GP Federation Toolkit

Content

1. Introduction2. Chapter 1 - Communication and Engagement3. Chapter 2 - Vision, Mission, Values4. Chapter 3 - Aims and Objectives5. Chapter 4 - Legal Forms and Governance6. Chapter 5 - Service Provision7. Chapter 6 - influencing Commissioning Outcomes8. Chapter 7 - Tackling Health Inequalities9. Chapter 8 - Budget and Financial Control10. Chapter 9 - Information Management and Technology11. Chapter 10 - Premises and Equipment12. Chapter 11 - Risk Management13. Chapter 12 - Back Office Functions

14. Chapter 13 - Training Education and Workforce

1. Introduction

This toolkit provides advice and support to enable you to develop your GP Federation Business Plan. The content is directly linked to the sections of the Business Plan template, which you are required to complete (See Appendices).

When completed by you it will be a mixture of the practical plans of who you wish to work with, your vision and the objectives of the organisation. To aid you in completing this, this support toolkit includes prompts, guides, and tips of what elements need to be included along with case examples. The full template for the Business Plan will cover the following topics:

• Introduction • Communication and Engagement • Vision, Mission, Values • Aims and Objectives • Legal Forms and Governance • Service Provision • Commissioning • Tackling Health Inequalities • Budget and Financial Control • Information Management and Technology • Premises, Equipment and Staffing • Risk Management • Back Office Functions • Training Education and Workforce

ELR CCG has shared with GP practices its vision for the development of a GP Federation.

“For all of our member practices to have joined other like minded colleagues with the purpose of:

• Supporting patient care and reducing inequalities • Improving quality of GP/Nursing working lives • Protecting general practice from the pressures of Patient expectations and

demographic change All of this must to be delivered through a sustainable model whereby the CCG can continue to increase investment in general practice at scale through the federation. This should make ELR a more attractive place to work for existing staff and support recruitment.” East Leicestershire and Rutland will have five levels of working

Practice

Hub

CCG

Federation

Network

ELR CCG 321,000 population

GP Federation level 321,000 population

Network MRH 159k, B&L102k, O&W 60k,

Hub level population circa 80k

Practice level

It is planned that an ELR Federation will have formally federated by the end of March 2016. The full completion of a Business Plan will require the Federation to agree a vision and establish a project team in the next few weeks. A CCG Federation Support Team will support completion of the Business Plan using the Toolkit and there will be time available in Practice level PLTs and time at locality meetings to progress this. What do Federations do? Federations enable smaller organisations (like individual GP Practices) to take advantage of opportunities normally only available to larger organisations, such as combining services for patients, combining back office functions, reorganising day to day working patterns to provide opportunities for GPs and nurses to offer a different model for patients and varied working patterns, whilst also building greater buying power, or bidding for tenders. Larger organisations with standard operating models also makes it more plausible for CCGs to commission improved and responsive wrap round community services to support GPs to look after their patients in a community setting.

The toolkit seeks to draw on the practical experience of existing primary care organisations or Federations, to inform local clinicians and managers seeking to establish a Federation in their own area. Where appropriate, research evidence is also used to inform the advice given, and there is a strong focus on signposting practical resources sourced a wide range of management, academic, national and international experts.

Chapter 1 - Communication and Engagement

This chapter is designed to support engagement and communication with staff, GP Federation partners, patients and key stakeholders who are directly associated with the development of the GP Federation.

Stakeholder communication and engagement is vital and necessary for you as an emerging GP Federation to understand stakeholder expectations and to determine to what extent those stakeholders could and would exert an influence regarding establishment and decisions and will:

• Gain buy in to your GP federation, its vision, mission and values; • Ensure support for GP Federation developments and plans; • Support your GP federation to gain influence for achieving your plans; • Increase leverage and influence within health and social care markets; • Increase employee and stakeholder engagement; • Improve communications and feedback with stakeholders

Upon completion of the toolkit checklist, use your information to complete the Communication and Engagement section of the Business Plan template provided. CHECKLIST 1 – Communication and Engagement Development Activity

Good Practice Benefits Support Resources

Date Completed

Stakeholder Analysis

Using the stakeholder analysis template, identify who your key stakeholders are. Consider the following: Ø Who you will commission

your services from? Ø What services would you

like to provide? Ø Who will you be providing

services to? Ø Who will be influential in

your Federation in the short, medium and long term?

It forms the foundation of your communication and engagement plans.

Sample stakeholder analysis proforma Appendix 2

Staff Engagement

Ø Involve staff from the outset in shaping your vision, mission and values

Ø Gather simple messages

about your plans to Federate which should include:

§ What are GP

Federations? § Why are you establishing

a Federation? (share your vision, mission, values, objectives)

§ What are the pros and

Staff engagement is a vital ingredient in helping you to establish and develop your GP Federation By involving your staff in shaping your GP Federation and communicating clearly with them, your GP Federation can

ELRCCG GP Federation FACT Sheet

cons of federating?

§ How will this change day to day operations?

§ What will it mean for staff?

§ What are the timescales involved?

§ How and when will staff be engaged in developments?

§ What are your next steps?

Ø Present your information

on a few slides or produce a FAQ

Ø Organise a number of

staff engagement sessions. Start with a longer session that will mark launch of your GP Federation Development followed by monthly updates

Ø Establish a feedback process inviting staff opinions and provide opportunities for staff to have access to a Manager and/or GP Lead to discuss specific concern

Ø Complete a record of staff engagement sessions, communication provided and any specific one to one sessions held with staff.

seek to maintain and improve staff morale, especially during periods of difficulty and change.

Patient Engagement

Patients should play an active part in Federation plans. Ø Get all GPs, senior Leads

and staff bought into patient communication and engagement

Ø Involve patients in your

establishing your Vision, Mission and Value setting

Ø All of your thinking and

planning should be centred around patients so put yourself in the shoes of a patient to test each section of your

Engaging patients in the development stages of your plans and providing them with an opportunity to get involved will ensure that patients are engaged, informed and supportive of your plans and developments.

ELRCCG GP Federation FACT Sheet Who’s NHS is it anyway? Sharing the power with patients and public http://www.nationalvoices.org.uk/sites/default/files/Whose_NHS_is_it_anyway.pdf A

plans

Ø Produce simple, key

messages about GP Federations and communicate them to your patients this may include:

§ An email campaign § Information on your

website § Read about Practice

Changes’ text message directing them to your website

§ Leaflets and posters in

your surgery § Open evening for

patients Ø Use existing patient

forums/groups to engage with patients

Ø Tap into guidance/support on how to effectively engage with patients from local Health Watch reps and CCG communications Lead

Commissioning Leader who puts himself in a patients shoes, how refreshing – What Next? http://www.pickereurope.org/news/blog/commissioning-leader-puts-patients-shoes-refreshing-next/ National Association for Patient Participation http://www.napp.org.uk/Case Study 1

Wider Primary Care Engagement

Continuing with your approach to engagement, include Practice Nurses and Practice Managers both within the Practice and in the Locality in your discussions and plans. Use the case studies and resource links to help guide your approach and see what has worked elsewhere.

Opportunity to achieve greater integration and accountability between primary care team and GP Federation. Your wider primary care team will be influential in developing and improving provision and commissioning of services.

Case Study 2

Producing a Communication & Engagement Plan

Your communication and engagement plan should include the following: Ø Introduction to your

plan: what is the purpose of your plan? What effect do you expect to have?

Ø State GP federation values (take from Vision and Mission Chapter)

Ø Provide a stakeholder

analysis – you can use sample template to complete this

Ø Set Communication

objectives - For example:

• We will ensure all

Communication is accessible, understandable and available in alternative formats to meet the needs of all those we communicate with;

• We will share

information with partners and other organisations to enable joint promotion and improved understanding of the Federation, its vision and values;

• Patients and public

will have improved understanding and will be meaningful engaged and involved in the design of primary and community services to improve their experience;

Ø Set Communication

principles - For example: • All our

communication and engagement activity should be: Clear, timely and accurate; Targeted to our stakeholders; Accountable Planned, consistent and professional, two way

Ø Set Key Messages –

these are based on the heart of the GP federation and what you your stakeholders to hear; For example: Providing high quality, clinically safe and financially sustainable services, commissioning services that are based on the needs of the patients we serve

- Ø Identify Key Topics –

as your GP federation develops you may wish to talk about certain topics such as how you are commissioning services to meet specific chronic diseases; what you plan to commission

Ø Establish Communication channels and methods This may include existing groups; social media, email campaigns, newsletters (internal and external), rumour boards, as key examples

Ø Planned Activities and

Timescales This should underpin your communication and engagement objectives together with timescales for achieving this

Ø Measuring Effectiveness – consider how progress of your plane will be measured and monitored to ensure it meets your objectives. This may be through the GP federation Board on a monthly basis

Ø Plan Review

Identify when your plan will be reviewed and updated. An annual plan in the development stage of GP Federations would be beneficial

Case Study 1 PATIENT AND PUBLIC INVOLVEMENT PATHFINDER HEALTHCARE DEVELOPMENTS, Smethwick Pathfinder Healthcare Developments has used a network of “community champions” both as a sounding board for service developments but also a vehicle to communicate public health messages. By going out to communities, as opposed to expecting them to come to health services, the community champions have enabled practices to engage with people who are often hard to reach. Key characteristics:

Ø A provider organisation that grew out of a ten-year partnership between two inner city partnerships in Smethwick, West Midlands. One of the two GP partnerships, Smethwick Medical Centre, now owns Pathfinder Healthcare Developments (PHD).

Ø Set up in 2008, as a Community Interest Company (CIC), it is a social enterprise organisation – ‘this means we reinvest our profits and assets for the public good’.

