main problem resides in designing a delivery system that will deliver sufficient quantities of therapeutic DNA into a large enough number of cells, and then express the desired proteins at high enough levels to have a therapeutic effect on the disease. In addition, difficulties lie in the costs and risks associated with clinical trials, financial and logistical difficulties inherent in moving beyond basic research to large-scale manufacture and marketing, as well as research in the sector has generally been taking a much longer time to market than the already lengthy average of seven years for most pharmaceutical drugs. Currently, there are twenty-two new gene therapy candidates in clinical trials for multiple cancer indications. Currently, one of the most promising gene therapies in multiple clinical trials is the Adenoviral p53. Adenoviruses can infect and multiply in cells in which the p53 tumour suppressor gene has been inactivated. Luckily, cancer cells are the only type of cells in the body with an inactivated p53 gene, and about 50 percent of malignant head and neck tumours are composed of cells with the inactivated p53 gene. Therefore, when the adenovirus gets into a cancer cell with an inactivated p53 gene, it replicates, and then lyses (kills) the cancer cell thereby releasing more virus particles to infect neighbouring cancer tissue. With the p53 adenovirus gene therapy in clinical trials for multiple oncology indications, it looks as if it might be the first big leap into the actual application of gene therapy for curing cancer. Many companies such as Introgen/Aventis, Matrix Pharmaceuticals, Schering Plough, and Transgene are currently testing different applications of the p53 tumour suppressor Adenovirus on oncology patients. Phase III trials will hopefully prove whether or not this potential therapeutic will be able to clinically work better than existing therapies and thereby gain a substantial percentage of the skyrocketing cancer market.

Background Frost & Sullivan, an international consultancy firm, has been supporting clients’ growth for over four decades. Our market expertise covers a broad spectrum of industries, while our portfolio of advisory competencies include strategic consultancy, market intelligence and management training. Our mission is to work with our clients’ management teams to deliver market insights and to create value and drive growth through innovative approaches. Frost & Sullivan’s network of more than 500 consultants, industry experts, corporate trainers and support staff, spans the globe with 19 offices worldwide.

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Features

The New Pharmacy Contract Effectiveness - Integrating Pharmacists into the NHS family

by Admin 1. April 2004 05:00

By Andrew Platten MSc, MRPharmS, DipM, MCIM, Associate Director, Consultancy at HealthGain Solutions

There are currently 10,460 community pharmacies in England and Wales, which dispense 665 million prescriptions per annum and are visited by over six million people every day. 80% of the typical community pharmacies turnover is derived from dispensing NHS prescriptions and the current contract pays a pharmacist 94.6p for each item dispensed. In addition to professional fees from dispensing community pharmacists receive additional income through a monthly professional allowance ranging from £755 to £1,460 based on the number of prescriptions dispensed in a month.

I worked as a community pharmacist between 1987 and 1995 for both an independent pharmacy and a supermarket chain and during this time the quality of the service I provided was mainly judged by how quickly I could dispense a prescription. The familiar cry from a patient who had to wait longer than they wanted was ‘But it’s only tablets!’ based on a perception that community pharmacy was purely a supply function with no professional input required. This perception amongst patients was often reinforced by other community pharmacists who did not provide any ‘additional services’ but saw themselves as running a ‘prescription factory’ with a focus purely on the number of prescriptions that could be dispensed within a given time period. This attitude was understandable as the majority of a pharmacists’ NHS remuneration under the current contract was based on the number of prescriptions dispensed and not on the range and quality of other non-dispensing services they may provide. This is all about to change however and the new pharmacy contract will focus much more on the range of services a community pharmacist provides rather than on the volume of prescriptions they dispense. In order for the contract to be implemented successfully however there is going to need to be some changes in the mind sets of both pharmacists and patients with regards to how the services provided are valued.

