Dr Curran and Partners



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Dr Curran and Partners
www.claphamhealth.org.uk

Practice Business Plan
2009 - 2012

APRIL 2009

Table of Contents
1. Purpose of this Business Plan …………………………………. 3
2. A brief overview of the Practice and of activity ………………. 3
3. Staffing ………………………………………………………… 5
4. Premises ……………………………………………………….. 6
5. Information Technology ………………………………………. 6
6. Patient Services/Service Development ………………………… 7
7. Profitability and a changing market place ………………………7
8. Management …………………………………………………… 8
9. Communication …………………………………………………8

10. Skill Mix – Clinical and Administrative ……………………….. 8


11. Patient Forum ………………………………………………….. 9

12. Practice Based Commissioning ………………………………... 9


13. Summary ……………………………………………………….. 9
14. Table of Goals and Objectives 2009 and forward to 2012……… 10

DR CURRAN AND PARTNERS – MANOR HEALTH CENTRE


Business Development Plan 2009 – 2012
1. Purpose of this Business Plan
The purpose of this plan is to set out clear objectives about what we are trying to do here and to describe something about the practice and the changes we think are important to introduce over the next three years.
We hope that our staff (especially any new staff) will be able to see what we are doing, that the PCT will feel they understand our direction and that as a business we continue to prosper in a changing world.
In producing this plan we have learned a lot about ourselves and we have shared a considerable amount of information among the partners and staff. We genuinely believe that we are stronger as an organisation because of this work. We consider this plan to be a “living document” and we want to see it updated and changed as we progress through the year.
2. A brief overview of the Practice and of activity
Dr Curran and Partners – Manor Health Centre is a well-established GP Surgery that has operated in this locality since 1989. There are 9,300 patients and currently three partners, all male. There are also five salaried doctors (three female and one male).
The Practice is situated on Clapham Manor Street just off Clapham High Street and draws patients from residents of Clapham.
Clapham is an area of contracts with high levels of social deprivation side by side with areas of affluent private housing. Hence we are faced with deprivation-associated problems such as poor housing, poor education, poverty, drug and substance misuse, and chaotic lifestyles. At the same time, we also have many patients from professional backgrounds.
Increasingly, young affluent people are coming to live in Clapham bringing with them busy, stressful lifestyles and high expectations of service quality and availability. The Practice seeks to find models of medicine, nursing, administration, counselling etc. that can accommodate their spectrum of needs.
The Practice is not currently a training Practice, but does have very good academic links with Imperial College London (through Dr Majeed) and with St. George’s Hospital Medical School (through Dr Oakeshott).
We have also developed a practice web site which contains information on our services. The site also has links to local health authorities and NHS Trusts and to reputable providers of health and medical related information. The URL is www.claphamhealth.org.uk.
Our mission, the reason we are here, we see as:
“To provide an appropriate and rewarding experience for our patients whenever they need our support”.
Our practice aims to maintain a responsive and better quality service for our patients. We want to continue to achieve improvements in patient care, delivered with sensitivity at a patient level. To this end, we will continue to strive for the means to provide an improved, efficient and cost effective service.
Our core values that are shared among the partners and staff are:


  • Openness

  • Fairness

  • Respect

  • Accountability

The practice has always prided itself on providing high quality medicine in a traditional family practice setting and that has been the unwritten rule for many years. We believe we are respected by our peers and we have built a positive relationship with our consultant colleagues at the local hospitals. One of our salaried doctors is a Trainer, and learning and education is an important part of what we do.


Achievements in the past year
In the past year, we have


  • Restarted a regular weekly diabetes clinic

  • Carried out a patient satisfaction survey

  • Completed a cycle of clinical audits

  • Achieved our aspiration targets in the Quality Outcomes Framework

  • Recruited a new practice manager

  • Updated our practice booklet

  • Updated our Development Plan

  • Undertaken a housekeeping of our clinical system to identify those who have left the area or who have died; and then removed these patients from our target population

  • Upgraded all our PCs

  • ScriptsSwitch software updated on all PCs

  • Used QMS to highlight areas needing to be improved; carried out audits and effectively managed the change process.

  • Current Infection Control procedures and policies now in place and single-use instruments now in use. Initiatives in all these areas are ongoing

  • Information Management and Technology procedures and policies now in place in line with NHS Connecting for Health criteria for Component One and most of Component Two

  • Staff annual appraisals completed

  • Staff training undertaken on our clinical software systems

  • Using QMS to help the clinical team manage chronic diseases more effectively

  • Resuscitation training carried out effectively for all clinical staff

  • Practice Nurse training requests and updates implemented

  • All nursing homes and The Robertson Street Project have had a physical health and medication review completed within the last year

