Improving Resilience
Case Studies
Various projects have been undertaken over the last few years and some examples have been briefly described below. The largest project required a team of 20 clinicians and management to help a Practice respond to their CQC Section 31 notice and was carried out over two years. The smaller projects required single-person support for Partners or Practice Management. The smallest of these has been a 3-month Interim Practice Manager assignment. Projects have been funded directly by Practices, or through the CCGs (now ICBs). Many of the projects have been self-funded through the improvements made to the Practice.
Finance & The Partnership
Practice A was a medium-sized single-site Practice in an urban location. They had recently had the retirement of senior partners and were looking for support to review their partnership structure and improve clinical leadership. The longest-serving partner did not want to be a Managing Partner and support was given to look at other leadership models within the team. Support was given so that the remaining partners started to better understand the financial processes within the practice.
Work was also done on revamping their recall processes as they had single disease recall and there were issues with the use of appointments and engagement from their patients. The practice was moved to a multi-disease recall process using the month of birth. Long-term condition reviews and care for the housebound were also reviewed and improved.
Merger Support & Finance
Practice B was a small Practice working out of partner-owned premises in an urban location. The partnership was struggling as the senior partner had retired and the second partner was on long-term sickness leaving a very inexperienced junior partner to run the practice single handily with two part-time salaried GPs. The junior partner decided to hand their notice in as they did not want to run the practice in this manner but had to work their 6 month notice period. The local CCG were involved along with the LMC and the remaining partner and the practice manager were supported for that notice period along with facilitating an emergency merger with another practice to support the survival of Practice B when the second partner returned from sick leave. This support involved clinical sessions, advice and help with understanding finances and the partnership agreement and liaising with the two practice teams regarding aspects of the merger.
Investigation, Duty of Candour & Workflow
Practice C was a large multi-site urban/suburban Practice that was run by a corporate provider who was withdrawing from their contract following CQC conditions. There were clinical safety concerns in multiple areas and the CCG needed clinical leadership and input to stabilise the practice whilst alternative providers were sought for the contracts. The project required regular liaison with the Quality lead at the CCG as well as the lead clinician at the Performers team, Duty of Candour work and also investigative work into concerns regarding workflow filing by a single clinician. The practice was supported until the new providers took over.
COVID, Process, Recruitment & Leadership
Practice D was a medium-sized suburban Practice operating from a single site that was in need of updating. The practice was affected by a partner on long-term unplanned leave and the retirement of the senior partner. The new managing partner required support as they took on and learned about their new role and the practice team was looking to improve workflow processes within the practice. Very soon after this project commenced, the country was hit with the first covid lockdown. Leadership support was given to assist with decision-making as to how to respond to this new challenge to the practice. Support was given with recruitment, quality improvement audits, significant event investigations and process/protocol updating.
CQC Section 31 Conditions
Practice E was a medium-sized urban Practice who were directly supported by the CCG. They had issues with coding, appointment templates, recruitment and maintaining safe staffing levels due to a partnership dispute. Support was provided to start to address all these areas and then subsequently to address CQC conditions that were imposed as a result of a virtual inspection. A full team of Project Leadership, GPs, Management, Nurses, Clinical Pharmacists, and Administrators were assembled and formed the team that worked alongside the Practices Core Team.
The Section 31 conditions were onerous and involved complete health and medication reviews for a subset of 5,500 patients. A bespoke process was designed to manage the patients alongside the day-to-day running of the practice. The project ran for 2 years and the final report detailing the work, the learning and patient outcomes comprised over 400 pages and 150,000 words.
Leadership, Staffing & Processes
Practice F was a large multi-site Practice run by a corporate body. They had challenges with finances, recruitment, staffing, coding and leadership that was not from a primary care background. The financial review revealed multiple areas where monies had not been claimed and education and support to the management team was provided to help to address this. Support and help successfully recruiting a new Lead GP was provided, including writing the job advertisement which attracted the successful candidate. Coding work was done to improve disease prevalence and thereby improve income. Recall education was provided. An education session for the ANPs was requested by them and provided in Family Planning. Support was given in exploring new clinical models for care provision with a multidisciplinary team.
Practice Closure with CQC Section 31 Conditions
Practice G was a small Practice situated in a town. There were 3 partners running the Practice, but 1 had recently resigned. This was a CCG appointment as the Partners had decided to hand back their contract. However, almost at the same time as giving notification the Practice underwent a CQC inspection that resulted in the serving of Section 31 Conditions. An interim Practice Manager was provided along with other support staff and GPs. The team helped address the Section 31 conditions and manage the closure of the Practice. The Partnership was being continually monitored by the CQC. 3 months before the Practice was to close the levels of concern with the care being delivered by the Partners were so high that a closure notice was issued with immediate effect. Our team worked closely with CCG to manage the change in the situation and successfully closed the practice, managed the patient dispersal and found new positions for all staff members who wanted to remain in Primary Care.
Practice Management Support
Practice H was a medium Practice located on the outskirts of a small town. The Practice had a chequered history of different Practice Managers and had been going through a transition of stabilising the Practice. The Partners appointed a new Practice Manager who had little experience working in Primary Care. Support was provided through one on one mentorship with an experienced Practice Manager. The support was a day a week over a 12-month period. Areas such as the flu campaign, LTC recalls and QOF analysis was undertaken. The QOF analysis provided detailed year-to-date performance with a plan to improve prevalence and where to focus for maximum return. Detailed job descriptions and an annual review process was implemented and help was provided for their CQC inspection. Finance was analysed and claims were submitted for the missing income. Surgery Network for procurement with stock control was implemented. Also implemented was Quality Compliance Systems for policies and procedures.
Finance Analysis & Pension Support
Practice K was a small Practice in a semi-rural location. The project was a full analysis of the finance function looking at reimbursements, income and pension contributions. The Practice was looking to strengthen the partnership with the appointment of a new partner. The project was looking at the partnership viability of the Practice. The pension for the salaried GPs was found to be in a complete mess and had been incorrectly managed for a number of years. The Partners had no reason to believe that there was an issue with pensions. Unfortunately, the financial liability for the Practice ran into tens of thousands of pounds. Everything was corrected and the financial analysis also found unclaimed income that more or less balanced the pension liability. If this project had not been undertaken then the Practice would have drifted into financial ruin. The trigger would have happened when one of the salaried GPs looked at retirement and found a massive hole in their pension contributions.