 

The purpose of the New Contract In September 2000 the Department of Health publication ‘Pharmacy in The Future’ stated that the existing national contractual framework for community pharmacy would be modernised to establish minimum standards and to promote and reward high quality services, not just volume of prescriptions. The New Contract for Community Pharmacy aims to:

  • Provide clear minimum standards for community pharmacy, to meet the needs of Pharmacy in the Future - implementing the NHS Plan
  • Provide clear and fair rewards for high quality services and promote best value for money
  • Harnesses the skills of community pharmacists and their staff, to deliver better primary and community care services to patients by developing opportunities and rewards for integrated working
  • Minimise bureaucracy for both Pharmacy and PCTs
A new range of remunerated services The proposed contract is similar to the new GMS contract in that it consists of difference levels of services; essential services, advanced services and supplementary enhanced services. The contract is being negotiated nationally between the Department of Health and the Pharmaceutical Services Negotiating Committee (PSNC). The aim is that the contract should gradually develop over time to meet the needs of patients, the NHS and the profession.
 

Essential services – These will be offered by all pharmacy contractors and will include: Dispensing – the supply of a product and advice to the patient about the correct usage of the product including advice about interactions with other products if appropriate Repeat dispensing – assessing the patient need for a repeat supply of a particular product in partnership with the patient and the prescriber and notifying the prescriber of any issues or changes recommended Signposting patients to other health care providers Clinical governance – the use of standard operating procedures, evidence of pharmacist CPD and service audits Public health – opportunistic intervention to provide advice such as smoking cessation, the appropriate use of antibiotics or weight reduction Medication waste disposal – collection of unwanted medicines Sharps disposal – collection of sharps in sealed containers for disposal Advanced services - These will require accreditation of both the pharmacist and the premises i.e. appropriate training has been completed and acceptable facilities are available from which to deliver the service. This means that a pharmacist may well be trained in every service possible but if he is practicing from a pharmacy that looks more like a market stall than a NHS healthcare provider then he will not be commissioned by the PCT to provide the services. Examples of advanced services are:       Medicines Use Review – the pharmacist performs a medicines use review face to face with the patient which assesses the patient’s knowledge and understanding of their medication and aims to ensure any identified problems are addressed       Prescription Intervention Service – the pharmacist will highlight issues to the prescriber and make recommendations for improvements in treatment e.g. dose synchronisation, therapeutic substitution based on local protocols Supplementary enhanced services – these will be commissioned locally by each PCT based on the need of their local population. The service specification and value will be negotiated nationally. Services may include:

 

  • Minor ailments management
  • Substance misuse services
  • Disease specific medicines management services
  • Emergency Hormonal Contraception service
  • Concordance services
  • Care home and Intermediate Care services
  • Home care services – domiciliary assessments
  • Smoking cessation service
  • Needle exchange scheme
  • Diabetes screening
  • CHD screening/Healthy Living
  • Palliative care services
  • Full Clinical medication review
  • Out of Hours service
  • Prescriber support services (medical practice based)
  • Head Lice management service
  • Gluten Free food supply service
  • Services to schools
Funding and the timescale for delivery It was initially hoped to have the new pharmacy contract agreed and implemented by April 2004 but the length of time it has taken to agree the remuneration levels and service specifications means that implementation has been put back until October 2004. A cost of service inquiry has been carried out in partnership with the Department of Health and this involved a survey of 470 pharmacy contractors being carried out to determine the current costs of staff, property and overheads. A basic formula for funding has been proposed:
 
When proposals for funding have been negotiated, the PSNC will put this to a ballot of all pharmacy contractors and only if the funding is approved by a clear majority of contractors will the New Contract be implemented. Implications for the pharmaceutical industry Traditionally the relationship between community pharmacists and representatives from the pharmaceutical industry has been limited to afternoon visits to pharmacies close to target GPs to validate the GPs prescribing habits and local sales data. This relationship has been viewed by many community pharmacists as one way with the representative receiving valuable local prescribing data in return for a couple of pens and no other added value. The community pharmacist will become an increasingly important contact for local representatives particularly if they are providing additional and supplementary services which impact directly on prescribing such as medicines use review and prescriber support services. It will be important for representatives to have an awareness of what services are being provided locally as well as any protocols and guidelines that form part of the service agreement between the pharmacist and the PCT. If your products are placed favourably within these protocols you will need to make sure that the community pharmacists are fully aware of the patient benefits that your products can deliver.
Andrew Platten, MSc, MRPharmS, DipM, MCIM is Associate Director, Consultancy at HealthGain Solutions, a contract services organisation supplying specialist sales, nurse and pharmacist and PCT teams to the pharmaceutical industry and NHS.

