This is the second in our short series of podcasts on Pharmacists and PCNs and this week we talk to Peterborough GP, Neil Modha. Neil (who’s innovative approach we covered in this previous episode) has gone from employing one to three pharmacists in just over a year. He explains why and how they have proven invaluable in everything from self-care, shared care drug monitoring and document management to audits and chronic disease management.
Show Notes
Neil reminds us how his practice operates (44secs)
From one to three pharmacists – how they help (1min 39secs)
The journey of introducing a pharmacist (2mins 32secs)
What are pharmacists doing in Neil’s practice (3mins 41secs)
Pharmacists and self-care prescribing (4mins 19secs)
The outcome of self-care prescribing (5mins 10secs)
Signposting to self-manage conditions (6mins 08secs)
Shared care drug monitoring (6mins 50secs)
How the rapid growth in pharmacists took place (7mins 50secs)
The impact on the practice (9mins 16secs)
How productive are pharmacists? (10mins 23secs)
The financial benefits (11mins 54secs)
Impact on the drug budget (12mins 53secs)
A vision for the future (13mins 23secs)
How does the pharmacist work in the federation/PCN? (14mins 36secs)
“Home” practice or not? (16mins 23secs)
Advice for other practices thinking of employing a pharmacist (16mins 59secs)
The challenge of the 30% gap in funding (18mins 06secs)
What’s next for Neil’s practice? (19mins 12secs)
What’s next for Neil’s practice? (21mins 35secs)
Neil’s practice website can be found here
His email address is neil.modha1@nhs.net
Our previous podcast with Neil is available on our website here
All PCNs have the opportunity to recruit clinical pharmacists into general practice and this week we begin a four part series of podcasts to support that recruitment. We begin, in Episode One, by talking to GP Pharmacist Hala Jawad. Hala discusses the role of a pharmacist within general practice, the way a pharmacist can work within a PCN and how a PCN can make themselves more attractive to pharmacists.
Show Notes
Hala was the first “Pharma Face” and is known as “The Brighton Titan” (55secs)
She moved from running a restaurant to becoming a pharmacist (2min 02secs)
Getting involved with general practice (2mins 47secs)
Trying GP out for a week (3mins 48secs)
The benefits of working in a practice (5mins 01secs)
Learning in general practice (6mins 31secs)
The role of a pharmacist in GP (7mins 32secs)
Support for pharmacists (8mins 30secs)
Pharmacists in PCNs (9mins 39secs)
Advice to make an appointment successful (10mins 41secs)
Overcoming isolation (11mins 51secs)
How attractive is working in GP to a pharmacist? (12mins 42secs)
What makes one role more attractive than another? (14mins 15secs)
How will the pharmacist/GP relationship develop? (15mins 51secs)
Contacting Hala (16mins 44secs)
Hala can be found on Twitter - @jawad_hala
She is also on Facebook and LinkedIn
Her Ask Hala public website is here and her You Tube channel is here
Hugh Reeve is a GP in Grange-Over-Sands in Cumbria. The practice wanted to improve the way they met patient demand and initially began to look at introducing an online consultation system. They soon concluded that this could not be simply about introducing a “bolt on” digital system and it quickly became a process that forced them to radically reconsider all aspects of their patient flow. In this episode Hugh explains how they went about transforming their practice, how the new system now works for GPs and patients with the resultant outcomes including the fact that only 40% of patient contacts are now face-to-face.
Show Notes
Why introduce an online consultation system? (59secs)
Improving continuity of care (1min 49secs)
Researching the options (2mins 57secs)
The kind of system they didn’t want (4mins)
A much bigger task than choosing a system (4mins 44secs)
Improving the “flow” of patients (5mins 21secs)
How the system works for GPs (6mins 13secs)
Changing the way they work rather than “bolting on” a system (7mins 16secs)
Radically rethinking “flow” (8mins 03secs)
Only 40% of contacts are face-to-face (9mins 33secs)
Not just introducing online (10mins 05secs)
Establishing what capacity is needed (10mins 45secs)
Introducing the new system (11mins 19secs)
Patients using the system (12mins 07secs)
Not about workforce challenges (13mins 15secs)
A typical day for a GP in the practice (14mins 13secs)
The reaction of patients (18mins 45secs)
Pilot site for the Health Foundation Programme on Continuity of Care (19mins 39secs)
Hugh’s advice for others (22mins 03secs)
You can email Hugh at hugh.reeve@gp-a82053.nhs.uk
The askMyGP website is available here
Today (8th July) is the first ever National Social Prescribing Link Worker Day! Organised by the National Association of Link Workers it aims “…to celebrate and showcase the contribution of social prescribing link workers in improving population health and wellbeing.” In support of this our podcast this week is the fifth in our series looking at Social Prescribing. Nick Sharples is Managing Partner at DNA Insight, a specialist training consultancy that is increasingly involved in training Social Prescribing Link Workers. In this episode he talks about the various models that are emerging for employing, recruiting and training Link Workers.