  • Improvements made to our website www.claphamhealth.org.uk

  • Website information updated

3. Staffing


We are fortunate in the ability and commitment of our staff. Our staff turnover is low and the staff are always willing to explore different ways of working. An example of this is the way we have responded to the pressures of 48 hour access and the need to “marry” the legitimate demands of our patients with the need to play the game of meeting targets set by the government. Another recent example was the extended opening hours when the practice decided to open until 8.00 p.m. on a Monday and a Tuesday evening each week. We believe that our patients will say that their needs are now met with the flexibility we have built into our system and our staff are to be congratulated for the way they have responded to the problems we experienced here.
All staff have regular reviews and an annual appraisal where the goals of the individual, teams and practice are discussed and agreement reached on the way forward. Regular reviews act as a way of reinforcing effective performance, highlight areas for improvement and recognise developing strengths.
The 2004 GMS contract arrangements and funding mechanism has given us the opportunity to re-examine the payment arrangements for our staff and we are doing this. We have decided as a short-term measure to give bonus to our staff as a result of the points awarded to us under QOF.
Practice Staff
Doctors Sex Qualifications

Dr David Curran Male MB BCh BAO (Dublin 1976) (Male)

Dr Azeem Majeed Male MB BCh (Cardiff 1985) MD MRCGP MFPHM

Dr Dev Verma Male MBBS (London 1997) MRCGP

Dr Pippa Oakeshott Female MD FRCP MRCGP (Cambridge 1975)

Dr Andrea Davis Female MBChB DFFP MRCGP MSc (Bristol 1995)

Dr Niamh O’Carroll Female MB BAO BCh MICGP (Dublin 1999)

Dr Chris Davis Male BSc MBChB DCH DFSRH MRCGP


Nurses
Tess Monem SRN

Clementina Amoah RGN

Natasha Carikas RGN

Health Care Assistant
Mandy Downer

Practice Manager


Rose Allan MIHM AMGP (Dip)

Deputy Practice Manager


Caroline Rafter

Receptionists


Jayne (Senior Receptionist), Olga, Michelle, Mandy, Pauline, Patricia and Alison

Secretary


Debbie

Counsellor


Michaela McCarthy

4. Premises


The practice has been in this building since 1989.
The premises are purpose-built, have been refurbished and house, as well as us, another single-handed practice doctor and staff and also Lambeth PCT and some of their staff. As we are progressing we now find that we could do with more space. Hopefully that could become available if Lambeth PCT decide to move their ancilliary staff to another location. This would mean that we could expand within the building and provide further services for our patients.
5. Information Technology
We would describe ourselves as satisfactory but with room for improvement. We have seen the great strides taken by other practices when they have invested in new technology and we are committed to doing more with IT.
All of our IT equipment is now up to date and functioning well.
As a first stage in improving we will be looking at an intranet for internal use and will be investing in appropriate training, initially for the partners and the Practice Manager. The practice has an existing website which is used by many patients for information. Patients are also able to book some of their routine appointments online via our software Access.
Areas of training on our clinical software program have been identified for our staff at their annual appraisal and these areas will be acted upon with immediate effect. Our Emis trainer has been booked and will be coming during the months of April and May 2009 to update our staff in their various areas of work.
One of our main aims is to successfully meet the Connecting for Health’s criteria and to reach component four of the IM&T Des where the practice will achieve the “paperless” criteria set by the NHS.
6. Patient Services/Service Development
At the end of the first year of the new GP contract we did quite well but each succeeding year we are improving and can now look back at our performance and the way we have responded to the challenges placed before us. We were pleased with the number of points awarded to us under QOF this year and we believe we worked hard on our clinical systems and administrative systems to make improvements. The responses made by patients under the questionnaires were broadly pleasing but we know we have some action to take to address some of the problems that our patients identified.
Telephone access is one area for continuing work and we know we must work on the way to improve access. We have introduced GP telephone consultation time between 11 and 11.30 a.m. each day on a trial basis. If this meets some of the demand we will continue to provide this service to our patients.
We all use the skills that we each bring so that patients are dealt with by the professional with the most appropriate skills. We recognise that this will mean many of us being prepared to work in different ways.
7. Profitability and a changing market place
The government has negotiated a new contract with general practice and we have accepted this as a way of working for the future. We opted for the Personal Medical Services contract that has been on offer to general practice for the past five years. The new PMS contract gives us more flexibility and allows us to identify areas of need and then we can follow through with the appropriate action to address any gaps to provide appropriate care and attention to the patients registered with us. A proportion is taken as profit but most monies are ploughed back into the business to allow us to grow to meet demand.
We appreciate that the market place is changing and although the earnings of GPs have increased significantly over the last four years we realise that this sort of increase is not sustainable and that the market will see change and consolidation. We have already seen the entry of a new “player” (the new GP lead polyclinics). We have noted the economies of scale that this new player can bring in the way of surgery premises and staffing and we need to change our thinking about how we organise ourselves to meet the very changing market place. We need to make sound economic and business decisions about our future.
We need to think how else the market may change and whether we are best geared as a relatively small unit to meet the future needs of our patients and, as importantly, of the partners and staff. We will continue to look at how best we can do this.
8. Management
Our management style is best defined as functional and informal. Our new practice manager has now been with us for six months and together we have been trying to bring some new ideas into the practice. We try to instill a stress-free and lively environment, which encourages employees to remain focused and project a positive attitude to patients. A relaxed and friendly culture has developed among doctors, management and employees.
But we do need to re-examine our senior management arrangements. Our current systems leave our present manager with little scope for looking at some of the “bigger picture” issues; for us things like our IT usage, our need for larger premises and Practice Based Commissioning. We need to re-examine the way we organise our routine management tasks to see if there are ways in which we could make improvements.
9. Communication
The partners meet as a group along with the Practice Manager on a weekly basis with a pre-prepared agenda. We hold a monthly meeting with representatives of our staff and we have a monthly clinical meeting with the doctors, nursing team and attached staff (district nurse, health visitor, physiotherapist etc.). We believe our communication is good but there is still room for improvement. We want to explore making better use of our computer system to address this. Our internal e-mail system is used quite extensively by some members of staff.
10. Skill Mix – Clinical and Administrative
A recurring theme to our re-examination of our current activity and our plans for the future has been to examine carefully why we undertake certain activities that we have taken as a “given” for many years; one of these is a re-examination of our skill mix looking at who does what. Not just in the clinical areas but also in all our administrative areas.
The reason why certain people undertake certain roles is often hidden in the mists of time and is then often fiercely protected! Apart from some areas where the law is involved (who can sign prescriptions; who accepts final legal responsibility for the work of others) much of the rest of the organisation and distribution of our clinical work is simply down to tradition.
We need to examine who does what and look at what activities can be undertaken by people other than those who have traditionally worked on that role; this could result in significant delegation and cost savings; it then gives the ability to redeploy the resources we have released in other ways and thus improving the job satisfaction of staff who have been given greater responsibility. It is an area that will take time and needs to be well-planned and thought out strategically in the long-term.
11. Patient Forum
We have traditionally worked with a patient forum yet the idea came out of the responses to patient questionnaires done under QOF and this will be re-introduced again on, hopefully, a more business footing where the needs of the practice only will be addressed and not allow any room for patients’ personal agendas. So far we have just dipped our toe in the water.
12. Practice Based Commissioning
One of the biggest challenges, or opportunities as some would say, is the issue of Practice Based Commissioning (PBC). What are the advantages of taking part in this and, of course, what are the disadvantages.
We have had some discussions, have lodged interest with the PCT, signed a collective agreement with other practices that we will work together to improve our local service provision based on need. As Lambeth PCT are now due to re-organise yet again we hold no great expectation of rapid progress during their reforming. We are adopting a watching brief and looking carefully at any opportunities that may emerge.
13. Summary
This is the first business plan since the most recent new contract we have produced at this practice and we are pleased with the outcome. We recognise that we could have included much more information, but as a first attempt it gives all our staff and others interested in our progress (the PCT, our accountant, our bank and our patients) a picture of what we are doing here and some of the changes we intend to make over the coming period.
We have arrived at this stage and produced this document as a result of consulting with our staff with a questionnaire and, following a series of meetings with partners, where they have expressed their hopes for the future and all the information has been prepared along the way. It is important to keep this document up-to-date and this we intend to do on a regular basis so that at any time all of us know what is happening, what areas of change are delayed and what changes have been achieved. We have become great believers in the maxim that the process (of preparing this document) has been as important as the document itself.