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Features

Making corporate hospitality work for you

by Admin 1. April 2004 05:00

By Alison Morris, Healthcare Sector Head, Huthwaite International

Corporate hospitality is now recognised as one of the most powerful tools for developing long-term business relationships. But if a company is to reap real business returns from what can be a significant investment, such events must be well planned, structured and have a true sense of purpose. In this article, I look at how to combine ‘Business with Beaujolais’ – to ensure that, as your clients enjoy themselves, you meet your business agenda. TODAY, pharmaceutical companies have become much smarter in targeting those clients likely to provide consistent, quality business. As a result, we now talk about multi-level relationships, bonding, and, of course partnership. Yet what is the best way to deepen a relationship with an existing customer or start to bond with a potential new customer? The answer may be to take them out of the usual business environment – with its sometimes formal and adversarial overtones – and put them in a social setting. Here, by contrast, you can relate to each other much more readily as human beings and your customers can talk about their needs and decision criteria in a low-threat environment. In the typical multi-level contact environment of our industry however, this has also given rise to a new set of problems. Some of those involved in corporate entertaining for example, such as medical experts and others on the periphery of the sales function, may have had little or no training in selling or influencing. Similarly, those arranging such events may not have a clear understanding of the broader marketing context in which the event is being organised. When planning an event which involves an element of corporate hospitality therefore, it is essential to keep the following five key issues in mind –

  • Event planning – It is essential to position the event within the company’s broader marketing strategy or account management plan. At the same time as ensuring it is appropriate to meeting business objectives however, any client entertaining must, of course, stay within industry guidelines and rules. Key to the success of an event is to ensure that the right audience can attend. This requires targeting the right people early on. A problem for example will arise if marketing organises an event and fails to advise the sales team responsible for inviting clients until perhaps a few weeks prior to the event. Doctors and other target customers are busy people and crowded diaries are likely to reduce the numbers available – and thus lessen the impact or value of the event. Worse still, if the hospitality event forms part of an industry-wide conference or exhibition, it is likely that major competitors will already have ‘snapped up’ key clients for their own activities. Sponsorship budgets typically form an integral part of the annual sales and marketing budget and so are established well in advance. Those responsible for inviting clients to any event involving corporate hospitality should be made aware as far as possible in advance so they can plan accordingly.
  • Setting measurable objectives – at one level there are the straightforward ‘housekeeping’ issues, such as the percentage of attendees, the quality of catering and so on which of course must be right. Yet here, we are far more interested in quantifiable – and realistic – outcomes: it is unlikely for example that at a social gather ing an agreement to prescribe would be realistic and so should not be set as a goal. However, establishing appointments, securing follow-up calls, or gaining introductions where access is difficult are achievable and essential if real value is to be derived from the event. A planning meeting therefore held, say, six to eight weeks in advance should identify what would be a successful outcome with regard to each client or prospect invited. And this should not be restricted to each individual salesperson’s own guests. It may well be that someone invited by a colleague may be able to provide valu able information or make a useful introduction: engineering the opportunity to make this happen should not be left to chance. In other words, the skills and tactics required to achieve these outcomes – by identifying client needs and gaining commitment – can be determined in advance and to a large degree will be determined by where the customers are in their decision-making.
  • Managing interactions – At the event itself, it is critical to assign the right people to key roles and in each case clearly define responsibilities and expectations. This means ensuring the right people are on hand, from the initial ‘meeters and greeters’ to the ‘statues’ – those who should typically stay in one place and to whom invitees are brought. Everyone involved needs to be aware that, even though the event may appear to be primarily social – or even casual – it is a shop window for the host company. This is especially important for those who have limited client contact day-- to-day. The company too needs to recognise the importance of assigning its best people to each part of the event: if it is an evening activity linked to an exhibition for example, it should not simply be a case of ‘dragging along’ those manning the stand earlier in the day.
  • Persuasion skills – in training effective social influencing skills, Huthwaite tends to avoid the use of the word ‘selling’. This is because at a social event you are not seeking to transact business. What you are trying to do, by contrast is gain information, extend relationships, perhaps give some information about yourself or make some progress in a major deal. The key to success therefore centres on influencing rather than selling. Yet this is a social event. You can’t ‘influence’ all the time, for that would be crass; it’s outside the rules, which are that you have got to have some fun! This is precisely why effective influencers make a conscious distinction between ‘social’ and ‘purposeful’ conversation. They devote an appropriate amount of air time to each and switch seamlessly between the two modes of communication. Similarly, they recognise the value of both the ‘push’ style of persuasion or influencing – that is, giving information and putting forward ideas – and the ‘pull’ style of asking questions and building on others’ ideas, depending upon the topic or situation in question.
  • Working the room – it is very easy to cause offence by butting into a conversation or leaving abruptly, so many people don’t try. As a result, the commonest failing is that those attending on behalf of the host tend to cluster with colleagues, as they feel uncomfortable starting conversations with clients or prospects. And this does not just apply to non clientfacing staff; experienced salesmen will often spend too much time with friendly clients or former colleagues, convinced they are networking yet in truth much of it will be of little value – no more than gossiping in fact! Skilled networkers by contrast are constantly proactive, selecting the right targets and adopting appropriate verbal ploys to enter or exit a conversation. The secrets of successful ‘intros’ and ‘outros’ can be taught, enabling attendees to work the room effectively, without causing offence.