Ø Covers a population of 12,000; one of the most deprived areas outside London, with a high minority ethnic population.

Ø PHD is comprised of three practices. It is led by three GP directors, a nursing director, business director and a non-executive director. They are supported by a business manager and a financial manager, as well as staff running specific projects (such as its asylum seeker and refugee service).

Ø For more details see www.path-finderhd.com

Learning - patient and public involvement Ø PHD is committed to genuine involvement with its local communities. As part of the Healthy

Communities Collaborative, it bid and won funding to deliver a patient�led programme of community activity in Sandwell on behalf of Sandwell Primary Care Trust (PCT). This included developing a network of community champions that PHD could work with to disseminate health and wellbeing messages.

Ø A group of 45 community champions – a mix of patients and active community workers has been established. PHD uses the community champions to test its thinking and ideas for service development, such as its plans for the creation of a health and wellbeing centre and around proactive care management.

Ø It also uses the champions as a vehicle to transmit public health messages to friends, family, colleagues and neighbours, and into the wider community. For example, PHD holds Healthy Community Collaborative events at supermarkets, where community champions will invite members of the public for screening and provide information about community groups. The champions have also been trained to help members of the public undertake online health assessments.

Ø Other activities involving the community champions include awareness raising sessions in the waiting areas of PHD health centres, informing patients about services and inviting participation with the champions group; a Health Education Day at a community centre; events in after-school clubs; and health checks carried out in local workplaces.

Ø The PHD community champions meet monthly to plan activities to raise health and well being awareness. Initially a senior GP would facilitate the meetings, but clinicians have stepped back as the group has taken off and now the PHD Operations Manager chairs meetings.

Ø PHD’s efforts to involve and engage local communities through its community champions have been extremely well received by the public and patients. By going out to communities – as opposed to expecting them to come to health services – PHD has been able to engage with people who are often hard to reach. Dr Niti Pall, Chair of PHD, gives the example of a Muslim woman who had not left her house for a decade and has now become a community champion helping to reach other Muslim women.

Ø The PHD community champions are currently formalising what they do and setting up a patient reference group, which PHD promises will be an important part of everything it does in the future: ‘Experience tells us that it is essential to evolve a service with the people who use

it because they feel part of its development. This means it is more likely to succeed and to be well-used by its target community’.

Case Study 2

ENGAGING THE WIDER PRIMARY CARE WORKFORCE WESTONGROVE PARTNERSHIP, Buckinghamshire Key characteristics

Ø A provider organisation, that brings together three neighbouring practices. Ø It was established 1998. The three practices retained their own practice agreements and the

Westongrove Partnership agreement became the vehicle for federated working. Ø Covers a population of around 27,000 patients. Ø It is comprised of nine GP partners; each leads in a particular area, including clinical

governance, contracting, and GP training. They are supported by a general manager, an operations manager, a finance manager and a nurse manager. Day to day issues at each site – such as staff rotas and patient queries are dealt with by a site manager.

Ø Westongrove Partnership holds a PMS contract with the PCT; the way the contract is delivered at the three sites varies according to the individual partnership.

Ø Learning – engaging the wider primary care workforce Ø A key feature of the Westongrove Partnership is its emphasis on capitalising on a broad skill

mix of health professionals. Amongst the staff it employs are 12 salaried GPs, and 20 nurses and healthcare assistants with skills and experience ranging from basic phlebotomy to nurse practitioner.

Ø It has been particularly keen to draw on the skills of nurses and healthcare assistants, both to expand the range of services it is able to offer and to free up its general practitioners to provide more care for their more complex patients. It has a big nursing team of fifteen nurses and five healthcare assistants, who are shared across the practices. These include eight nurses specialising in minor illness nursing, five nurses specialising in chronic disease management, and a treatment room nurse.

Ø The emphasis on multidisciplinary working carries through to the Westongrove Partnership’s strong focus on education and training. Louise Grant, General Manager of the Westongrove Partnership identifies education and training as ‘a huge area of benefit’ as a result of the practices having joined together. For example, GP trainees benefit from shared tutorials, practice swaps, and a wider clinical field to draw upon. Education and development programmes for the wider primary care workforce benefit from a cross-fertilisation of ideas and a wider clinical field. It has also helped to strengthen clinical governance – for example, significant event reviews are informed by a wider clinical field of opinion and expertise.

Chapter 2 Vision, Mission and Values This chapter is designed to support you to develop your Federation’s vision, mission and values. Upon completion of this toolkit checklist section, use your information to complete the Vision, Mission, Values section of the Business Plan template provided. Your Vision Statement describes what you ultimately want to achieve. It explains why you’re doing what you’re doing. It usually includes the answers to a number of the questions below.

Ø How big is your Federation? Describe it. Ø How do you measure success? (Be specific) Ø What are everyday tasks? Ø Is there anything you don’t do?

The RCGP GP Federation Toolkit cites a number of GP Federation case studies that are useful reading. See end of chapter. As the Washington GP Practices case study shows, if vision and mission are missing it can be difficult to hold people together and make progress towards common goals. Developing the shared vision also takes time. As the case study reveals, people giving a commitment to join an organisation does not mean that they understand and share its vision. Having a specific project to work on can help clarify the vision. CHECKLIST 2 - Forming your Vision Development Activity

Action Benefits Support Resources

Date completed

Create your vision

Examine your strengths and weaknesses; Ø Look at all areas of

your Federation/Locality from services, to facilities and staff.

Ø Involve your staff in

this and patients if you can. Use the template below.

You need to be clear on what strengths you have and where you may be vulnerable

SWOT - Strengths, Weaknesses Opportunities and Threats analysis proforma Appendix 3

Analyse your findings. Ø Review the

information you gathered and ask yourself questions like: -

• How would we summarise this analysis?

• What are our greatest strengths?

• What are our greatest weaknesses?

• How can we build

You need to have plan to work on weak areas

SWOT analysis proforma Appendix 3

on strengths and improve the areas where we are weak

Put it in writing Ø Take the

information you gathered from your analysis and begin the outline for your statement

Ø Write sentences that describe what you want your Federation/Locality to achieve/look like

Ø Write sentences that emphasize your strengths

Ø Create a three to five sentence paragraph that reflects your vision for what you would like to see your organisation to become in the future

These statements form the foundations for your vision

Vision statement examples

Ø Refine the statement Review the statement several times to make sure it is smooth, clear and easy to understand

Ø Make take several revisions to get it right. Ask yourself, "Does this paint a clear picture?"

You must be happy with the wording

Vision statement examples

Ø Seek feedback; Ø Ask other staff

what they think of the statement. Do they understand the vision? Does it inspire them?

The statement needs to be understandable and acceptable to people who have not been directly involved in the development session

Ø Go public with it Ø Once you've

finalised your statement, share it

Ø Put your vision statement somewhere everyone can see it

Make sure that your all your stakeholders know that this is what your Federation is going to do.

Your vision statement tells your patients, staff, and other stakeholders know that you have a plan for

where you want to take your business.

Toolkit Resources to assist completion of your plan: Vision Statement Examples Ø Shrewsbury and Telford Hospital to ensure that the interests of our patients, and providing the

best possible care to them, are at the heart of everything we do; Ø South West Health Care Federation - Dedication to the health, healing and wellness of those

we serve with compassion and integrity; Ø Amazon.com Our vision is to be earth's most customer centric company; to build a place

where people can come to find and discover anything they might want to buy online; Ø ELRCCG to improve health by meeting our patients needs with high quality and efficient

services led by clinicians and delivered closer to home; Ø Harness Consortia (Brent) Through mutual cooperation and collaboration to support practices

in ensuring high quality primary care delivery across the patch in partnership with the local community;

Ø Langton Medical Group delivers high quality services to patients, work closely with our patients, make efficient and effective use of NHS resources

Ø eBay pioneers communities built on commerce, sustained by trust, and inspired by opportunity. eBay brings together millions of people every day on a local, national and international basis through an array of websites that focus on commerce, payments and communications.

Ø Mid Hampshire Health Care works in partnership with our patients and staff to provide the best healthcare services possible working within local and national governance, guidance and regulations.

Ø PRINCIPA not a single decision made without patients being involved from the outset Ø NHS England Everyone has greater control of their health and their wellbeing, supported to

live longer, healthier lives by high quality health and care services that are compassionate, inclusive and constantly-improving.

Creating your Mission Statement

Taking time out to create your mission statement is an important step in making sure that everyone understands what you want to achieve. If you don’t do this at the outset it will cause you problems later on when writing aims and objectives without a crystal clear plan.

Your mission statement should provide an overview of your plans to achieve your vision by stating who you are, the services you want to deliver, who you are delivering them to, and your organisations values and aims.

Remember not to confuse a mission statement with a vision statement. Mission is about your core purpose whilst vision is about your desired state.

The mission statement needs to be:

Ø Short

Ø Inspiring

Ø Memorable

Ø Explicit

Ø Clear on what you want to be remembered for

CHECKLIST 3 - Achieving the Federation Mission: Development Activity

Action Benefits Support Resources

Date Completed

Developing your Mission Statement

Ø Protecting time - Set aside a designated time to create the mission statement –

You will be able to concentrate fully and not feel rushed

CCG Funding

Ø Make sure you have you invited the right people. You need to have varied staff input and representatives from the management team. You may also want to involve other agencies that you work with like the voluntary sector or Local Authority

This exercise is forming your identity. All the key people in your organisation are likely to be supportive if they have been involved form the outset

Ø Have you asked for ideas from everyone (Get every one to put their ideas on a sticky note during a facilitated session)

More ideas will help choose to you the right words

Mission statement examples

Ø Form the words into a couple of simple statements

Ø Is this the shortest statement that you can make

Ø Agree on a few selected words that best describe your purpose.

