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4b - 2010 Budget and Business Plan - Annex D

Achieving Improved Economy, Efficiency and Effectiveness 1. Achieving improved economy, efficiency and effectiveness within the Fitness to Practise Directorate

Completed initiatives or those underway

Initiative

Overview Benefits

Economy – Improvement activities targeted with reducing the cost of acquisition of the various resources we need A. Reduce reliance on external legal providers and expansion of the IHLT

• Since 2002 the GMC has expanded its in-house legal team while at the same time reducing its reliance on external legal providers.

• The driver for this has been three-fold. First, to achieve better

value for money and consistency in the prosecution and litigation work undertaken by the GMC. Second, to support greater legal input into the early stages of Fitness to Practise cases. Third, to support policy development work and the ongoing programme of reforms across the GMC.

• In the latest phase of the expansion, we have seen the number of cases that are presented by the IHLT, rise to 65% of the total number of cases from just over 50% in 2007.

• We are currently in the process of expanding the team further, and anticipate that the proportion of cases held by the IHLT in 2010 will rise to 90%.

Initiative

Overview Benefits

• Clearly, undertaking legal work in-house eliminates the usual profit margins and added costs associated with using external legal suppliers. Savings achieved in this area have increased gradually over the past 7 years as the experience and capacity of the IHLT has grown.

• In 2009, the bulk of the legal budget, 87%, will be expended on

the preparation and presentation of cases before a FTP panel. • The number of cases waiting to be heard at a FTP panel has

increased from 195 in 2007 to just over 310 in 2009. This has been driven by a significant increase in the number of referrals received over the last 10 months, and although we are continuing to hear the majority of cases within the agreed service target, there is clearly an impact on the overall cost of preparing these cases. Average costs have however decreased as planned and will continue to do so as we reduce our reliance on external legal providers further during 2010.

• Additionally, we have 4 in-house advocates who take on a number

of cases at panels thereby reducing the reliance on often expensive external counsel. We have recently trained up our advocates so that they can take on some court work which will further reduce costs and the reliance on external counsel.

• The average cost (calculated using the

total number of cases waiting to be heard by a FTP panel and the proportion of legal costs that are dedicated to preparing and presenting cases at FTP hearings) has reduced from £71,435 per case in 2007 to £49,210 per case in 20091. This equates to an annual saving of £6.9 million.

• As well as the quantifiable benefits that

have been identified, there are a large number of non-quantifiable benefits which include the development of internal, more consistent processes and decision making which is dynamic and reflects changes, both legal and societal.

B. Introduction of a capped fee arrangement for external legal services

• Since 2000 we have market tested the quality and value for money of external legal services by engaging different firms to present fitness to practise cases at panels. In 2006, we used this experience to tender for and then award an initial contract for 100 panel hearing cases at a capped fee. Since then we have awarded two further contracts.

• The key benefit of the capped fee arrangement is that it provides greater certainty around future expenditure. Prior to the move to the arrangement, the organisation found it relatively difficult to undertake budgeting activity around its legal costs accurately.

1 This is based on the IHLT dedicating 65% of their time to preparing and presenting cases before a FTP panel. Total expenditure on preparing and presenting cases during 2007 was £13.93M and compares to estimated expenditure of £15.25M in 2009. The total number of cases that have been referred (which have been allocated to external or internal solicitors to prepare for, and present at a FTP panel) was 195 at the end of 2007 and 310 in August 2009.

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Initiative

Overview Benefits

• The award of the contact enables the successful firm to have confidence in the flow of work and to build and maintain an experienced GMC-focused team accordingly.

• The planned expansion of the IHLT in 2010 will mean that further

contracts are unlikely to be awarded, however the principles around cost probity, that are now embedded in the way we manage legal expenditure, will continue.

• The tendering process itself also

ensured that we achieved value-for-money, as a number of organisations competed for the contracts.

C. Reduced reliance on external venues to undertake Performance Assessments

• In 2006 we undertook a project to run FTP tests of competence (TOCs) in the GMC’s PLAB test centre. The tests form part of an assessment of doctors whose professional performance may be deficient.

• The driver for the project was two fold: first, to reduce the cost of

running individual TOCs and second, to improve the utilisation of the GMC’s assessment centre.

• In 2007 we used the centre for 59 TOC days and 17 validation days saving around £281k.

• FTP also used the centres rooms for

more general associate training on 39 days, amounting to a cost saving of approximately £39k.

• We have also recorded a number of

training videos at the centre at virtually no cost.