Though more closely regulated than in many industries, in taking such an approach pharmaceutical companies are exactly similar to any other. By planning well in advance, ensuring you have the right, properly briefed and trained staff attending on your behalf and controlling the event in this way, you can achieve an excellent balance of business and pleasure. On the one hand, you and the customers will be assured of an entertaining and enjoyable event. At the same time, you will secure a measurable advance in your business relationships – and in a way which is unlikely to be achieved through your more formal commercial dealings with both customers and targets.

 

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Features

THE MATRIX

by Admin 1. April 2004 05:00

10 Things You (and your customers) ought to know about the Consultant’s Contract - (Part 5 CONTRACT FACTS 31-39)

31. Consultants Contract: Hospital Consultants also have the bane of their life trying to sort and organise their contract. There are many differences not just in structure of the consultants contract but also in the essence of what the implications are. The consultants contract doesn’t have any points nor does it have any prizes. Begs the question – what exactly is in the consultants contract?

THINK POINT PF: The consultants contract is more along the lines of an ‘employment’ contract. It’s more about salary, working hours, on-call and training rather than the new GMS contract which is much, much more than that.

32. Who implements the consultants contract?: The consultants contract was initially pushed nationally by the government. This didn’t work – so the consultants contract needs to be ‘agreed locally’.

THINK POINT PF: This is not good news. The government didn’t get their way. They were unable to push the small print. So what they are now doing is saying ‘agree locally’. What this means is that some poor soul (usually the medical director) now has to push this contract locally in their own hospital trust. This person is not Mr/Mrs Popular right now. They will be facing the brunt of any reprisals, disagreement, discord and anti-contract feeling that may exist.

33. So what is in the consultants contract?: A significant imperative is a much stricter definition of the contractual commitments for the consultant. For example, core contract of 10 sessions is highlighted with fixed sessions to include on-call, all clinical work, teaching & audit!

THINK POINT PF: Consultants will be earning higher salaries (mean starting jump from £55000 to over £80 000) but will be working hard! Any extra work will be remunerated as ‘additional sessions’. However annual job plan review will be linked to appraisal and subsequent adherence to the new contract.

34. Key Points on the Consultants Contract: A significant imperative is a much stricter definition of the contractual commitments for the consultant. For example, core contract of 10 sessions is highlighted with fixed sessions to include on-call, all clinical work, teaching & audit!