Ø If your statement is longer than 20 words try to reduce it by taking out any words that don’t add value.

If it is short it is more likely to be remembered and repeated

Mission statement examples

Ø Do the T-shirt test to select the final statement – Does it fit on a T-shirt and would I wear it?

Ø If it feels ‘fluffy’ change it

Mission statement examples

Tool kit resources to assist completion of your plan: Mission and Value Statements to help you develop your Mission Ø Mid Hampshire Health Care: To improve the health, well-being and lives of those we care for. Ø Livestrong: To inspire and empower people affected by cancer. Ø Invisible Children: To bring a permanent end to LRA atrocities. Ø Brent GP Federation: Closer ties and Better Working Ø Langton Medical Group exists to provide our Patients with high quality Personal Medical

Services delivered across our 2 sites in Lichfield & Whittington. Building on the sound Medical Practices delivered by its founders the Group seeks to adapt to changing environments by being caring, pragmatic and innovative in its approach to maintaining and improving the Medical Services that we provide to our Patients.

Ø The Humane Society: Celebrating Animals, Confronting Cruelty. Ø Wounded Warrior Project: To honor and empower wounded warriors. Ø Oxfam: To create lasting solutions to poverty, hunger, and social injustice. Ø Best Friends Animal Society: A better world through kindness to animals Ø Care Fertility: At Care we are dedicated to achieving the best chance of pregnancy for our

patients. Ø The Nature Conservancy: To conserve the lands and waters on which all life depends. Ø NHS England High quality care for all, now and for future generations Ø Environmental Defense Fund: To preserve the natural systems on which all life depends.

Ø Public Broadcasting System (PBS): To create content that educates, informs and inspires.

Ø South West Health Care Federation: Dedication to the health, healing and wellness of those we serve with compassion and integrity

Ø Smithsonian The increase and diffusion of knowledge

Ø Salford Health Matters exists to make you feel better. We deliver excellent primary health care in areas of need from a dedicated team of skilled and committed staff.

Useful Resources Case Study 1 WASHINGTON GP PRACTICES, Tyne and Wear This case study reveals the importance for a Federation of creating a shared mission and vision.

Key characteristics:

Second attempt by GPs within the new town of Washington, to create a successful Federation – GPs learnt important lessons about developing a shared vision and mission from their first attempt at federated working.

Loose association of practices, although preparing to adopt a more formal federated structure.

Covers population of around 66,000; relatively isolated community close to Gateshead and Sunderland.

Learning – where to begin

SunWest Social Enterprise, a community interest company (CIC), was set up in 2008 to ensure that its ten member practices were ready to bid for a practice as a result of Lord Darzi’s review of the NHS. Divisions emerged when a for-profit organisation, involving two of the practices, sought to bid in competition with the not-for-profit CIC. This undermined the spirit of collaborative working and the Federation was abandoned.

Dr Ashley Liston was a member of SunWest Social Enterprise and is now closely involved in the association of Washington GP Practices that has replaced it. He says: ‘The £1 joining fee for the CIC was a poor measure of commitment for developing a business’. Member practices had attended practice based commissioning (PBC) meetings, but collaborative working was not sufficiently

established and members were unprepared for the level of commitment the CIC required. ‘When the challenge came we weren’t up to the test’, says Dr Liston.

It underlined the importance of developing a shared vision amongst member practices. ‘It is easy to develop a CIC. What really matters is developing the culture of collaborative working’, says Dr Liston.

Dr Liston and colleagues have focused on getting practices to come together and share ideas and skills, from collaborating around the annual winter flu campaign, to networking amongst practice managers. Education also has an important thread in developing collaborative working. With the help of PCT funding, a range of educational events have been developed for the patch. More details about Washington GP Practices’ work around education and training.

The shared vision for the local Washington Practices is for a Federation that provides support in five key areas: education, practice business development, submitting bids for contracts (for example for enhanced services), preparing for Care Quality Commission registration, and quality assurance and clinical governance.

Key advice

‘A key dilemma is whether you run with it with energetic and committed individuals or do you wait for everyone to come on board’, says Dr Liston. ‘There is a critical mass of practices and people that you need, but I don’t think you need to have everyone on board.’ Washington GP Practices has been driven forward by a few committed individuals, and support is growing all the time.

Dr Liston adds: ‘Local knowledge is everything – you need to have a sense of who has to be on board for it to be viable’.

Case Study 2 TOWER HAMLETS, East London

This case study provides a good example of how active support from a PCT can facilitate the establishment of a Federation.

Key characteristics

The 36 Tower Hamlets practices have formed eight Federations (called ‘networks’) with the strategic and financial help of the PCT. Each network covers a population of about 28,000 and 33,000 in the 3 most deprived borough in England. Loose associations of practices, which is beginning to form legal structures. A vision for an integrated system built around federated networks of services was first developed by the PCT in Tower Hamlets in 2006. The key motivations for establishing networks included focusing on population health across a geography, encouraging collaborative working with a wide range of partners, and having sufficient scale for specialisation of staff. The network development process began in April 2009 and the first wave of networks was launched in September 2009.

NHS Tower Hamlets provided each network with a management allowance of £150,000. This allowed each network to develop its own management infrastructure, including a senior manager and a co-ordinator, as well as cover to release GPs to provide senior clinical leadership.

To help networks get started, the PCT provided a tailored organisational development programme. Networks identified a range of gaps:

Governance represented 35% of development needs

Leadership and management skills represented 12% of development needs

Culture and team work represented 20% of development needs. On the basis of these identified gaps, networks put together Network Development Plans. The PCT formed Network Support Teams to

support networks with organisational development. The Support Teams also served as communication links between the networks and the PCT, and helped to ensure the smooth running of the networks and address any problems.

Once underway, the networks commissioned management consultants to help them work on four key areas: governance, culture and teamwork, leadership and management, and information technology.

The PCT agreed with each network performance targets focused around the redesign of ten care packages. The first care package was developed for Type 2 diabetes.

Key Advice Dr Tzortziou Brown, a GP in Tower Hamlets, says, ‘It is natural that some practices may be more ready than others. Strong clinical leadership, agreeing common aims and a close working relationship with the PCT have been very important, especially in the initial stages of our Federations.’. She adds that the networks have facilitated collaborative relationships not only among GPs and other clinicians, but also with a wide range of partner, including schools and charities.

Chapter 3 - Creating your Aims and Objectives This chapter is designed to support you to develop your Federation’s aims and objectives. Upon completion of this toolkit checklist section, use your information to complete the Aims and Objectives section of the Business Plan template provided. The aim is about what you hope to do, your overall intention in the project. An aim is therefore generally broad. It is ambitious, but not beyond possibility. Remember that an aim is different from a mission statement. Mission statements are an overview, aims are more detailed. You can have more than one aim.

The aim of a business can change over time. This can happen in response to internal factors, such as growth, or in response to external factors, such as an economic recession. Your aims will influence the eventual legal structure that you select for your Federation.

The objectives, and there are usually more than one, are the specific steps you will take to achieve your aim. This is where you make the project tangible by saying how you are going to go about it.

You should be able to track progress of and measure the outcome of achieving your objectives.

CHECKLIST 4 – Setting Aims and Objectives: Development Activity

Action Benefits Support Resources

Date Completed

Developing aims and objectives

Ø Set aside time to agree what your aims and objectives are

Ø You may have a few aims

You need protected time to do this to give you the space to think carefully

CCG Funding

Developing aims and objectives

Ø Have you have you invited the right people. You need to have varied staff input and representatives from the management team. You may also want to involve other agencies that you work with like the voluntary sector or Local Authority

If you do not have the right representation you may find stakeholders not supporting some of your projects.

See stakeholder analysis

Ø Use the S.M.A.R.T.

guidelines to try and develop your objectives:

• Specific – avoid general statements and include detail about what you are going to do.

• Measureable – there should be a definable outcome.

• Achievable – be realistic in what you hope to cover, don’t attempt too much. A less ambitious but completed objective is better than an over-ambitious one that you cannot possible achieve.

• Realistic - think about logistics. Are you practically able to do what you wish to do? Factors to consider include: time; expense; skills; access to sensitive information; participant’s consent; etc.

• Time constrained – be aware of the time-frame of the project.

If you follow these guidelines you will have a set of goals that will be clear and measurable to determine your progress.

See examples

Ø Review your aims and objectives against your Stakeholder Analysis and develop and action plan

This will help you identify where you may have conflicts of interest or where you may have may have too much reliance, which possibly could disrupt your business plans if relationships are not solid.

Stakeholder analysis and SWOT

Example Aims: Suffolk GP Federation aims to:

Ø Facilitate practices working together in an open, democratic and transparent way. Ø Address issues by collaboration. Ø Provide a management infrastructure, skills and expertise that an individual practice would

find uneconomic to employ.

