2. The Problem  Stenhouse Practice overspend with a cost to NNECCG at month six of £800,000 over budget. *NNECCG (Nottingham North and East Clinical Commissioning Group)  21 Clinics  145,000 patients  £165m annual budget

3. S.M.A.R.T. Objective  To reduce Stenhouse overspend by 20% (of projected) by year end at 31 3 13 and to establish systems to bring Stenhouse in budget by 31 3 15

4. Root Cause Analysis  A+E 237k  Critical Care 527k  Day Case 576k  Emergency 2,111k (148k)  OPD 1 st 514k  OPD f/u 548k  OPD procedures 451k

5. Alternative Interventions  Focus Peer Review (T&O and Gastroenterology)  External Scrutiny  Targeted Peer Education and Support

6. Comparative Analysis InterventionEmpoweringExpense Peer ReviewSelf Encouraging Builds on Existing Strategy Internal use of time only Some restructuring of the day External ReviewerA bit ‘Big Brother’ like Could be Disempowering Would cost 1-2 hours per day of additional clinical time Periodic GPwSI Support Educational and Skill Developing Could be Empowering Would cost 1-2 hours per week for specific skill expertise and internal time

7. Select, Implement and Create Evaluation Plan  Select a Strategy-----Focus Peer Review  Implementation Plan-----Meet Daily, Review Guidelines, Share Good Practise  Creating an Evaluation Plan-----CCG feedback monthly to practice, focus on non urgent GP driven activity, review at year end

8. Preliminary Results

9. I am Happy  Logical and easy to follow  Follows what I know from P.R.I.D.E. and 4DX  Empowering  Transferable  Delivers  Encouraging  Reflective

10. Thank You