  • Overall increase in consultants pay
  • Consultants expected to be on site when scheduled for NHS duties
  • Strict adherence to contract replaces the 10% limit on private practice
  • Significant change in working patterns and on-call site residency and accommodation
  • Average 48 hr working time directive not to be exceeded
  • 5 yearly career development review to allow portfolio career & less on-call later on
  • Incremental pay for professional performance rather than short term bonuses
  • Provision for sabbaticals, CPD leave and assessor duties
  • Increase availability for part-time & flexible working hours
  • Measures to retain consultants who seek early retirement

35. So what’s being contested?: Varied grading of consultants (ie junior consultant & senior consultant) has been rejected outright. On-call payments are being thrashed out (the Paris Test) Enforced reduction in private work (significant politics!). Also the way in which consultants receive merit points & discretionary points to their salary is being reviewed and amended.

THINK POINT PF: The Medical Director of the Trust has a significant job here! Some understanding of this conveyed to the medical director will be received compassionately right now. This task is a lonely one and everyone can seem against them. Your rep-friendliness and ability to influence one of the key medical members may pay off later in life! Everyone will be asking for higher on-call (see Paris Test) and working around private clinic commitments. Leave cover & rotas are very hot topics indeed. Also very contentious – the backpay the consultants are demanding for increased salary!

36. What about on-call?: This is interesting. It’s probably the most contentious part of the consultants’ contract currently being implanted. The Paris Test refers to on-call payment scales based on ‘whether or not on call involves visiting the hospital’.

THINK POINT PF: If you really want some sparks to fly at your lunch meeting or a hospital KOL evening seminar bring up the Paris Test! Sure way to get things into a ‘heated debate’ it goes something like this. Consultants receive a % increase on their salary for doing on-call. However, this can range from 4% - 10% + this depends on 2 main factors – how frequent is your on-call rota & when you do get called, do you have to come in. Regarding the rota – a minimum set of 1 in 5 defines criteria for higher payment. However, the wording is ‘rota’ and not ‘cover!’ So most consultants may be down for 1 in 5 rota but due to cover, leave, sickness, etc, end up covering 1 in 4 or even 1 in 3! Well – the contract says – tough. It’s what you are down for the rota not cover! Not friendly! Also – some consultants will be on 2 separate rotas – where each rota is more than 1 in 5 but together leads to very frequent on-call. Yet again – tough.

37. But what about the Paris Test itself?

THINK POINT PF: If you are a consultant on-call do you ‘usually’ have to visit the hospital site. Now – what does this mean? More common than not? (ie over 50% of the time) All the time? Some of the time? Relatively frequently? Hence the Paris Test asks whether or not you could manage the problem from Paris !!! Or – would you have to be on-site!! As you can see – it’s open to perceptions and believe me, these perceptions are being put directly to the medical director demanding ‘higher scales’ of on-call payment. What’s more – the medical director cannot just award based on the each and every argument. For the government has allowed only for 40% of all consultants to claim the ‘busy on-call’ and the rest to take ‘lower scale’!! So the chief executive will not accept the whole of the consultants’ staff to receive ‘higher grade on-call’ remunerations!! I would not want to be the medical director who has to set these limitations… Furthermore – there is room for manoeuvre in the Paris Test which asks ‘does your on-call involve complex telephone conversations’!!! What does that mean? I suspect all consultants will say their on-call involves this!! And hence demand higher scale remunerations!!

38. So what will happen to on-call as a result of this?: Firstly we will see a lot of toys being thrown out of the pram. Secondly – those physicians that are awarded higher scales will probably do what they currently do. But what about those consultants who are forced to accept ‘lower scale’ % for on-call because they do not meet the Paris Test criteria?

THINK POINT PF: Well – it’s obvious. If they do not get the higher pay for complex calls & visiting on site you can be guaranteed 1 thing. They won’t come in to hospital and won’t spend time on the telephone. The Trust can’t have it both ways. I do hope that if I ever have to go to hospital and the junior phones the consultant on-call, that he/she is getting paid a higher scale. Otherwise, not only will they not come in to see me… they may not answer the phone…

39. Views from Questionnaires: Whilst questionnaires are only snapshots at certain time frames they do make for interesting previews. This one is from 195 specialist registrars prospective to be consultants, anonymously responding to set questions.