Croydon GP Federation aims to: Ø Improve understanding and match appointment capacity to patient demand Ø Improve the quality and response to urgent same day patient requests Ø Influence the patient perception

Example Objectives UCLH

Ø Improve patient safety Ø Deliver excellent clinical outcomes Ø Deliver high quality patient experience and customer service Ø Enable staff to maximise their potential Ø Reduce waiting times Ø Achieve sustainable financial health Ø Develop and implement year 1 of our transformation strategy Ø Develop the research agenda Ø Develop education Ø Progress service developments

Shrewsbury and Telford Hospital

Ø Reduce harm, deliver best clinical outcomes and improve patient experience. Ø Address the existing capacity shortfall and process issues to consistently deliver national

healthcare standards. Ø Develop a clinical strategy that ensures the safety and short-term sustainability of our

clinical services pending the outcome of the Future Fit Programme. Ø Undertake a review of all current services at specialty level to inform future service and

business decisions. Ø Develop a sustainable long-term clinical services strategy for the Trust to deliver our vision

of future healthcare services through our Future Fit Programme. Ø Through our People Strategy develop, support and engage with our workforce to make our

organisation a great place to work. Ø Support service transformation and increased productivity through technology and

continuous improvement strategies. Ø Develop the principle of ‘agency’ in our community to support a prevention agenda and

improve the health and wellbeing of the population. Ø Embed a customer focussed approach and improve relationships through our stakeholder

engagement strategies. Ø Develop a transition plan that ensures financial sustainability and addresses liquidity issues

pending the outcome of the Future Fit Programme

Chapter 4 - Legal Forms and Governance

This chapter is designed to support you in understanding the legal issues involved in setting up a GP Federation, and the steps that need to be taken to form a GP Federation. Upon completion of this toolkit checklist section, use your information to complete the Legal and Governance section of the Business Plan template provided. What is a GP Federation?

GP Federations have been described as "a group of GP providers and primary care teams working together, sharing responsibility for developing and delivering high quality, patient focussed services for their local communities1". 'Federation', 'network', 'collaboration' and 'joint venture' are all names given to joint working arrangements between GP providers, and can be used to describe joint working across the whole CCG area, or smaller groups of GP providers within that group. These terms are often used interchangeably to describe GP providers coming together for a defined set of goals and you will hear them used differently across different areas of the country. The aims, goals or purposes of each GP Federation do not need to be the same either. Broadly, joint working or collaboration arrangements are used to enable GP providers to share costs, resources and, in many cases, create an entity that is able to bid for contracts and deliver a great array of services in community settings. This allows commissioners to ensure population coverage for those services. There are a number of different legal options available to you, each of which has different features and will suit different objectives. We have set out details of these below and in Appendix 4. How can GP Providers participate in a GP Federation? GP providers in England are usually set up as sole traders, partnerships or companies limited by shares. They are independent of the NHS, but are subject to certain eligibility criteria that they must fulfil to hold GMS, PMS or APMS list based primary care contracts, which are commissioned by NHS England. The eligibility criteria differ between the different types of contract, but in broad terms, GP providers are independent organisations with differing legal structures. They are not "NHS bodies" and therefore, unlike NHS trusts and Foundation Trusts, are not established by statute or subject to the constraints on their powers of being a statutory body. However, they are subject to external regulation by the Care Quality Commission and GPs must comply with their own professional standards as set out by the GMC in "Good Medical Practice"2. Your GP Federation will exist in this same legal and regulatory framework. The three main ways in which a GP provider can participate in a GP Federation are by:

1. Becoming a member of a new legal entity (corporate joint venture) 2. Entering into a contract with other GP providers (contractual joint venture) 3. Merging with other GP providers to form a larger partnership (practice merger)

Details in respect of each option are set out in Appendices X

This toolkit does not detail an informal alliance (i.e. where GP providers do not document their co-operation arrangements), or a single organisation providing all services (e.g. acute, community, primary care, etc.) and employing salaried GPs. The following checklist will help you to decide which option is best for you, and how you will set up your GP Federation and otherwise collaborate with other GP providers. CHECKLIST 5 – Legal Forms and Governance

1 http://www.rcgp.org.uk/clinical-and-research/clinical-resources/~/media/19A1F84B41A04DFE8AAAF2F65FD3D757.ashx 2 http://www.gmc-uk.org/guidance/good_medical_practice.asp

Development Activity

Best Practice Benefits Support Resources

Date Completed

Size and Objectives Ø Identify the GP providers who will be working together as the GP Federation

Ø Identify the GP providers who will be working together in smaller groups within the GP Federation (localities, sub localities or hubs)

Ø Identify the objectives

and scope of the GP Federation and any hubs

Ø Consider and agree what each GP provider's role will be if different contributions are being brought to the collaboration

Ø Consider and agree

which legal option(s) provides the best fit as against those objectives

The legal form for any collaboration should follow the function and objectives that the GP providers have agreed it is being created to fulfil Clear objectives will help you to choose a legal form that enables you to achieve your mission Choosing a legal form will inform the next steps in this checklist

ELRCCG GP Federation Communication and Engagement Chapter, Vision, Mission and Values Chapter and Aims and Objectives Chapter Appendix 4 – Available legal forms Appendix 5 Corporate vehicle choice

Management Structure and Control

Ø Consider and agree how the collaboration will be managed on a day-to-day basis and how key strategic decisions will be made

Ø Consider whether any committees will be required to deal with different elements of the collaboration (e.g. regulatory requirements; tendering for services)

A clear management structure will aid the smooth and efficient running of operations, and will ensure that each GP provider is aware of its obligations and commitments

ELRCCG GP Federation Governance Chapter

Business Planning Ø Develop a business plan for the GP Federation

Ø Consider how the collaboration will be financed (both in the short-term and the longer-term)

To facilitate horizon-scanning for opportunities for the GP Federation, and ensure readiness to benefit from procurement opportunities

Legal and financial advisory support

Ø Consider what

opportunities are available to the GP Federation (e.g. what contracts does it intend to bid for)

Ø Consider what

resources the GP Federation and any hubs will need, and how they will be provided (e.g. staff; premises etc.)

Rights of each GP provider

Ø Consider and agree what rights and obligations each participating GP provider will have, including voting rights, funding obligations, right to share in the profits, right to receive information

GP providers to protect their own interests within the larger collaboration

Legal and financial advisory support

Restrictive covenants

Ø Consider whether individual GP providers should be restricted from competing with the GP Federation (i.e. by bidding to provide the same services)

Ensure that the GP Federation will be able to fulfil its business aims and objectives

Legal support

Stakeholders (staff, patients)

Ø Consider whether the legal form chosen will allow the GP providers to continue to perform any existing contracts and to satisfy stakeholder requirements (e.g. will employees and/or GPs have access to the NHS Pension)

Enable GP providers to comply with their existing legal and contractual obligations

ELRCCG GP Federation Communication and Engagement Chapter Legal support

Partnership Deeds Ø Consider whether your partnership deed permits participation in the agreed legal form

Allow GP providers to determine whether any amendments are necessary

Legal support

Form legal vehicle and agree contractual documentation

Ø Engage with legal advisers to incorporate any legal vehicle(s) required and prepare relevant documentation

Ø Agree who will lead this process and how

Agreeing the process before engaging with third party advisers will allow the process to be carried out efficiency and cost effectively

Legal and financial advisory support Appendix 6 – Legal documentation

each GP provider will be engaged in the process

Example objectives for GP Federations

Ø Create greater scale to provide / bid for a wider range of services

Ø Combine back office services

Ø Share staff and assets

Ø Create an organisation with greater negotiating power

Governance

This section is designed to support you to identify and establish a robust governance structure for your GP Federation/locality. The governance structure you adopt will depend on the type and function of GP Federation you decide to establish. The primary functions of the governing body are to:

Ø Establish the organisation’s strategic direction and aims, in conjunction with the executive Ø Ensure accountability to the public for the organisation’s performance Ø Assure that the organisation is managed with probity and integrity ways of achieving these

primary functions include: constructively challenging and scrutinising the executive Ø Ensuring that the voice of the public is heard in decision making Ø Forging strategic partnerships with other organisations

(Source: The Good Governance Standard for Public Services)

Whendecidingthemostappropriateorganisationalformandstructure,oneofthekeyconsiderationsiswhereresponsibilitywilllieforclinicalliabilitymatters.GPsconsideringworkingwithotherpracticesandGPconsortianeedtoaddressthissamequestion.

Thelegalpositionforalimitedliabilitycompany(orLLP)differsfromthatofastandardGPpartnership.Unlikeapartnership,acompanyorLLPisaseparatelegalentity.InaGPpartnership,eachpartnerisjointlyandseverallyliablefortheactsoromissionsofallthepartnerswhiletheyareengagedinthepartnership’saffairs.IndividualGPpartnerscanbesued,butthepartnershipitselfcannotasitdoesnotexistasalegalentity.

ThemedicalindemnityprovidedtoaGPpartneronanindividualbasisistheretohelpwithallegationsofclinicalnegligenceandtheirvicariousliability,asemployer,fortheclinicalnegligenceofstaffundertheirdirection.Acompany,asaseparateentitytotheGPs,maybesuedseparatelytotheGPseitherintort(fornegligence)orincontract(forbreachofcontractualdutyorfailuretomeetitsagreedcommitments).Inordertoprotectthecompany(and,therefore,theshareholders’investmentinit),thecompanywillneedarangeofinsurancecovers.Oneoftheseiscorporateclinicalindemnitycover.

Traditionally,claimsforclinicalnegligencehavebeenmadedirectlyagainstindividualhealthcareprofessionals.Whereacompanyemploysthedoctorornursepractitionerandwherethepatientreferralisorganisedthroughthecompany,itislikelythataclaimmaybemadeagainstthecompany

itselfinsteadof,ormorelikely,inadditionto,theindividualhealthcarestaffinvolvedintreatingthepatient.

Willemployers’clinicalindemnitycoverindividualGPs?

GPsareadvisedtomaintaintheirindividualclinicalindemnityregardlessoftheorganisationalstructurefortheirbusiness.Thisisbecauseanemployer’scorporateclinicalindemnitycoverisacontractualagreementbetweenthepolicyholder(thecompany)andindemnityprovider-ineffect,therefore,itonlyprovidesindemnitytothecompanyforitsvicariousliabilityfortheactsofitsdoctorsandnottothedoctorsintheirownname.Iftheemployerstoppedtrading,orsimplystoppedpayingfortheinsurance,aclaimmightsubsequentlybebroughtagainstthedoctor,whomayhavenopersonalcoverinplace.

