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