Coping with NHS CutsA Consultant's Survival Guide Dr Sabyasachi BhaumikMedical Director – Leicestershire Partnership TrustChair – Faculty of LD, RCPsych

Overview

Setting the scene Current scenario Shape of things to come

How to survive and possibly grow Discussion – examples of

innovative practice

Current scenario

Perspective of mental health services in the overall NHS context

Growth factors Barriers to growth Implications of zero growth budget

Current economic climate £20 billion savings over next 5 years 30% or more in first 2 years Emergency budget on 22nd June Public debt – increasing by £3 billion per week Cost - £77000 per head Local health economies – total place PCTs (commissioners) perspective Acute care trusts perspective Mental health trusts perspective

Consultant

How to Survive being an NHS Consultant in a downturn

Keep up to date withwhat is happening

Focus on efficiencies

Support your teamFocus on patient care

Honesty

Care pathways

To patients/staff team

Trust wide

CIPS delivered

Dr S Bhaumik, Medical Director

Sense of perspective

Impact onannual plans

New market areas

Be the leader‘drive the bus’

Best way to reduce stress

Not many consultants are

ever sacked

Patient care

Consultantssee up and downturns

Commissioners andMarket Intelligence

Shape of things to come

Commissioning process PCTs / PBCs Provider services PbR in mental health Next Stage Review Local health economies including

shared services

How to survive & possibly grow!

Review everything you do Individual level Service level Regional level National level

What to review

Activity – NWW

Quality – Outcomes

Cost effectiveness

Always be aware of your competitors

Individual level (1)

Review what you are doing. Review your job plan. Does your practice line up with your specialties’ and Trust’s vision and objectives?

Record activity figures. Audit your clinical practice and show

evidence of providing quality services – 360 degree appraisal etc.

Individual level (2) New ways of working for consultant

psychiatrists. Think innovatively and reduce wastage and

duplication in your work – Lean thinking. Apply this for your management responsibilities too – attend fewer meetings and only those relevant to you.

Delegate work and set small, measurable and agreed targets for projects. Use meetings to discuss outcomes rather than discuss issues.

Individual level (3) Review your specialist skills and volunteer

to use those skills to develop a service or acquire specialist skills to provide a better service. Develop your specialist skills in line with local population needs and commissioning intent. Develop a niche area so that regional services may also depend on you.

Keep up to date with CPD, appraisal, revalidation etc.

Keep up to date with not only clinical evidence but also with the changing political scenarios, policies etc – read HSJ.

Service level (1)

Review your service and set a vision with objectives

Concentrate on what the service does well and develop it further

Handover things that the service does not provide well

Engage other services for things they could do better (Together we grow stronger)

Invest in care pathways based on stepped care model.

Service level (2)

Care pathways Framework for leaner system Built on a platform of good relationship Collaborative working is must

Multi agency User / carer

Dynamic interaction with evidence base Clinical Network should underpin the

pathways.

Leaner working - system

Self care

Primary Care

Community Psychiatry

IPSpecialist services

Self Care

Health PromotionSelf guided care forLong term conditionsSign posting

Building bridges with GPsMental Health services in Primary care (IAPT etc)

Primary care

Secondary care

Care pathways based on stepped care modelWorkforce developmentNew ways of workingSkills development in Primary care

Care pathways based on stepped care modelWorkforce developmentNew ways of workingSkills development in Primary care

IP / Specialized

Reaching out to communityEarly intervention to shorten the staySkills development in lower tier

Reaching out to communityEarly intervention to shorten the staySkills development in lower tier

Voluntary sector

Voluntary sector

Service level (3)

Plan your workforce by reviewing their skills mix in line with care pathways and provide training accordingly. Workforce planning should be with a long term plan and not reactionary.

Invest in IT systems that are user friendly, relevant and compatible with other systems used by other providers for easy sharing of information.

Be innovative and develop services and teams which are virtual and needed for the local population and which is compatible with commissioning intent.

Service level (4)

Develop shared services with acute trusts, primary care and 3rd sector to use resources more efficiently.

Decommissioning of services – have a discussion with commissioners about decommissioning of certain services outside the Trust like OAP’s.

Establish outcome measures to provide commissioners with evidence of the quality of the service you provide.

Aim for FT status

Service level (5)

Learn from good practice in other regions and in the private sector.

Assessing the CPD and training needs of staff in the service and providing in house training in mass may reduce the amount of money spent on study leave.

Develop training packages and organise conferences with the support of local specialists in your Trust.

Rationalise and question the time spent in meetings by staff in the service.

Regional & National level

Be actively involved with the respective Faculty of RCPsych to influence local decisions.

Be aware of national policies and strategic directions so that your are better prepared for changes.

Use market intelligence & business development schemes

Forge partnerships

Remember – Maintain quality whilst achieving efficiency What is quality?

Professional perspective User / carer perspective Peer review Dialogue with commissioners

Leading beyond authority

Horizon scanning – constantly gathering intelligence (always be one step ahead)

Influencing others – mutually beneficial trades

You have to loose small battles some times for a major victory

Keeping the bigger picture in mind all the time

Turning adversities in to opportunities if possible