ItisimportantthatGPsfullyunderstandtheextentofcoveravailablefromtheiremployer’sclinicalindemnityarrangement.

Clinicalgovernanceissuesmayalsocometotheforewhenpracticesbeginworkingclosely.Theremaybevariationinpoliciesandproceduresthatcouldleadtoadverseincidentsifnotidentifiedandresolved.Forexample,systemsofrecallforspecificriskgroups,orformonitoringpatientsoncertainmedications(e.g.warfarin)coulddifferwithintheconsortiumandconsequentlyleadtoconfusion.Systemsthatareconsistentacrosstheconstituentelementsoftheconsortiumwillhelptomitigatesuchrisks.

ThecurrentNHSandSocialCareComplaintsprocedurerequiresindividualswithin‘responsiblebodies’(ofwhichGPpracticesareanexample)todesignateacomplaintsmanagerandaresponsibleperson,toensurecompliancewiththestatutoryarrangements.Withpracticesjoiningconsortia,itwillbenecessarytoensurethatthestatutoryrequirementsofthecomplaintsproceduresaremet.

The following checklist will help you to complete the Legal and Governance section of your Business Plan. CHECKLIST 6 – Governance Development Activity

Best Practice Benefits Support Resources

Date Completed

Form & Function Ø Identify and agree the function of your GP Federation for example commissioning and/or extended provision of primary care service

Ø If you are a legal

entity, check that you will be able to meet the governance requirements within the Memorandum and Articles of Association set out in the legal chapter.

Ø Identify, agree and document a governance model for the Federation that

Good governance will improve services

ELRCCG GP Federation Legal Chapter Appendix X – Key Principles of Good Governance in the Public Sector http://www.ifac.org/system/files/publications/files/Good-Governance-in-the-Public-Sector.pdf “What makes great boards great” Sonne

enables the Federation to carry out all its objectives including:

- providing services - employing staff - decision making - addressing

conflicts of interest - codes of conduct - principle for

whistleblowing - non-compliance - active engagement

with patients - active engagement

with practices and staff

Ø To achieve this,

think about:

- What would be the best structure to support delivery of your agreed function;

- If your Federation is commissioning and providing services, your structure will need to have clear distinction between the structures for commission and provision;

- The finances available to support your structure;

- Defining specific roles, their accountability and who staff and your membership will report to

nfield JA 2002 Harvard Business Review September 2002 https://hbr.org/2002/09/what-makes-great-boards-great Case Study - GPs and Practice/Business Managers working together in the delivery of quality services in a financially challenging and frequent policy changing environmenthttp://217.20.36.210/editorial/attachment.asp?aaid=994 Principles and rules for cooperation and competition https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216279/dh_118220.pdf Procurement guide for commissioners of NHS services https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216280/dh_118219.pdf

Check that your Federation and individual practices have

Reduction of risk See legal advice through CCG

the right indemnity arrangements in place

FAQs

What is the difference between a contractual joint venture and corporate joint venture?

A contractual joint venture in this context is simply a contract between a number of GP providers setting out how they will collaborate (i.e. what will they give to each other or contribute) and the terms upon which they will share risks and rewards. Unlike a corporate joint venture, a contractual joint venture does not in itself create a separate legal entity. Therefore, a contractual joint venture cannot itself hold a contract, and either each provider will need to be a party under its own contract with the relevant commissioners, or one party will need to be nominated to hold the contract.

Will collaborating with other GP providers affect our primary care contract (GMS/PMS/APMS) with NHS England?

Generally, no. However, if you are seeking to collaborate by virtue of a practice merger with other GP providers, this will require consideration of the transfer of those primary care contracts to the acquiring GP provider / new merged entity, as well as the consent of NHS England to transfer the contract from one entity to another, therefore this would affect your primary care contract. The same principles would apply if the GP providers were setting up a new corporate entity that they wanted to hold each GP provider's GMS/PMS/APMS contract – this would require the consent of NHS England for such transfers of contract from each GP provider to the newly formed corporate entity to take place.

Chapter 5 - Service Provision This chapter is designed to support you to develop your Federation’s service provision. Upon completion of this toolkit checklist section, use your information to complete the Service Provision section of the Business Plan template provided. By working together practices can develop new services that improve the quality of patient care, particularly those with long term or chronic conditions, and bring services closer to patients. Practices could also develop more integrated care by creating organisations that incorporate broader elements of service provision including community nursing and some elements of hospital care.

Many Federations will have early ideas for services that they want to improve or develop. Remember that federations will have to tender to commissioners for service contracts in accordance with the NHS Principles and Rules of Cooperation and Competition.

Agreeing what these services are needs to link to the aims and objectives you set and be supported by a majority of practices in the Federation (see Governance Section) and depending on the scale of change - be supported by a Business Case. Services provided also need to take account of the agreed health priorities as noted in the Leicestershire JSNA and Health and Wellbeing Strategy 2013 – 2016 http://www.lsr-online.org/reports/694611. Also see Tackling Health Inequalities section for summary.

If the Federation, as a separate legal entity, wishes to provide services it may have to register with the Care Quality Commission. See Appendix for more details.

Because a number of areas across the UK have already moved to Federated working we have the benefit of learning from their experience.

In this section we will share with you case studies for developing and redesigning services based around practice based commissioning consortia that used their collective action around commissioning to stimulate new ways of providing services in their practices including an example of an integrated care model.

Here are some areas where we know federations have been actively changing current structures or provision.

Ø Out of hours services Ø Holiday and sickness cover Ø Enabling combined practice education/training events Ø Improving minor injury services Ø Diabetes services ( Suffolk GP Federation) Ø Improving and extending minor surgery provision Ø Improving access to investigations e.g. mobile MRI scans Ø Improving transport for test samples to improve result turnover Ø Improving access to Physiotherapy, chiropody services Ø Providing counselling services or extending existing services Ø Outreach specialist consultant clinics, GP specialist clinics, nurse specialist clinics Ø Shared expertise in practice management Ø Increased purchasing power for practice supplies Ø Developing integrated care by running of certain elements of their local hospital including the

A&E/Urgent Care centre and medical wards (LADMS - Louth and District Medical Services)

CHECKLIST 7 – Agreeing Service Provision Development Area

Action Benefits Support Resources

Date Completed

Developing your services

Ø Pursue some “quick wins”

Ø Make sure your services help deliver relevant aims and objectives

Will encourage participation and help people see the shared vision in practice.

See Sample List

Ø Describe how you will separate commissioned services and those provided by your Federation

Reduces conflict of interest. Commissioning and provision need to be clearly separated with transparency in the process and ways of working. (GPs with an interest in providing a service cannot participate in discussions about who should be commissioned)

See Governance section.

Ø Describe any patient feedback on services that you have access to

Acts as stimulants to change and improvement

Ø Actively develop clinical leaders and distribute clinical leadership across practices

Ø Check that your plans are complementary to the Better Care Together Programme

Spreads the workload and gains trust across the partners

Ø Have you described your Federation population?

Ø Where are your geographical boundaries?

Clarity for staff and patients

Ø Have you found out what do members feel needs improving? How did you do this? Include the results

Shows consultation and support

Ø Describe your health

needs. Have you checked what the area JSNA and Health and wellbeing strategies say about health needs

Shows how you are developing services in line with population needs.

JSNA http://www.lsr-online.org/reports/694611

Ø Describe any barriers to change

Informs your action plan.

Ø What health outcomes do you want to see for your population

Describes how you can measure change

See Appendix X examples

Ø State what funds you have to invest and time lines. Over what period?

Shows you have ability can make changes

Ø Agree when a business case for service change or growth may be needed. The business case for new services should be well evidenced and underpinned by financial and activity analysis.

Ø Agree in conjunction with the CCG which service developments need business cases and ensure they contain the following information

Ø Make sure that you have done a risk assessment if you are planning to change a service or create a new one

A business case helps obtain management commitment and approval for investment in new services, through providing an evidence-based rationale for the investment.

See Chapter 12. Risk Assessment

Case Study 1 CROYDON FEDERATION OF GENERAL PRACTICES, Greater London

While the primary function of the Croydon Federation is practice based commissioning it still provides a good example of the opportunities to develop services within primary care and some of the means to do this, for example the use of clinical leads to stimulate developments in different clinical areas.

Key characteristics

Ø Comprised of 16 practices across Croydon, covering an urban population of around 140,000; Ø Established in 2007, as a loose association of practices with a legal accountability agreement;

Learning – developing new services

Ø The Federation has developed a number of award winning and innovative services, redesigned pathways and brought services closer to patients. Three notable examples include around diagnostics; urgent care access; and the use of clinical champions.

Ø Diagnostics: This was one of the Federation’s first projects and brought ultrasound and echo to six practices, which served all of the Federation’s patients. It also enabled practices to make direct referrals for MRI. The new services have reduced waiting times, made services more accessible to patients and avoided referrals into secondary care. The direct access to diagnostics has also enabled a number of care pathways to be redesigned including heart failure, low back pain, musculoskeletal and gynaecology. It took less than three months from conception to implementation to deliver this improved access to diagnostics, and the project won a Health Service Journal (HSJ) award in 2008.

Ø Urgent Care Access: This three�month rapid improvement project helped member practices respond better to patients’ urgent care needs, and was a finalist for an HSJ award in 2009 under the ‘improving access’ category. A baseline assessment of each practice examined capacity versus patient demand, patient experience, and other relevant practice factors (such as receptionist skills, and the way in which telephone calls and home visits were managed and prioritised). Each practice learnt something different and made different interventions to improve their service as a result. These have included:

- Providing extra training for reception staff; - Changing the way in which home visits are prioritised; o changing telephone systems; - Improved on-line and email access for patients.