THINK POINT PF: I have picked out some interesting ones. For example, whilst 70% said they were prepared to be resident on-call consultants (remember extra pay comes in) over ? would not accept the 7-year ban on private practice (initially proposed by the government). In fact over 80% stated they would be prepared to take some form of industrial action when original government proposals were put to them!! Many still feel that the starting salary is not high enough and would want to seek alternative ways of working (retire from NHS and set up ‘chambers’ who would set sessional fees to work. Bit like a GP saying rather than work a full day week with all the politics of the PCT, NICE and NSF, they will forget being a practice partner and do 1-2 days a week locum/oncall – where they could earn far more, with far less hassles!! What a way to run the NHS!

OMAR ALI is the Formulary Development Pharmacist for Surrey and Sussex Healthcare NHS Trust and is a PCT Formulary Adviser to 2 PCTs. He is a lecturer on the MSc on Pharmacy Practice at Portsmouth University and is also an adviser to three Drugs and Therapeutics Committees in the South of England. Omar is a National Speaker in the UK (cardiovascular, diabetes, mental health) and is an Executive Board Member for the National Obesity Forum. He can be reached directly on ‘alipha@aol.com

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Features

Therapy focus: Leukaemia

by Admin 1. April 2004 05:00

Leukaemia is a type of cancer which affects the blood cells. In the UK, leukaemia is the 12th most common cancer in adults, affecting more men than women. It is the most common cancer in children.

Cancer The building blocks of the body are cells, which normally repair and reproduce in a controlled process. With cancer, this process goes wrong and cells divide and grow in an uncontrolled way. The body is made up of many different types of cells, such as skin, nerve, muscle and blood cells. With leukaemia, it is white blood cells that are affected.

About leukaemiaWhite blood cells are produced by the bone marrow, the soft spongy centre of bones. They then pass from the bone marrow into the blood stream and lymph system. White blood cells are involved in various functions of the immune system (the body’s defence system), which protects the body from infections. In leukaemia, some blood cells do not grow properly, but remain within the bone marrow and continue to reproduce in an uncontrolled way. These cells fill up the bone marrow and prevent it from making healthy white blood cells. This means the body is less able to fight off infections. The bone marrow is also able to make other types of blood cells, such as red blood cells and platelets. Problems can result from a reduction in number of these cells. For example, a lack of red blood cells leads to anaemia, which can result in breathlessness and fatigue. A lack of platelets can lead to problems with the blood-clotting system, resulting in bruising. Leukaemia is the most common cancer in children, but cancer is generally rare in children, and leukaemia affects nine times as many adults as children.

Types of leukaemiaThere are many types of leukaemia, named depending on the type of white blood cell affected, and how quickly the disease develops. Only the common types are discussed here. The two main types of leukaemia are acute and chronic. Acute leukaemia tends to affect younger people. The symptoms develop rapidly, and it can quite quickly become life-threatening if not treated. The most common form affects white blood cells called lymphocytes. This is called acute lymphocytic leukaemia (ALL). Chronic leukaemia tends to affect older people. The disease gets worse slowly and has a more prolonged progression. With chronic leukaemia, the white blood cells are almost fully grown and normal when they enter the blood stream. They can function, but not as well as they should do. One type of leukaemia called chronic myeloid leukaemia (CML) affects a particular type of white blood cells called myeloid cells. It has two phases, a chronic phase that may last several years, during which symptoms develop slowly, followed by a more aggressive phase (accelerated phase), where symptoms become rapidly worse.

What causes leukaemia?The cause of most cases of leukaemia is not known, although there are some risk factors that increase the chance of developing the disease. These include:

  • a weakened immune system - this may be a result of drugs that suppress the immune system (such as those used for organ transplants), high doses of radiation (such as in radiotherapy for another cancer), or diseases that affect the immune system (such as HIV)
  • age - chronic leukaemias are more common over the age of 40
  • smoking
  • certain genetic conditions, such as Down’s syndrome
  • previous chemotherapy for another cancer
  • other blood disorders, such as aplastic anaemia, a rare condition where the bone marrow fails to produce blood cells correctly
  • contact with a chemical called benzene, one of the chemicals in petrol and a solvent used in the rubber and plastics industry

Symptoms of leukaemia The symptoms of leukaemia vary greatly, depending on the exact type of disease and how advanced it is. Few or no symptoms may occur in the early stages, especially in people with chronic leukaemia. Many symptoms are vague, such as fever, headaches, weight loss and night sweats.