Show Notes
Nick describes his involvement in social prescribing (44secs)
Who employs the Link Workers? (1min 53secs)
Reluctance to outsource the role (3mins 30secs)
Outsourcing the role (4mins 16secs)
Competition for Link Workers – three options for recruitment (5mins 36secs)
External recruitment (6mins 40secs)
Recruiting from within the practice (7mins 16secs)
Advantages of the options – building an appropriate model (7mins 54secs)
The provision of training (9mins 18secs)
Resources for training (10mins 28secs)
How much budget to put aside? (11mins 02secs)
Effective working with large scale – prioritising (11mins 58secs)
Average workload (13mins 13secs)
Managing a caseload (13mins 53secs)
A practical example from Scotland (15mins 32secs)
Sharing best practice – learning co-ordinators (16mins 33secs)
Finding out more (17mins 31secs)
The DNA Insight Social Prescribing pages are here
Nick has put together a list of useful resources below:
Gerry Morrow was a full time GP for twenty years before he joined Clarity Informatics as their Medical Director. Clarity, (who describe themselves as “international leaders in healthcare solutions”) developed TeamNet “a web-based sharing and compliance platform for primary care”. In this podcast Gerry explains how TeamNet enables practices and other agencies to share information, how it is adaptable to individual circumstances and what the future might hold.
Show Notes
Gerry begins working Clarity (54secs)
The importance of sharing information (1min 20secs)
Clarity develops TeamNet as a natural extension of their business (1mins 53secs)
The benefits of sharing information through TeamNet (2mins 37secs)
Where does the information come from? (3mins 29secs)
The opportunities of practices moving into PCNs (4mins 15secs)
Transparency – sharing information and building trust (5mins 08secs)
How TeamNet works in practice (6mins 41secs)
Practices and community teams working together (7mins 39secs)
Structuring sharing with other agencies (8mins 53secs)
Controlling the flow of information (9mins 55secs)
Who uses TeamNet now? (11mins 16secs)
Two way communication with practices (11mins 46secs)
The future of information sharing – interoperability (12mins 45secs)
Sharing patient-identifiable data (13mins 37secs)
Future projects for Clarity (14mins 23secs)
Finding out more (15mins 06secs)
The Clarity TeamNet web pages are here
The email address is teamnet@clarity.co.uk
Dr Mark Newbold is an experienced NHS doctor, manager and academic who, until recently, was Managing Director of the Birmingham super-practice, Our Health Partnership. In this wide-ranging discussion Ben and Mark focus on the bigger picture: the strategic implications of Primary Care Networks and the role of general practice in integrated care systems. They cover everything from leadership and influence to scale and accountability. Mark begins by describing the introduction of PCNs as “an NHS led…radical process of transformation”
Show Notes
Mark updates us on what he has been doing (1min 06secs)
NHS-led transformation (1min 39secs)
Moving from “institution” to “system” (2mins 43secs)
Bringing general practice into the system (3mins 18secs)
General practice is the foundation of integrated care (3mins 46secs)
Size, scale and influence (4mins 53secs)
The question of existing at-scale general practice (6mins 23secs)
Tiers of collaboration (7mins 36secs)
Geographic spread and the “offer” of working at-scale (9mins 47secs)
Differentiating the “offer” for member and non-member practices in an at-scale organisation (10mins 34secs)
The Clinical Director role (11mins 56secs)
The future for Community Trusts (12mins 44secs)
The balance of power between general practice and Community Trusts – emerging GP leaders (13mins 27secs)
PCNs – beginning of the end for independent general practice? (14mins 58secs)
A collective approach (16mins 06secs)
Evolving a new model of general practice (17mins 20secs)
The accountability of integrated care systems (18mins 04secs)
Taking a long term view (19mins 01secs)
A discussion forum for GPs (20mins 36secs)
The GP View website Mark mentions can be accessed here
Our previous podcasts with Mark on the setting up of Our Health Partnership can be found below:
Episode 13 – Our Health Partnership: The story so far
Episode 41 – Progress with a super-partnership
This is the episode all about VAT. No, come back! It’s complex but vitally important stuff for PCNs and you’ll regret not listening... We are delighted to welcome Katie Collin, Client Services Partner at Ramsay Brown Chartered Accountant to explain it all. She covers who needs to be registered for VAT, what services incur VAT, Cost Sharing Groups and the VAT implications of the three models for PCNs. She has also produced a frequently asked questions document which you can access at the end of these Show Notes.