At the end of the project 98.6% of 1,200 patients surveyed, positively rated the responsiveness of their GP practice in addressing their urgent care needs. The Federation is now exploring ways in which to improve urgent care for children.

Ø Use of clinical champions: The clinical champion programme began in 2008 with clinical leaders identified for priority areas including heart failure, learning difficulties, cardiac arrhythmias, COPD, paediatrics and mental health. This leadership has proved to be immensely valuable in providing focus and impetus to service improvement, as well as a means of distributing leadership across all sixteen practices.

For example: The Learning Disability Champion encouraged practices to undertake extended health checks for their learning disability patients using a specially designed web- based assessment tool, which exposed significant unmet needs.

The Mental Health Clinical Champion successfully completed a brief intervention to a psychological therapies pilot, which aimed to improve outcomes and reduce the wait for patients to see a psychologist.

Case Study 2 COLCHESTER PRACTICE BASED COMMISSIONING (PBC) GROUP, Essex

While the primary function of the Colchester PBC Group is practice based commissioning it provides a good example of the opportunities to develop services within primary care.

Key characteristics

Ø Established as a not-for-profit company, limited by guarantee to undertake commissioning

work; Ø It has 23 member practices and serves a population of 180,000 patients in Colchester; Ø Annual indicative budget of over £140 million.

Learning – developing new services

Ø Colchester PBC Group has worked with the PCT and the local authority to drive the development of a number of services. Three examples are described below.

Ø Screening for Atrial Fibrillation (AF) at Flu Vaccination: This innovative service enables practices to screen patients for AF – a major cause of stroke – when attending for flu vaccination. Initially 20 practices in the cluster took part, screening 16,079 patients, of which 101 were identified with previously undiagnosed AF. Many of the benefits of this service are long term due to the preventative nature of the scheme. The service has been presented to the National Priority Project on Stroke and has won the Management in Practice Award for the opportunistic AF Screening within the Flu Vaccination programme.

Ø GP Care Advisors (GPCAS): This service was jointly commissioned by the PCT and the local authority following a proposal made by Colchester PBC Group. The role of the GPCAs is to facilitate access to social care and self-help support to help people maintain their independence at home. GPCAs assess the person’s current needs and identify the support that will enable them to remain independent. Four practices employ the GPCAs and manage the provision of this service on behalf of the other practices in the PBC Group. The service is reported to have been very successful and highly valued by patients.

Ø DVT Assessment and Treatment Service – with direct access to ultrasound: This initiative involved the development of a risk assessment tool that, with direct access to ultrasound, enabled GPs to assess the severity and risk of patients with potential DVTs. It has allowed many patients to get immediate reassurance and avoided the need for a hospital visit.

Key advice:

• Funding for the development of new services can come from a mix of sources: GP practice contributions (direct and via DES) as well as direct PCT and local authority support;

• Colchester has managed conflicts of interest by creating a clear separation of commissioning and providing. GPs with an interest in providing a service cannot participate in discussions about who should be commissioned and the PCT has overseen all procurements;

• The original business case for new services were well evidenced and underpinned by financial and activity analysis;

• Continued support for newly developed services has been strengthened through robust evaluation with measurement of the baseline position and the impact of the service, including obtaining feedback from service users and other stakeholders;

Case Study 3 LADMS, Lincolnshire

LADMS provides an example of GPs working together to develop an integrated care model. They have taken over the running of certain elements of their local hospital including the A&E/Urgent Care centre and medical wards.

Key characteristics

• LADMS – Louth And District Medical Services – is a provider company limited by shares. • It is comprised of 14 practices in rural Lincolnshire, covering a population of around 100,000.

• All of the 42 GPs belonging to LADMS bought a £1,000 share; other practice staff and also

specialists are eligible to purchase shares. • The board structure comprises a chair, chief executive, medical director, business director,

chief operating officer and four other directors. The directors are employed by LADMS on a part-time basis;

• LADMS has a strong working relationship with Lincolnshire Community Health Services (LCHS), the PCT provider arm, and draws on LCHS structures, for example, in relation to clinical governance and community engagement;

• Six practices (a subset of the 14 member practices) are working more closely, for example by sharing back office functions, and hope to form LADMS Primary Care.

Learning – developing new services

• Poor access to diagnostic services had already prompted LADMS to bid to provide diagnostic services in the community. The 14 member practices started providing echocardiograms in local surgeries, as well as diagnostic MRI and CT scans. Waiting times for echocardiograms dropped from between four and six months to just two weeks; and MRI waits fell from 10 months to less than six weeks.

• LADMS was keen to build on these successes, so when the sustainability of County Hospital Louth, part of United Lincolnshire Hospitals NHS Trust, was in doubt, the 14 practices decided to pursue a more integrated model of care delivery. ‘As a cluster, we focused on the fact that if we didn’t do something, the hospital would shut’, says Dr Neal Parkes, Medical Director of LADMS.

• Ownership of the hospital site transferred from the NHS Trust to NHS Lincolnshire. The PCT then publicly consulted on four models of care, of which one was for LADMS to work with LCHS to run the Accident and Emergency Department/GP led Urgent Care Centre and the medical wards of the hospital, with the secondary care Trust continuing to run the surgical departments.

LADMS holds a subcontract with NHS Lincolnshire and therefore did not have to bid to run the hospital services. It was awarded a three-year contract as a preferred provider, which began in 2010 which nurses are now employed by LCHS, while LADMS employs GPs and staff grade doctors working within the hospital.

Consultants are reported to have been supportive of the integrated model. ‘We had to have consultants on the ground talking to us to develop a safe structure’, says Dr Parkes. However, it is too early to assess the impact of this new way of integrated working in Louth. The LADMS board is looking for evidence of impact on patient pathways – by controlling the route patients take and what happens to them, LADMS can then control the budget. Lincolnshire University is being commissioned to undertake a formal evaluation.

The LADMS directors deliberately chose a legal model that provides them with flexibility in the future. ‘We tried to set up a company that is more than fit for purpose than just integrated working with one hospital – it is fit for multiple purposes’, says Dr David Hughes, Chief Executive of LADMS. For example, LADMS plans to launch an internet pharmacy, as part of a joint venture, by the end of 2010.

The requirements LADMS had in terms of legal form included being able to pay NHS pensions and employ NHS staff (should they wish to expand the range of staff they employ within the hospital), TUPE staff across to the organisation, and protect the shares held by people who leave the organisation.

Key advice

• Dr Parkes advises: ‘Don’t presume that everyone understands and shares your vision. It may not be clear and obvious to all’. Investment of time is needed to engage with key stakeholders to ensure they both understand and share the vision.

• Developing new services requires significant engagement with senior decision makers in commissioning organisations. ‘You’ve got to engage at the top and keep it there because decisions are made at that level’, says Dr Hughes

• Good legal advice is key to making sure you adopt the right organisational model for new

services.

Case Study 4 Suffolk GP Federation Suffolk GP Federation won a £10m contract to provide a full community service for patients with diabetes from April 2014. The Suffolk GP Federation provides diabetes screening, training and care for patients with the disease in the community. This includes a dedicated helpline and mobile dietetic, podiatry and antenatal clinics provided in GP surgeries. The federation will co-ordinate the provision of the service, which will be carried out by 43 practices in Colchester and Tendering. The federation, a non-profit organisation, will be paid £2m a year to run the service over five years. Dr Gary Sweeney, chair of the NHS North East Essex CCG said: ‘I am confident that this innovative approach will make the services more convenient.’ Suffolk GP Federation chair Dr Tim Reed, said: ‘We are looking forward to working with local GPs, local hospitals and healthcare professionals to provide a simple-to-access service for all diabetes patients in North East Essex. ‘This will help those living with diabetes to monitor and manage their condition more easily and provide convenient, high quality services and the best possible care in general practice” Case Study 5 The separation of commissioning from provision has been an important feature of federated working for Gateshead GPs. By having two distinct organisations that separate commissioning from the provision of services, practices have been able to overcome a potential conflict of interest. A good example of this is a new primary care based musculoskeletal (MSK) assessment service.

GAT-NET Commissioning Consortium plans to adopt a formal legal structure to strengthen its functions as a commissioner. Gateshead Community Based Care is also seeking to strengthen its structure and has asked practices if they will top slice PBC incentive scheme money to fund the appointment of a manager.

Key advice:

• ‘My advice is to keep commissioning completely separate from the provision of services, and to have different people leading on these different functions. This is the best way to ensure that there is clarity about the role you’re playing and to achieve openness and transparency of working,’ (Sheinaz Stansfield, Organisational Development Lead for GAT-NET Commissioning Consortium)

Chapter 6 – influencing Commissioning Outcomes

This chapter is designed to support you to develop your Federation’s approach to commissioning. Upon completion of this toolkit checklist section, use your information to complete the Commissioning section of the Business Plan template provided.

General consensus in Leicestershire is that commissioning is the prime function of East Leicestershire and Rutland Clinical Commissioning Group and that Federations have the prime function of service provision, however a fundamental part of the federation is to ensure health outcomes are improved and measured through the Federation. This will meant that the Federation will strongly influence commissioning processes and outcomes.

As service providers practices have information on how local community, social and acute services are being provided to their patients and are likely to have first hand information on the positives and negatives of patient experiences. This information will be used to drive service changes.

Working together as a Federation or Locality practices are extremely well placed to have an oversight of the quality of services commissioned by the CCG and have the ability to work in partnership with both providers and the CCG to influence and support improvement and where necessary redesign.

