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Taurus Healthcare Primary Care @ Scale
Graeme Cleland
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The Brief Our Experience of Rapid Multi Practice Change- the Successes and Lessons
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The Landscape Today Primary Care is the foundation of the NHS
Has excellent levels of competency and satisfaction It is by it’s very nature is Entrepreneurial and Flexible It has a vast array of resources and skills that are not capitalised upon Believes in itself as an entity – perhaps not always as a whole Is majoratively tied to a “GMS” contract that isn’t in itself necessarily a catalyst for change Is eminently capable Is being encouraged to think beyond the doors of the practice Is already by default delivering Outcomes Based Commissioning with a place based budget Has a very unique opportunity, the sum as a whole is greater than the sum of it’s individual parts.
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The Need to be different Pressure in General Practice
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What has Taurus Done and Delivered
Taurus was incepted as a concept by the primary care community nearly 5 years ago, having initiated from conversations at LMC Having gained suitable support in that forum Has a high level of system wide GP engagement Is supported by all 24 practices, having raised share capital on capitation basis from partners Taurus was then established as an LLC 4 years ago
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About Taurus in 2016/17 An independent company limited by share
Owned by the partners of all 24 practices in Herefordshire Incorporated as a stand alone provider business, contracting vehicle and Primary Care Federation CQC, NHSIG and N3 registered Holds NHS Standard, Local Authority and APMS Contracts Correct Configuration also allows Taurus to hold a GMS contract Part of the wider NHS family “Legal” countywide Data Sharing arrangements in place Collective Incident Management and Reporting protocols
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About Taurus in 2016/17 Exploring new models for Property
Exploring new models for Resourcing Working with Education West Midlands, and NHSE on Role development for ECP, ANP and PA in General Practice Moving to models of standardised General Practice Preparing the Partnerships for the Future
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The Journey
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Why did we embark on this journey
Demand is increasing year on year Net funding including Cost Aggregation will continue to reduce Recruitment and retention difficulties – even in “solvent” dispensing practices Patient Care is exposed to greater risk To keep a modicum of destinational control Coming together at scale isn’t easy when everyone believes their model is best in class One size does not fit all – a degree of individuality A vehicle for closer working together Scaling Access to services Enables shift of resources from Secondary “In Hospital” care to Primary “Out of Hospital” care Gives formal credibility to a “Federation”
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What are the Practices telling us
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Coming Together at Scale – First Steps towards PC@S
IG Accreditation N3 Registration CQC Registration
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Our PC@S Program A raison d'être for closer working together
Since inception we have always been minded to work collegiately and collaboratively Coming together at scale isn’t easy when everyone believes “their model” is best in class One size does not fit all – a degree of individuality A raison d'être for closer working together Scaling Access to services Enables shift of resources from Secondary “In Hospital” care to Primary “Out of Hospital” care Gives formal credibility to a “Federation”
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Taurus Current and Future Offerings
Highest Complexity Offerings Clinical Appointment Clinical Delivery Qualified Onward Referral Clinical Triage Clinical Audit / Peer review Scale of Complexity and Cost Midrange Complexity Offerings Admin Triage Choose and Book Clinical Education Admin Referral Audit Clinical Audit Best Practice Research Clinical Education Admin Referral Audit
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Challenges Being Faced
What were / are our challenges Legal challenges CQC Registration Confused Shareholders Corporate Governance NHS “Authorised” Body Status Patient Engagement Compliance Experience Acute Provider Scale Alliance Contracting Contracting Process Acute Provider Property Scale MCP Contract
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What have we learned None of this is easy – everyone has an idea of what “Good” looks like Some still hold firm to a 1970’s principled “General Practice” – difficult as contracts are changing To be successful we must have a Viable, Vibrant, Growing and Flexible with an empowered culture. We must look at the “Sustainable” Future of General Practice New contracting models will be needed to drive change – Capitation based contracts are potentially an opportunity for General Practice Unified Primary care is Stronger than the sum of it’s parts New resourcing and clinical pathway models are upon us. New models for property will reduce risk and encourage GP retention Refocusing strategic objectives to create an Alliance Ready Primary Care team.
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Critical Success Factors
Leadership – this is a complex changing environment, and needs “Leadership” Maturity, focus on delineating service lines, focussed on Delivering services as a provider organisation Maturing a sense of Federation – different to Co-Operative Developing an “Alliance Ready” culture Driving forward principles of maximising strategic primary care by sharing expertise, delivering excellent clinical care, standardising inputs, outputs and clinical pathways. Maintain a high level of clinical input and GP Leadership, whilst leading change Flexible governance structures
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A Pragmatic way Forward
Stay the course No Monopoly on Good ideas Make time to do this properly Establish Pillars CQC, IG, N3 Partnering Governance
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Summary These are complex changing times, and Primary Care needs “Leadership” Be willing to both “Stand To” and contribute to change Don’t underestimate the scale of the task, Be willing to make mistakes Be “Open to Challenge and Change” “Breathe” – both in and out Don’t fall into the trap of Micro Management – stay the course focussed on the strategic end game