Show Notes
VAT – the hot topic of the moment (45secs)
Who has to be registered for VAT (1min 04secs)
The three main reasons why a GP might be registered for VAT (1mins 47secs)
What services incur VAT – provision of services and staff (2mins 54secs)
Holding the contract and keeping control (5mins 12secs)
Other services – admin and back-office functions attract VAT (6mins 19secs)
Part of an overall contract – an example (6mins 58secs)
How does a Cost Sharing Group work? (8mins 23secs)
Members of a legal entity (9mins 16secs)
On-costs but not a management charge (10mins 23secs)
Is VAT chargeable on what PCNs are being asked to do? (11mins 13secs)
Employing a Link Worker (12mins 47secs)
The VAT implications for the three models for PCNs:
1 The Lead Practice Model (13mins 26secs)
Is the lead practice registered for VAT (15mins 28secs)
2 The Flat Model – the easiest model? (16mins 38secs)
Liabilities of joint employment (17mins 45secs)
3 The Federation Model (18mins 26secs)
The big issues with federations (19mins 54secs)
The federation as a cost sharing group (20mins 36secs)
Core members/non-core members of networks (21mins 43secs)
Setting up a legal entity now – is it worth it? (23mins 06secs)
Employing staff and pensions (23mins 57secs)
Other things to consider (25mins 06secs)
Don’t go it alone (25mins 51secs)
Getting in touch and finding out more (26mins 20secs)
You can find Ramsay Brown’s “VAT and Primary Care Network FAQs” here
The Ramsay Brown website is here
Katie’s email address is katiecollin@ramsaybrown.com
Draft national guidance has been produced by NHS England to help Primary Care Networks introduce the role of Social Prescribing Link Worker. In this episode Social Prescribing enthusiast and GP, Dr Marie-Anne Essam, explains the value of the new guidance and takes Ben through a number of the elements it contains. They look at the Framework for Social Prescribing contained within the guidance, the salary for Link Workers and how their effectiveness and much more. The guidance will be published in its final form in the summer.
In this podcast Clare Allcock outlines the four main areas on which nascent networks should be focussing if they want to accelerate their development. Clare works for Kaleidoscope Health and Care, an organisation devoted to facilitating collaborations that improve health and care. Prior to this she had a distinguished career in the NHS at local and national level; most recently heading up the primary care and community development team for three CCGs in Surrey and Sussex.
Minesh Patel is the Chair of the National Association for Primary Care and he joins us this week to explain what lessons the NAPC’s Primary Care Home programme has for emerging Primary Care Networks (PCNs). He focuses on wide engagement, the multi-disciplinary team and leadership. He looks at the different challenges of voluntary and mandated networks and has some sound advice for the new Clinical Directors of PCNs.
This week sees the return to the General Practice Podcast of Tara Humphrey, Managing Director of THC, a group of project managers who aim to influence and support positive change in primary care. With the introduction of new roles into Primary Care Networks many are asking detailed questions about how to guarantee successful implementation and ensure the people in the new roles are happy, effective and want to stay. In this episode Tara answers those questions.
The state-backed clinical negligence scheme for general practice launched on the 1st April this year. In this podcast Ben talks to Riaz Jetha, a GP and consultant with an interest in at-scale general practice. Riaz explains how the new scheme differs from the traditional indemnity providers, how claims can be made and what and who is covered by the scheme.
In this podcast Ben Gowland, Director and Principal Consultant of Ockham Healthcare, launches a new publication from Ockham; “Ten Steps for Developing a Powerful Voice for General Practice”. With the development of Primary Care Networks and the greater integration of care come huge opportunities for at-scale general practice. However, if they are to partner with often larger and more established organisations it is essential that they develop a more powerful voice. In the Ten Step Guide and in this podcast Ben explains why it is important, how it can be done and the pitfalls to avoid.
