Hierachy of Plans Karen Stubbs Corelli Consulting Limited

What is the overall plan for primary care ? NHS Plan (10 year plan for NHS) nGMS Contract (Gps terms and conditions) Business Plan ‘Fail to Plan = Plan to Fail’ 3 – 5 years (updated every 6 months) Why do you need a plan

Partnerships Practices & PCTs Patient & wider population Voluntary & Independent sectors Secondary Care Local Authority

Knowledge and Skills Plan new services Develop business plans and business cases Planning is a proactive process Planning ensures services are developed in line with local and national priorities and patient need Improve health and inequalities

Plans – 2 main types Strategic Plans Some examples Commissioning Plans Access PBC LES/DES Health Inequalities LDP About the Bigger Picture = The WHAT Broken Down into manaagement/operational objectives

Strategic Plans in Practice Linked to achievement of national and local strategic objectives translated into aims of the practice Improving particular services Raising/Improving Quality standards Increasing Market Share Financial Return on assets Profitability Achieving a major project (new premises etc)

Strategic Monitoring Practice Meetings Regular basis – at least once each quarter Lead GP for each element of strategy Clarity about the overall objectives and direction of travel by all Ownership and understanding by all

Operational Plans The ‘How’ – the detail of how the strategic aims are going to be achieved Operational Plans Who What Where When Need regular monitoring (weekly/Monthly) Project Plans are used to monitor achievement

PBC Evolving landscape in Primary Care Care Closer to Home Patient voice VFM Patient safety Choice of providers

Practice Development Plan Setting the Strategy What needs to change to develop the practice to achieve the strategy PDP = operational plan What are the resource implications Where is the evidence Who is the market

Case Study 1 Practice Employed First-Contact Health Visitor Why – minor illness management of children = lots of GP appts and follow up Needed to improve skill mix and provide central point of contact for on-going management

Health Visitor Service Recruit a health visitor to lead the service Communicate with patients about the service Engage practice staff to support and deliver the service Train the health visitor to provide the service Measure the impact of the service Extended formulary nurse prescriber and supplementary prescriber

Outcomes 30% of cases previously seen by GP now seen by health visitor in first year 60% in second year 80% in third year In the 3 years of the project 6 patients referred to hospital 14 were referred and treated by GP

Why did they need a plan What level of plan was required What elements of planning needed to be addresses ?

Case Study 2 – Low Back Pain Initial 18 week wait for out patient appt Or 14 weeks to physio appt These waits resulted in increased demand for GP appts for pain management etc The LBPS transferred care of patients to ESPP led service ESPP had direct referral rights to range and choice of services to patients

What sort of plan did they need ? What are the planning issues that need to be considered in this case ? Modelling to predict demand Planning the scope of the seervice Commissioning capacity from specialists Securing commitment from management teams Documenting process, policies and referral pathways Governance and accountability frameworks Sharing information with practices

Outcomes Service established Reduction in GP workload Reduction in waiting times to 2 weeks Increased patient satisfaction Increased GP satisfaction with the service they had planned From a sample of 150 patients 109 reported %improvment in symptoms

Case Study References - WiPP 1. Mike Richardson – Whaley Bridge, High Peaks 2. Kim Rickard – Horsham West Sussex

Refs; Business Planning in the Health Service A guide for managers ISBN Thomson Business Press Amazon on-line