D. Changes to the number of panellists that make up a quorum

• In July 2006 Council changed its policy on the number of panellists to be empanelled for each case. Since 4 September 2006 panels considering cases of three days or less comprise three panellists. In order to protect the quorum in longer cases, panels of four or five continue to be empanelled.

• We have monitored closely the impact of the policy change,

particularly in terms of risk to the quorum in panels of three where a panellist is unexpectedly unavailable or is otherwise unable to sit. The evidence to date has demonstrated that the risk is manageable.

• The change in policy has resulted in an annual saving of £1.18M2.

2 Based on 1956 hearing days in 2008, during which the quorum was three instead of five.

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Initiative

Overview Benefits

• We have also monitored the number of issues raised by the

Determination Audit Group and found that the number of cases that raise concern has not increased as a result of the change.

E. Changes to transcription services • In 2008 we undertook a review of transcription services provided by our external transcription providers and identified a number of areas where savings could be achieved.

• The savings were achieved first through a decrease in the

numbers of transcribers used on ‘write-outs’ in London (to bring in line with practice in Manchester), second by re-negotiating the transcribers’ contracts to make additional marginal savings and third, ensuring transcribers use less costly approved hotels in Manchester.

• The review has resulted in a reduction in transcription costs of c. £300k per annum.

Efficiency – Improvement activities that have enabled us to increase output from the same input resources F. Improved hearing utilisation • During 2006 performance against the 9 month Adjudication target

fell to 54% (against a target of 90%) due to a significant rise in the number of cases being referred for a hearing. In order to improve this performance, we increased our hearing capacity and the utilisation of hearing rooms. We set a target of increasing utilisation from 67% (achieved in 2006) to 80% from August 2007. The main tools used to improve performance were over-listing of cases and the use of flexible capacity as well as improved management reporting and communication between parties.

• Since August 2007, we have consistently achieved hearing utilisation over 80% and in 2009 have achieved an average of 93% over the first 6 months of the year.

Although the key driver of the project has been improved timeliness, the overall average cost per hearing day is now £318 lower than it was in 2006, which represents a full year efficiency saving of £809,000.

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Initiative

Overview Benefits

G. Stream 1 improvement project: improving performance against key timeliness targets

• The stream 1 improvement project was run in late 2007 and early 2008, with the aim of exploring ways of improving performance against timeliness targets at the Investigation stage of the Fitness to Practise Procedures.

• The project explored ways in which time taken to complete an

investigation could be improved, particularly by improving the way in which health and performance assessments were undertaken, and by putting in improved management reporting capabilities within the Legal Team to improve the time taken to provide advice, draft formal allegations and obtain witness statements and expert’s reports.

• As well as improving performance against the timeliness targets,

our review also showed that in many cases, formal witness statements are not required at the early stages of the Fitness to Practise procedures, as there is usually sufficient information available to the decision-makers at that stage to allow them to decide whether there is a realistic prospect that a doctor’s fitness to practise is impaired. If the case does proceed to a hearing, we can test the information through a formal witness statement at that stage.

• Our performance against the stream 1 investigation target (which is set at 70% of stream 1 investigations to be concluded within 6 months) has improved as a result of the project, from 43% in January 2008, to 70% in June 2009 and a rolling average for 2009 of 59% as at end of August.

• The average time taken to complete a

performance assessment has reduced from an average of 213 days in 2008 to 162 in 2009, while the average time taken to complete a health assessment has reduced from an average of 101 days in 2008 to 73 in 2009.

• The average time taken to prepare an

expert’s report has been reduced from 103 days to 45 days, while the average time taken to prepare a witness statement has reduced from 105 days in 2007 to 40 days in 2009.

H. Improved Investigation team productivity

• Over the last 3 years we have achieved a more efficient use of resource at the Investigation stage of the FTP procedures through improved performance management, systems improvements and the adoption of a functional team structure.

• In 2009 we achieved further improvements in productivity by

undertaking a focused business improvement project. This involved setting challenging performance targets for individual Investigation Officers and Managers, developing enhanced reporting, and undertaking a regular route-cause analysis.

• The average cost per enquiry has reduced from £504 in 2006 to £444 in 2008. This is despite significant inflationary pressures during this period.

• Our analysis shows that in the first 3

months of 2009 we achieved a 35% increase in productivity within the Investigation team as a result of the improvements that were implemented. This has allowed the team to stay on top of a rising stream 1 intake level

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Initiative

Overview Benefits

which is currently 30% higher than in 2008. As a result of this the average cost per enquiry in the first 6 months on 2009 has fallen to £402.