  • tiredness, breathlessness and pale skin (due to anaemia, a reduction in number of red cells in the blood)
  • frequent infections that do not get better (due to reduction in white blood cells, which fight infection)
  • abnormal bleeding from gums and cuts (due to a reduction in platelets which are important for normal blood clotting)
  • increased bruising (due to platelet reduction)
  • heavier periods in women (due to platelet reduction)
  • nosebleeds (due to platelet reduction)
  • abdominal pain, due to an enlarged spleen or liver
  • swollen lymph glands (glands in the neck, groin and under the arms)
  • bone pain, due to the pressure of cell build-up
  • swollen gums, and occasionally, swollen testicles

DiagnosisLeukaemia can be diagnosed from a blood test to measure the number of blood cells and look for any abnormal cells. People with suspected leukaemia are referred to a specialist doctor, usually a haematologist (an expert in the treatment of blood disorders). Other tests are often performed to investigate the type of leukaemia and how far it has progressed. These include blood tests, X-rays, CT scans, removal of bone marrow for microscopic analysis and genetic analysis of the abnormal cells. These tests are all very important because they help guide the treatment. Diagnosis, investigation, treatment and follow-up for people with leukaemia usually takes place at specialist centres, in hospitals.

TreatmentThe effectiveness of treatment for leukaemia depends on the type and stage of the disease. Acute leukaemia often goes into remission (the symptoms go away; the disease is under control but not necessarily cured). However, many people with acute leukaemia have a relapse (the disease returns). Chronic leukaemias develop more slowly than the acute types, but respond less well to chemotherapy and are rarely cured.

Acute leukaemiaAcute leukaemia is treated with chemotherapy to destroy the abnormal cancer cells. Mixtures of drugs are given into a vein in a series of treatment courses. Medicines are available which reduce the side-effects of chemotherapy such as nausea. Hair may fall out during treatment but it re-grows once the chemotherapy has stopped. Some people may be able to use “cold caps” which cool the scalp and help prevent hair loss. If the leukaemia returns (relapses), intensive treatment may be given. This involves a bone marrow or a stem cell transplant. Bone marrow or stem cell transplants allow much higher doses of chemotherapy to be given. Before transplantation, very high doses of chemotherapy and sometimes radiotherapy are given to destroy all the bone marrow, both abnormal and normal. This improves the chance of completely curing the leukaemia. Then normal bone marrow cells, donated from a close relative or carefully removed from the person’s own bone marrow, are infused into the bloodstream with a drip. Stem cell transplant involves transplanting stem cells (the most basic type of cell, from which all types of blood cells develop), rather than bone marrow cells. Stem cells can be harvested (collected) from a leukaemia patient’s own blood or from a donor. New alternatives, which are currently experimental, include harvesting stem cells from umbilical cord blood or placentas of new born babies.

Chronic leukaemiaTreatment for chronic leukaemia depends on its type and stage. Often treatment is not started unless there are symptoms. In the early stage, treatment aims to control symptoms by reducing the number of abnormal cells in the blood. Biological therapy may be an option for certain types of leukaemia, such as chronic myeloid leukaemia (CML). This involves treatment with natural substances (such as a protein called interferon alfa that helps the immune system fight leukaemia). As the condition becomes more advanced, treatment may consist of mild chemotherapy, blood transfusion and antibiotics for infections. Some evidence indicates that in chronic myeloid leukaemia, bone marrow transplantation can prolong life if performed during its chronic phase. Another available treatment is monoclonal antibodies. Antibodies are proteins that are produced by certain cells in response to infection. They usually attach themselves to bacteria or viruses and help to destroy them. A type of specifically manufactured monoclonal antibody that recognises and selectively destroys leukaemia cells can be infused into the body. An example is alemtuzumab (MabCampath), which is used to treat chronic lymphocytic leukaemia (CLL). For consumer-friendly and reliable health information on over 200 conditions, treatments and living healthily, visit BUPA's website at: www.bupa.co.uk

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