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1. Future of management in general practice Charlotte Leggatt
Practice Manager Partner
VTS Trainer/Lead Assessor for IHM
LMC Lay Secretary
IHM Council
3. Where has management come from 10 years ago, largely an administrative role with growing managerial responsibilities
Involved good organisational and operational management skills
Risk low
Some change but pace was slower
4. Where are we at now Post 2004, most practices have some kind of management structure which is working beyond an operational level.
Relationship with Primary Care and some relationship with secondary care (CHPs)
More stream lined moving towards efficiency (staffing levels, IT, referral management, prescribing, patient ratios, accessible services)
Moved from administrative function to a management function (with some strategic overview)
5. What is our current role Strategic and operational management
All HR functions (growing salaried GP workforce and complexities of employment law)
Contractual arrangements (30 plus contracts are not uncommon)
Financing and budgeting (with the emphasis on the latter)
Partnership arrangements
Facilities management
Information and System management
Liaison with Primary Care Providers (may involve working on other groups)
Health and Safety Management/Clinical Governance
Publicity/Marketing/Patient Education
Managing change processes
Working in a higher risk situation
6. General health drivers - UK Changing demographics
Rise in chronic disease
18 WRTT
Accessible services
Public Expenditure
Public policy
7. Demographics A shrinking and ageing population = critical policy challenges for Scottish Government
Age rate is rising births are falling
2002 800,000 over 75s
30% rise will mean that by 2042 1.3 million
2002 800,000 under 15s
30% fall wil mean by 2042 620,000
8. Long Term Conditions LTC are growing at a faster rate in Scotland than many of our counterparts
80% of GP appointments are for chronic disease
60% of hospital in patients are for those with chronic disease
Chronic disease increases with age
9. Long Term Conditions COPD to rise by a predicted 33%
Diabetes 1 patient every 40 minutes in the UK being diagnosed
Depression WHO believes 2nd major chronic disease in the next 20 yrs.
Enoch Powell in his more unpopular years said any health service faces the problem of infinite demand meeting finite resources
10. Or put another way Capacity and demand are out of kilter
11. Scottish specific drivers Election year
Awaiting manifestos
Key policy
Kerr report and Better Health Better Care 2005
Delivering Quality In Primary Care 2010
Clinical and Staff Governance 2010
12. Kerr Report 2005 ..the next twenty years will see an ageing population, a continuing shift in the pattern of disease towards long term conditions and a growing number of older people with multiple conditions and complex needs. These changes in themselves will make the current model of health care delivery unsustainable
13. Delivering Quality in Primary Care: An action plan SGHD visited to all areas (primary care, GPs and PM)
Radical look at enhanced services aligning closely with health priorities by April 2012 (starting in the Spring of 2011)
Prepare for consequences of the White Paper
Role of community hospitals
Scottish Patient Safety Programme
Up to date suite of pathways
National Quality Indicators for OOH
Priority to Anticipatory Care
Workforce Planning
Partnership between Primary Care Professionals
Partnership between Primary & Secondary Care (electronic patient records, epharmacy, information & emergency care summaries, electronic links)
Enhancing leadership role that GPs play in CHPs
14. Clinical and Staff Governance Re-validation relevance
Legal (child protection, adults with incapacity, vulnerable groups, misuse of drugs)
Contractual (clinical gov lead, infection control)
Professional (regular clinical meetings, effective management of repeat prescriptiosn
Aspirational (leadership roles, managing conflict, adverse events and near misses)
15. White Paper English Implications for Scotland???
Re-organisation of the NHS
Abolition of strategic health authorities
500 GP commissioning consortia (risks of being too small?)
Patient choice to GP services (how will that work in practice?)
Role of hospitals/secondary care?? (very little mention)
16. The Global Economy
18. Whole System Re-design
19. What do others say BMA split on White Paper
SGPC dialogue with SGHD (election)
RCGP re-validation and federations
Policy Writers commissioning is not easy too much duplication in GP (Lilley)
On the Practice Manager more responsibility, wise up, skill up and become more proactive! (Practice Business)
20. What are the options for GP? Inward looking
Baton down the hatches
Ride out the storm
Count the casualties
Support a dialogue between BMA and Government
Support a dialogue between Primary and Secondary Care
Look at the balance of care (commissioning?)
Shifting the resource need SGHD help
21. What could PM look like in the future? More responsibility and accountability
Strengthened Leadership roles
More specialised roles (federating)
Managing GP consortia (larger groupings, different staff groups)
Doctor managers? Or manager managers? (cost effective management is key)
Savings have to be made (there will be casualties)
Understand and Explore Commissioning
22. What skills will Managers Need The ability to manage change
The ability to manage projects
Leadership (Visionary) Skills
Interpersonal (People) Skills
The ability to make tough decisions
The ability to negotiate
The ability to make the organisation more efficient
The ability to manage performance/capability
The ability to manage risk
23. How do we get there? Be proactive
Start influencing now
Provide Leadership (VTS Practice Manager Programme & The Frontline Leadership Programme)
Work with our clinical colleagues, CHPs and Secondary Care
24. On a personal level, from one to another The art of self preservation
Self belief
Self confidence
The ability to keep moving forward when you would rather not be there
The ability to self motivate because who else is going to do it for you