Record numbers are signing up for GP training and in this episode Ben talks to Dipesh Gopal and Ebrahim Mulla, two GP trainees, about why they chose to become GPs. He asks them about their expectations versus the reality of the role, how (and if) they see the partnership model figuring in their careers and why they think so many GPs are leaving the profession. They consider what can be done to “solve the problems of general practice” and give a view on whether the future for general practice is a bright one
In the third in our series of podcasts on social prescribing, GP and social prescribing champion Marie Anne Essam returns to tell us three powerful real-life patient stories in which a social prescription has changed a patient’s life; a carer who got his purpose back, a man with a housing problem who turned his life around and an anxious, reluctant patient who found the support she needed. Plus: guidance on the new link workers will shortly be issued to all primary care networks and Marie Anne gives us a sneak preview of what it will contain.
The specification and guidance for the new network DES runs to over 100 pages. In the days following its publication Ben and special guest Dr Riaz Jetha digested the content of the DES and, in this episode, they talk through the key differences they identified. They look at the nature of the network agreement, the role of federations, how clinical leaders will be recruited, population size, funding and much more. You might also be interested in Ben’s latest Blog which covers similar material.
We have three guests this episode to talk about the unique Salaried Trainee Practice Manager programme developed by the City and Hackney GP Confederation. Dr Mary Clarke CBE the Confederation’s Director of Workforce, Grace Neil, the Programme Co-ordinator for the scheme and trainee Practice Manager Kerry Reynolds join Ben to variously explain how and why the programme was developed, the format and content of the programme and what it felt like to be a participant.
Tom Howseman is a GP Partner in a large urban practice in Northampton. When their number of GP partners fell from twelve to six due to retirements and they couldn’t recruit they decided to adopt a more multi-disciplinary approach. Over the last two years they have introduced and refined a system of pre-triage protocols which enable reception staff to collect information from patients presenting on the day which is then helpful to the pre-triage clinicians in directing those patients to the appropriate member of the emergency care team. 20,000 additional appointments have been created through this system and in this episode Tom explains how they have done it.
Last Thursday (14th March) was International Social Prescribing Day and we brought you a short series of podcasts to recognise this. Last week we gave you social prescribing ambassador Marie-Anne Essam. This week it is the turn of Christiana Melam who is Chief Executive of the National Association of Link Workers; the national professional network for link workers. In this episode Christiana describes what the National Association does, outlines the roles and responsibilities of the link worker and suggests what primary care networks should be doing now to prepare for this role.
This Thursday (14th March) is International Social Prescribing Day. To recognise this and to focus on the new GP Contract commitment to provide link workers in all primary care networks, we begin a short series of two podcasts. In the first, this week, Ben talks to Marie-Anne Essam a GP in Herts Valley and an enthusiastic ambassador for social prescribing. She explains what it is and tells a powerful story about a patient of hers which amply illustrates the value of social prescription. She also talks about the role of link workers including their salary, their competences and their likely backgrounds
Ben’s special guest for the second week is Dr Nikki Kanani, Director of Primary Care for NHS England. You can listen to the first episode here. In this second part she addresses the concerns of podcast listeners about primary care networks including population size, hosting of the networks and the role of federations. She looks at how clinical leaders should be identified and focuses in detail on the timetable from March 2019 onwards and what practices should be doing now to guarantee success.
Ben’s special guest this week is Dr Nikki Kanani, one of the chief architects of the new GP contract. Nikki is a GP in south-east London and is currently Director of Primary Care for NHS England. This is the first of two discussions with Nikki and in this part, she explains the role of primary care networks in general practice and looks in detail at the funding behind the new contract. She explains how the money will be delivered and what it will be made available for including 20,000 new staff, support for clinical leadership and investment in innovation. The second part of the discussion will be published next week.
This week Ben is joined by Neha Shah, a Legal Director from Capsticks and Accountant Colin Haw from BHP Chartered Accountants. In this episode they discuss some of the legal, financial and governance issues facing general practice as it begins to establish Primary Care Networks. Specifically they consider how networks will be hosted and the implications for liability, choices around the organisational form, employment contracts, pensions and VAT.
Ross Dyer Smith is a GP Partner with the Hurley Group, a former Darzi Fellow, an expert in online consultations and developer of the GP eHub. He is also an NHS Digital Academy Fellow. In this podcast he talks about how online consultations work, how potential problems can be avoided and the benefits they deliver to GPs and patients. He also explains how the GP eHub operates and how it facilitates online consultations at-scale.
Something different this week; the tables are turned with Ben Gowland in the hot seat explaining the importance of the new GP contract. Ben, presenter of the General Practice Podcast and Principal Consultant for Ockham Healthcare, explains why the new GP contract is a huge opportunity and gives him optimism for the future. He describes the way that the additional £2.8bn attached to the contract will flow, how primary care networks will be developed and how they will be staffed. He also gives practical advice to practices about what they should be doing now, in preparation for the year ahead.