I. Transfer of FTP helpline to the GMC Contact Centre

• The project was established to explore ways in which telephone service within the Investigation team could be handled more effectively to support casework. The project has resulted in the reallocation of FTP helpline calls to the main GMC Contact Centre, the identification of certain activities that are now dealt with via the telephone (previously dealt with via written correspondence) and the delivery of customer service training to staff within the Investigation team who deal with direct dial calls.

• The project resulted in a saving of approximately £32,3643.

• The speed of response delivered

through the Contact Centre is higher than that previously offered through the FTP Helpline with 95% of calls now being answered within 15 seconds.

J. Implementation of consensual disposal

• In 2007 we extended our powers to agree undertakings at the investigation stage to misconduct cases. However, because these powers are subject to a range of criteria which have proved restrictive, we are agreeing undertakings in a relatively small number of cases. Only seven additional cases have been dealt with by consensual disposal since we extended our powers in 2007.

• We believe that the agreement of undertakings at the end of the investigation stage provides a more proportionate way to respond to certain types of concerns about doctors, particularly where the concerns are about their performance. For this reason, we are currently consulting on guidance that extends the use of consensual disposal to all cases involving a doctor’s performance, unless the case is so serious that the doctor would be likely to be erased by a Fitness to Practise panel.

• Since 2007, seven cases have concluded via consensual disposal, accounting for a saving of approximately £596,4704.

• Our current estimate, if the proposals

set out in the recent consultation are implemented, is that approximately 30 cases may be concluded via consensual disposal per year in the future.

3 One ML5 Investigation Assistant – saving achieved in September 2006 and realised in the 2007 budget. 4 Based on one hearing day costing £5000, 7.2 days average hearing length and the average case costing £49,210 to prepare and present at a FTP panel hearing.

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Initiative

Overview Benefits

Effectiveness – Improvement activities that have helped us deliver outcomes that match their objectives K. Introduction of the Civil Standard of Proof in 2008

• The change was suggested in the White Paper. The criminal standard of proof is intended for criminal cases and its use in civil proceedings is rare. There was a concern that this might discourage complainants from bringing complaints.

• The transition to the Civil Standard has been extremely smooth and no concerns have been raised with the GMC with regards to the application of the civil standard of proof.

L. Introduction of decision circular • In 2008 we introduced a new Decisions Circular. For some time we

have notified a range of international regulators about the outcome of Fitness to Practise Hearings in order to protect the public, however up until the implementation this was published monthly and distributed by hard-copy only carrying the risk that the information could be out of date. Now when any action is taken on a doctor’s registration either by the Interim Orders Panel or a Fitness to Practise Panel and, additionally to the previous circular, when action is taken during the investigation stage (such as the issuing of a warning or agreeing undertakings) this information is transmitted to the relevant competent authorities in other countries electronically by e-mail. The new electronic Decisions Circular includes the names of all doctors with decisions against them as well as other core identifying information and links to the relevant pages on the List of Registered Medical Practitioners. This ensures that the full public record is accessible to overseas regulators and any updated information is immediately available to them.

• As an associated measure the GMC also writes to specific

overseas regulators where possible whenever action is taken against a doctor who qualified in their jurisdiction or where there is information suggesting that the doctor is or intends to work in their jurisdiction.

• The Decision Circular is designed to prevent doctors who are subject to restrictions in the UK from practising in other countries where they maintain registration and putting patients in that country at risk.

M. Affiliate pilot • In 2008 we successfully developed and introduced GMC Affiliates into West Yorkshire and North London on a pilot basis. The purpose was to test how effective a proposed model for GMC

• The interim evaluation report, prepared by KPMG, was published in April 2009 and was very positive. It confirmed that

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Initiative

Overview Benefits

Affiliates is in bridging the regulatory gap between national and workplace regulation.

the proposed model provided value and support to Medical Directors, improved the handling of claims and contributed to best practice at a regional level.

N. Legal time recording system • In early 2008 we implemented a new time recording system to

support the work of the in-house legal team.

• The expansion of the in-house legal team, and the wide range of legal support provided by the team, has posed a number of challenges, both in terms of managing individuals and in allocating costs and agreeing forward budgets.

• In order to cope with the expansion, it is vital that we are able to manage and account for the work that is undertaken by the team.

• The drive for the new system was not directly about saving money but about justifying and monitoring legal expenditure.

