Straight talking: Getting to grips with new care models

Ross Clark, of Hempson’s Healthcare Solicitors, tells us why practices are coming together and how they can make it work.

When it comes to new care models, the changes taking place in general practice aren’t simple. We surveyed members and they told us that there just wasn’t enough practical information and advice to help them with some of the issues they were grappling with. Business planning, communications, data sharing and staff contracts were just a few of the common themes.

Practices need to strengthen their workforce

There is a great deal of concern across the country about the survival of GP practices given the regulatory, administrative and clinical changes they face and the fact that workload has grown so much. Alongside this there’s both a potential succession crisis, where partners are retiring, and recruitment crisis, where it’s difficult to get new partners or new GPs into a practice. That’s causing more pressure but working with or even merging with other practices to ‘scale up’ can make practices more resilient to workforce threats.

Collaborating ultimately means more available resources to a group of practices, to manage all the tasks and deliver the services that are required. People can specialise in what they’re good at, so you might get a GP providing specialist services and another GP doing general practitioner work. You could find practice managers that are really good at finance, or CQC, and they can focus on that. In this way you can get people becoming more focused and expert in the areas that they deal with, providing support to the whole group and benefiting everybody.

Collaboration can help practices plan for their future

It’s absolutely fundamental that each GP practice develops its own business plan or strategic plan for the future. But time is without a doubt the single biggest pressure on GP practices. Finding time to develop a business plan is hard, alongside patient care and management of the practice itself.

The answer often lies in delegation – ideally with a small team driving the development of strategy and business planning. That’s hard for a smaller practice, where there are fewer people, so it’s easier when groups of practices come together, either in a loose association, federation or a GP provider company. In those circumstances it may even be possible to engage an executive or consultant to help develop strategy and plans with the practices.  Either way, joining together can free up resources for structured planning.

There is an underlying bigger picture

Practices don’t operate in isolation. This is seen in CCG commissioning plans, but more importantly in the sustainability and transformation plans (STPs) for an area. These are plans developed by the council, the local authority, the CCG and some other providers, such as acute sector providers, to be an integrated plan for health and social care across the whole community. It’s fundamental that practices know what their STP includes, because that will shape the strategic direction of their own practice.

If you look at the STPs you can see that the overall direction is towards more capitation-based contracts for out-of-hospital care across the whole community – in other words, a healthcare plan that allows payment of a flat fee for each patient it covers. If practices aren’t formed together at scale, there’s a risk that they may lose out in this type of world, but actually if they can collaborate there are opportunities in that development as well.

Everyone should keep up with changes

It’s really difficult to keep up with the legal, financial and other regulatory changes that are taking place today. The best piece of advice to practice managers and teams is to look at their networks and sources of information and keep checking regularly, if not daily, so you can spot things early and decide who needs to know more. It is often people working as a team to keep track, keep an eye out for changes and make others aware that creates a solid foundation for anticipating and reacting to change.

Ideally your practice will have access to good professionals that regularly disseminate information and make you aware of key changes, for example your lawyers and accountants. In addition, think about organisations that can provide key information – for example, the RCGP, the BMA and the National Association of Primary Care. Your practice may operate in a more specialised area with organisations linked to that too. Finally, there are also a number of good journals and magazines for the primary care sector, such as HSJ and Pulse, whose job is to provide information in useful chunks. All these sources can help you and your practice team keep up-to-date and manage the legal and financial implications of change.

Two-way communication is so important

Once a federation, organisation or other type of collaboration has been set up, it’s fundamental that those leading it maintain good communications with the members. This might be simple when everyone is part of the same local community, but that community is also very busy in their own practice and might not know everything that’s going on.

The most successful collaborations are ones that communicate constantly using meetings, emails, letters and newsletters to keep each other informed, both top-down and bottom-up, with staff also playing their part in actively seeking out information.

Be prepared for technical challenges

Standardising IT systems across practices is vitally important for collaborating practices. When practices are working together but not merging, they need to look at the systems they’ve got – to plan interim measures but ultimately move every practice to one system so that everybody’s on the same platform. Linked to this, all staff need the same training so they all use the system in the same way.

Something that is often overlooked is data protection. Patients will have given consent for their data to be used within a practice, but practices working together without merging could be sharing information with what is effectively a third party, when they don’t have consent to do this. To avoid being in breach of the Data Protection Act, all the practices in a federation need to look at the consent that’s been obtained from patients, and if this isn’t expansive enough to cover sharing information with other practices in the area, then they need to re-establish consent. 

New care models: all you need to know

We have created a virtual panel of experts in other fields, all with a common interest in general practice being delivered at scale. We have put some of your questions and concerns to them, and they will be reporting back via our new online advice hub, which is currently being developed and will be going live soon.

Is your practice or organisation changing?

If your practice is merging, federating or developing new care models or services, your local Medical Protection representative can help you consider the medicolegal and indemnity implications. Simply email [email protected] and we’ll be in touch.   

Words by Michelle Southam