CHECKLIST 8 – Commissioning

Development Area

Action Benefits Support Resources

Date Completed

Commissioning Ø Describe how you will separate the functions of the CCG and Federation in commissioning services

Reduces conflict of interest.

See governance section.

Ø How will you use patient feedback on local services

Acts as stimulants to change and improvement of outcomes

Ø How will you work in partnership and influence local providers and commissioners?

Shows approach to improving services for the population

Chapter 7 – Tackling Health Inequalities This chapter is designed to support you to develop your Federation’s approach to tackling health inequalities. Upon completion of this toolkit checklist section, use your information to complete the Tackling Health Inequalities section of the Business Plan template provided.

The Leicestershire Joint Strategic Needs Assessment (JSNA) is an overarching assessment of the health and wellbeing needs of the Leicestershire population. The JSNA is a joint NHS and County Council production. See website http://www.lsr-online.org/reports/694611. The web site also has links to District level reports, which have more detailed health information for your Federation areas. The priority areas set out in the JSNA are supported through Health and Well-Being Boards.

Over arching priorities for health improvement are set out in the JSNA and are summarised under 4 main headings:

Children

• Supporting positive outcomes for children and families through: early years support, early intervention/prevention, continuing health programmes to develop well, and early identification of families in need of support.

• Improving health and educational outcomes in looked after children through high quality health and social care support.

• Enabling children to have the best start in life through the provision of high quality maternity services including pre and postnatal support.

• Good transition between child and adult services for children with complex physical and mental health needs.

Early intervention and prevention

• Maintaining or increasing the number of children and adults who are a healthy weight, through the provision of a range of healthy weight interventions and the promotion of physical activity and healthy eating.

• Reducing the (acute and chronic) harm caused by alcohol and drugs. • Improving sexual health services for the Leicestershire population. • Reducing smoking prevalence by preventing people from starting to smoke and helping

people to stop smoking. • Reducing the number of people who die prematurely from cancer.

Supporting the ageing population

• Planning for an ageing population, particularly an increase in the frail elderly population, by providing appropriate housing and adaptations to enable the frail elderly to live longer in their own homes.

• Maximising independence in older people by improving stroke care and rehabilitation services, preventing falls and reducing preventable hospital admissions.

• Improving the management of long-term conditions. • Ensuring care homes adhere to the highest standards of dignity and quality and make sure

carer training in organisations is improved.

• Improving of end of life care and support for people who wish to die at home and support for

their carers.

Improving mental health and wellbeing

• Promoting positive mental health promotion. • Ensuring the earlier detection and treatment of mental health problems in children • Improving the early detection and management of people with common and severe and

enduring mental health needs. • Earlier detection and treatment of dementia and support for people with dementia and their

carers.

As a federation you will be aware of local issues around health inequalities and may have your own ideas and plans for local services to address these.

CHECKLIST 9 – Tackling Health Inequalities Development Area

Action Benefits Support Resources

Date Completed

Developing your action plan

Ø Review your local data for health and well being needs by visiting the District level information in JSNA and Health and Well Being Strategies

Full understanding of local health need.

http://www.lsr-online.org/reports/694611

Ø Describe your health inequality local priorities

Helps to link priorities to Leicestershire wide and local health needs.

As above

Ø Describe any actions that you want to take with timescales

Ø Check that you have taken account of Better Care Together objectives

Direct impact on local issues.

As above www.bettercareleicester.nhs.uk

Ø What are the proposed outcomes

Helps to measure progress.

As above

Ø Do we need to use funding differently? Describe

Ø Do we need to change working practice?

Ensures that adequate funding is allocated if required.

As above

Chapter 8 – Budget & Financial Control This chapter is designed to support you to develop your Federation’s Financial Plan. Upon completion of this toolkit checklist section, use your information to complete the Budget & Financial Control section of the Business Plan template provided.

An overview of the Federations finances for the next 3 years is required to complete this section of the Business Plan

A financial plan will be required irrespective of the legal form that the Federation takes.

You will need to set out the detail of:

Ø Your planned operating model. Consider optimising levels of staffing, premises and IT infrastructure. Your plans will need to minimise set up and operating costs where possible and show how day-to-day operating is sustainable

Ø Estimated funds that are available to the Federation over a 3 year period with source Ø Identified Ø Financial targets Ø Operating Costs – include recurrent costs such as accountancy fees, staffing, premises,

software, insurance and non recurrent such as Marketing and website set up, one off software purchases, company set up, legal fees, IT

Ø Costs of establishing the company with share price Ø Planned spend Ø Plans for income generation Ø Plans for distribution/reinvestment of profit Ø Working capital - this is required to ensure the organisation has sufficient cash at bank to

operate. This takes account of the likelihood that payments to staff, providers and other suppliers will be required in advance of payments being received from commissioners and customers.

Ø How the chosen legal structure supports the financial plan.

CHECKLIST 10 – Finance and Budget Planning Development Area

Action Benefits Support Resources

Date Completed

Establishing a financial plan

Ø Establish what the recurrent and non recurrent operating costs are and potential income

Full understanding of sustainability of organisation

CCG

Ø Are there areas where you can save money e.g. shared functions, federation wide procurement

Allows funds to be directed to priorities and improving services

As above

Ø Where do you plan

to generate income from

Allows funds to be directed to priorities and improving services

Ø What profits are likely

Enables forward planning for reinvestment/profit share

Ø Does the income level enable you to make progress towards your mission, aims and objectives

Links funding to priorities and local health needs.

Ø Set out the above in a table which summarises the financial position

Ability to monitor See sample Operating Costs Spread Sheet

Sample Operating Costs Spread Sheet

TotalRegisteredPatients

FinancialPlan Apr-

16May-16

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

FullYear

Projectedinvestmentrequired First12monthsrecurrentcosts Workingcapitalrequired TotalInvestmentRequired NonRecurrentcosts Companysetup LegalFees IT Financesoftware TotalNonRecurrentCosts Recurrentcosts Directorssalary Staff Premisescharge Software CQC(ifrequired) Insurance

AccountantFees TotalRecurrentCosts

Chapter 9 – Information Management Technology This chapter is designed to support you to develop your Information Management and Technology requirements. Upon completion of this toolkit checklist section, use your information to complete the Information Management and Technology section of the Business Plan template provided. Information management is the way you account for the structure, design, storage, security, movement, quality, delivery and usage of information required for management and business intelligence purposes. Information management is controlled and supported by information governance policies and data strategies. Whilst each practice in the Federation has its own individual IT system the Federation will need to consider how these individual systems may need to develop in the future. The Federation may wish to develop its own IM and T Strategy however as a start point the following issues need to be considered for information and records management purposes and included within the Business Plan. CHECKLIST 11 - Information Management Technology Development Area

Action Benefits Support Resources

Date Completed

IM and T systems

Ø Allow at least an hour of meeting time to be able to examine the strengths and weaknesses of current information and technology systems; agree what your barriers are.

You need to be clear on what strengths you have and where you may be vulnerable

See SWOT analysis proforma - Vision Mission Values section Example Strength and Weaknesses

Ø Describe any imperative for change for example the need to meet government policies or expectations such as telemedicine.

Ensures that must do’s are addressed.

Ø Describe what the Federation is aiming to achieve through its information and records management systems - link this to your Federation’s mission aims and objectives.

IM and T should help your Federation to develop services and to work more efficiently

.

Ø List any actions that

need to be taken and include a timeframe within which each action is to be completed.

Major actions will fall within your organisations project management framework while others can be undertaken as a part of normal business

Creates a plan for change that can be monitored

Ø Identify who is responsible for leading and monitoring the overall strategic direction of agency records and information management as well as who has responsibility for implementing individual actions.

Ø Does the plan complement LLR guidance and strategies for IM&T and Information Governance

Ensures that there is accountability for progress

Ø Describe how you will evaluate and review the Federations progress on IM and T issues at regular intervals to ensure it is still appropriate.

Ensures that IM and T is on the agenda of the management team and that any presenting risks can be managed.

Example strengths and weaknesses Examples of strengths could include:

Ø A good corporate culture with staff who understand their obligations, regard information and records as corporate assets and comply with procedures and policies

Ø Up-to-date records of all core business of the practices who comprise the Federation, Ø A well-planned system which supports sharing and re-use of information, avoids silos

or unnecessary duplication of information. Examples of weaknesses, or areas for further improvement, could include:

Ø Staff are reluctant to use some IT systems/functions Ø There is a proliferation of individual systems holding information and records, with

duplicate information across a multitude of systems and difficulty in finding and accessing all relevant information when it is needed

Ø High risk records are held in business systems with limited records management

functionality and no ability to export to, or integrate with, a records management system

Ø There are large holdings of legacy information which should have been destroyed Ø There is continued reliance on printing digital records to paper for storage and

maintenance. Chapter 10 – Premises, Equipment and Staffing This chapter is designed to support you to develop your requirements for premises, equipment and staffing. Upon completion of this toolkit checklist section, use your information to complete the Premises, Equipment and Staffing section of the Business Plan template provided. As a Federation you will need to have an understanding of the scale of assets owned and managed across the constituent practices. This is critical whether you decide to bid to increase the scale of services provided by your practices or not. Whilst some assets and functions may be better retained solely for use in each practice, others may be better used being shared across a number of practices. Below is a list of potential areas where you may be able to save money and improve quality and safety Premises and Equipment

• Small practice shared accommodation • Minor surgery • Primary care based outpatients • Phlebotomy • Coil fitting • Purchase of equipment, stationery, medical supplies and vaccines • Service contracts such as telephony and internet • Standardisation and updating of frequently used forms • Media campaigns