14. Summary of Goals and Objectives 2009 and forward to 2012





Area of work to be examined

Tasks to be undertaken

Lead Person

Interim measurement

“Finished by” date

Cost

Partners/doctors personal development

Exploring the best ways of helping the partners and doctors to keep up to date clinically.
Aspire to maximum points under QOF by 31 March 2010

Dr Curran

On personal development


Dr Verma and Practice Manager



Dr Curran Report to partners by December 2009
Report to partners by May 2009 on those areas

Where we need to make changes to move to maximum points. What needs to be done and what investment is required. (to include LES/DES)





April 2010

31 March 2010






Information Management & Technology

Developing and implementing the computer security policy and all IM&T protocols. (These are presently communicated via the clinical software shared drive for all the staff to access and read.)

Creating a practice intranet



Practice

Manager


Practice Manager

Practice Manager




Update of practice website created by Dr Majeed

IT software already in place



April/May 2009

December 2010






Expansion of existing services

Discussions with PCT to be commenced May-December 2009. Discussions could include other neighbouring practices

Dr Verma and Practice Manager

Interim reports to partners by December 2009







Training and skill-mix review

Ongoing

Practice Manager

Report to partners with options and costing by October 2009

31 March 2010




In-house training

Information Management and Technology protocols
Information Governance policies
Infection Control Policies



Practice Manager

All three areas are on the shared drive for information

March 2010




Infection Control

Ongoing

Practice Manager

Constant monitoring for improvement

March 2012



Patient Forum/Participation Group


Further discussions with interested patients


Practice Manager


Report to partners by June 2009 indicating whether this project has possibilities



Ongoing





Practice based commissioning

Reading, research and discussion and training programmes and keeping up with the debate

Dr Verma and PM

Regular reporting back to management team

Ongoing




Market Position/Future organisation of the practice

Discussion with other interested parties/practices on the future likely make-up of the market place

Dr Verma and PM




Ongoing




Targets

To realise maximum patient uptake in:
Childhood Immunisations

Cervical Cytology



PM

Identifying patients who are eligible and contacting them with further explanation of the advantages of immunisation and screening and with the offer of another appointment

Dec

2009











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