Staffing

• Centralised appointment booking service • Joint practice management roles covering two or more practices • Specialist clinics run by one practice on behalf of a group of practices (e.g. diabetes, asthma,

CHD, MSK) • Domestic and handyman services contracts • Medical report writing • Accounting • QOF reporting • DNA follow up and management • Pre appointment telephone calls for expensive appointments • Training and education • Group nursing appointments

CHECKLIST 12 - Premises, Equipment and Staffing Development Area

Action Benefits Support Resources

Date Completed

Premises, Equipment

Ø Agree where efficiencies can be best made and are

Saves money and time See Back Office function section

and staffing most needed

Ø Undertake a cost benefit analysis

Ø Assess if a business case is needed

Ø Agree a plan to make changes with timescales and nominated lead

CCG Business Planning support

Chapter 11 – Risk Management This chapter is designed to support you to identify risks associated with the development and establishment of your GP Federation. Upon completion of this toolkit checklist section, use your information to complete the Risk Management section of the Business Plan template provided. The process of identifying and reviewing the risks that you face is known as risk assessment. By assessing risks you are able to be actively aware of where uncertainty surrounding events or outcomes exists and identifying steps that can be taken to protect the Federation, people and assets concerned. See Risk Assessment template Appendix 8. Before you commence identifying and assessing risk, it is important to agree the basics of how you are going to ensure that risks to your organisation are identified and managed. The amount of detail should be appropriate to the size, responsibilities and capacity of your Federation. Once completed the risk assessment must be reviewed and updated at regular intervals as new risks can occur and previously agreed ones may no longer be relevant. Typical risks may include:

Ø Failing Services; Ø Data Protection failure; Ø Clinical mistakes; Ø Conflict; Ø Financial instability.

CHECKLIST 13 – Undertaking a risk assessment Development Area

Action Benefits Support Resources

Date Completed

Managing risk

Ø Agree who will need to be present when the initial risk assessment is undertaken. This may be a small but representative group.

Ensures consensus and that all risk areas are noted

Ø Set aside protected time to do the risk assessment.

Allows adequate time

Ø Use a template to record the findings of the risk assessment.

Ensures robust assessment and recording of risk

Appendix 8 for scoring system and template

Ø Agree how identified will risks will be reported. Regardless of who carries out the initial assessment, the Management Team is responsible for

Enables governance function to be delivered.

reviewing the risks.

Ø Ensure that Risk is scheduled on to the regular management team meeting agendas to ensure that sufficient time is devoted to considering the information presented. Every 6 months is recommended.

Ensures that adequate funding is allocated if required.

Ø Prioritise attention to the most significant risks, considering whether further actions can be taken to reduce these and whether you are happy to accept these risks or need to take more drastic action.

Ø Develop contingency plans

Allows concentrated action around the most important risk areas.

Chapter 12 - Back Office Functions This chapter is designed to support you to establish the back office functions required to support the day to day operations of your practice. Back office functions are essential to ensuring the smooth running of your Federation. Upon completion of this toolkit checklist section, use your information to complete the Back Office section of the Business Plan template provided. Resources to run back office functions within General Practice are limited for some Practices and can place a heavy burden on practice costs and ensuring that a good quality service is provided to patients. Being part of a Federation will enable you reap significant benefits through sharing back office functions including efficiency savings, remove duplication and waste and standardise administration processes. Not all Practices have the same range and level of back office functions and some decide to commission support from external providers which is an option that can be considered in any Federation or locality. Sharing back office functions across a number of practices provides opportunities to improve the quality of support available to practices and save money. As the administrative burden within practices grows there is increasing value in a central business function serving a number of practices. Bulk purchasing, shared staffing and other overhead costs also provide opportunities for practices to make savings without compromising patient care. CHECK LIST 14 – Back office functions Development Activity

Good Practice Benefits Support Resources

Date Completed

Assessing your Back Office Functions

Ø Make a list of all current back office frustrations;

Ø Agree principles of what a good Back Office function should achieve?

Ø Consider the impact of

sharing back office functions on your current staff. For example; will you still need staff; can they utilised in other areas of the practice to support practice developments?

Ø Create a list of all back

functions and cost of back office functions at each practice;

Ø Make a list of all

resources used to deliver current back office functions;

Ø Compare information

with Practices in your

Enables you to identify where you can improve services, achieve efficiencies and reduce costs.

http://www.institute.nhs.uk/productive_general_practice/general/back_office.html

Developing your Back Office Functions Commissioning and Providing your Back Office functions Measuring Back Office Performance

Federation; Ø Identify all back office

functions that you wish to share to run your Federation, this may include:

- Human Resources - Finance - Contracts and

Performance - IM&T Support - Staff training and

development - Information

Management & Technology

- Patient involvement

Ø Think about how you will resource your back office function. For example, will you set up a business type unit for these functions or would it be more cost effective and efficient to outsource some or all of your functions?

Ø Compare the costs, control and quality of each option as well as the potential for delivering your ideas for an ideal back office function;

Ø Create a specification of

back office functions to include; what will be provided, who will provide it, how you will monitor cost and effectiveness and when you will review your specification;

Ø Produce appropriate Agreements for provision of services based on your specification;

Ø Monitor how your back office functions are performing on a monthly basis;

Enables you to commission and provide the right level of back office functions to meet your federation needs. Ability to review information associated with delivering an efficient and cost effective back office function and directly influence and control any changes.

Ø Provide reports on back

office operations to your governance structure

Case Study 1 SALFORD HEALTH MATTERS, Salford Salford Health Matters has set up a central business unit to provide support for human resources, information technology, finance, contracts and performance, and patient involvement. Key characteristics

Ø Salford Health Matters (SHM) was established in 2007 as a community interest company. Ø It provides services to a population of over 13,000, from five centres across Salford, including

a GP surgery, healthy living centre, and homeless medical project. Ø There is a board of directors, including a non�executive, lay chair and three executive

clinicians (two GPs, one advanced practitioner). For more details see SHM’s organisational chart.

Ø It is a social enterprise company and a Department of Health Social Enterprise Pathfinder. Any profits are reinvested in health and for the benefit of the local community. The annual report and company profile provide further details about the organisation. Learning – sharing back office functions ¬ SHM purposefully set up a central business unit to coordinate and rationalise activity across the three practices in areas such as human resources, information technology and informatics, finance, contracts and performance, and patient involvement. The central business unit has its own building (away from the three practices) and dedicated staff, including a chief executive, financial manager, and a contracts and performance manager. Team leaders are based at each of the three sites.

Ø This model has benefits in terms of economies of scale, and it allows the organisation to develop expertise and skill�up staff in key areas, says Neil Turton, chief executive of SHM. Contract performance and human resources are distinct specialisms within the organisation, for example. An intranet provides staff across the three sites with access to organisational policies and other information online, including SHM’s common clinical system. Mr Turton highlights training and payroll as other ‘quick wins’. Mr Turton describes SHM’s central business unit as ‘upwardly scalable’ and adds that the organisation is able to ‘absorb easily’ other practices. SHM will put this to the test if it wins a bid currently underway to take on another practice.

Key advice Ø ‘There is loads of really useful information available about how to form a good partnership –

people and relationships are at the centre of this’, says Mr Turton. He adds: ‘Enshrine agreements in something contestable and transparent and don’t be shy about using a lawyer!’

Chapter 13 – Training, Education & Workforce

This chapter is designed to support GP Federations identify current and future training and development needs in order for the GP Federation to achieve the organisations mission and objectives as well as the professional needs of your workforce.

Training and development forms a key part of any Organisational Development Plan and is a critical element to the success of your GP Federation. Spending time to understand the skills, experience and knowledge that exists in your GP Federation will enable you to understand the strengths and opportunities that different professionals will bring to the organisation and where plans need to be targeted. The following checklist will help you to complete the Training and development section of your Business Plan. CHECKLIST 15 – Training, Education and Workforce Development Activity

Best Practice Benefits Support Resources

Date Completed

Identifying Needs Delivering Training

Ø Undertake an analysis of current workforce, skills, experience and qualifications

Ø Using the GP Federations Vision and Objectives, identify key training and development needs at organisational and professional levels

Ø Consider whether there are any specific legal training requirements associated with your GP Federation

Ø Use service and

commissioning performance data to identify weaknesses in performance that may require new or refresher training.

Ø Use observations,

informal discussions, focus groups, interviews, questionnaires, appraisals to inform your training and development plans

Ø Using the analysis to

decide what types of training you will need and who is best

Enables GP Federation to utilise skills and experience effectively and Information can be used to support applications for training and development funding Supports achievement of Organisational Development of the GP Federation Supports adherence to governance requirements Using evidence based data to inform training and development requirements Utilising a range of approaches will help you to achieve first class training and development You will be able to commission the right level of

http://www.nes.scot.nhs.uk/education-and-training/by-discipline/nursing-and-midwifery/resources/publications/advanced-practice-development-needs-analysis-toolkit.aspx http://masterclasses.bmj.com

Sharing Knowledge Investment

placed to provide it

Ø Establish a mechanism for sharing learning within the GP Federation and where appropriate key stakeholders

Ø Use a range of approaches to share education and training including peer learning, networks, practice staff events, patient education events

Ø Produce a policy for training and development to guide staff

Ø Research opportunities to attract training and development funding

training within your budget Increased knowledge and skills of GP Federation staff and members Enables your GP Federation to champion education, training and development GP federation staff operate within clear parameters for training and development Your training and development will help you to attract and complete bids for funding.

http://www.rcgp.org.uk/practising_as_a_gp.aspx http://www.open.ac.uk/postgraduate/