• During 2008 and 2009 we have, as an organisation, gained a much better understanding of where we spend the legal budget and have a much tighter control over budgets that have been agreed to support individual directorates and specific pieces of work.

O. KPMG audit – new audit approach/DRG

• Following recommendations from KPMG, the scope of fitness to practise audits was extended to cover all business units (administrative and decision-making audits).

• The recommendation was made in order to provide improved

levels of assurance around fitness to practise work.

• The new audit programme commenced in April 2009.

• By the end of 2009 we hope to be in a

position to review the levels of errors and any improvements that have resulted from the introduction of the new audit programme.

P. Changes to the How to Complain section of the GMC website

• In 2008 we developed a new, interactive, area of the website to support individuals who are considering, or have decided, to refer or make a complaint against a particular doctor. This replaced our existing website publications and has provided a significantly enhanced service.

• The interactive content has enhanced levels of service and feedback from those using the system has been extremely positive.

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Initiative

Overview Benefits

Q. 360 degree feedback system for panellists

• In 2008 we introduced, following a successful pilot, a 360 degree feedback system for panellists.

• The system replaced a previous paper based system that failed to

provide sufficient information on individual performance.

• The system has been generally welcomed by panellists who see it as a considerable improvement on the previous system.

• The system provides information that

can be used when deciding to re-appoint panellists for a further term of office.

R. Witness Support Project • A continuous improvement project to improve witness support has been developed in the last year. This has consisted of three strands of work:

I. Producing information (online and pamphlet) describing the

hearing process so that witness are informed in advance of a hearing.

II. Piloting enhanced support to vulnerable witnesses in

conjunction with victim support and AvMA.

III. Provision of enhanced information for Doctors attending hearings, including the development of a virtual hearing room online.

• This project is expected to improve the overall effectiveness of hearings by having better prepared witnesses. In addition, improving witness support will enhance the reputation of the GMC and has already been cited as good or excellent practice by the CHRE5. A further survey of witnesses will take place later in 2009 to measure the effectiveness of the improvements.

5 CHRE, Performance Review of health professional regulatory bodies 2008/2009, p. 46

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2. Achieving improved economy, efficiency and effectiveness within the Registration and Resources Directorates

Completed initiatives or those underway Initiative

Overview Quantifiable benefits

Economy – Improvement activities targeted with reducing the cost of acquisition of the various resources we need A. Relocation of work We currently occupy 63,000 sq.ft of accommodation in Manchester at

a combined rent, rates and service charge cost of £23.20 per sq.ft. Our accommodation in London costs £58.90 per sq.ft. The decision to relocate work from London to Manchester and only expand services in Manchester is saving £35.70 per sq.ft. on accommodation costs. Our staffing arrangements in Manchester are based on salary bands that are between up to 20% below our London rates.

Around £2.24 million savings per annum in accommodation costs. Our Manchester staffing structure would cost around £2m per year more if it was based in London.

B. Pension Costs We have made two significant changes to our pension arrangements, with changes to the retirement age for new starters and the introduction of employee contributions.

Changes to the retirement age for new starters provides for a reduction of approximately 0.5% (or £100,000 per year) in the employer’s contribution rate since 2006. The introduction of employee contributions produces a saving to the employer of approximately £530,000 in the 2009/2010 pay year, rising to around £800,000 in 2010/11.

C. Recruitment Costs We have engaged in significant levels of recruitment in recent years and while this has reduced our planning assumptions are based on making 50-60 new appointments a year. A wide range of initiatives taken forward as part of our ongoing changes to our purchasing, advertising and processes has seen our cost per appointment fall.

In 2007 our costs per hire were £5700, in 2008 these fell to £4600 and in 2009 the figure is £4000. Savings in 2009 compared with 2007 amount to around £150,000.

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Initiative

Overview Quantifiable benefits

D. Waste management Implementing a number of cost saving initiatives across the directorate including double sided printing, turning off PC and monitors when not in use and using draft quality printing were possible.

£8,400 annual savings for initiatives so far. £5300 potential annual savings for another initiative currently being considered.

E. Reducing our distribution and fulfilment costs

As a result of a number of in house improvements we have managed to improve the timeliness of our handover of fulfilment requests to our mailing house. This has enabled us to reduce our reliance on first class postage and not see any reduction in Quality of service.

£40,000 full year effect savings. Implemented in May 2009.

F. Developing our internal change agent resources

Previously the directorate relied heavily on external project management consultancy. In 2006 our expenditure on KPMG consultants was in excess of £200k. In 2009 we will have spent less than £30k and delivered more change programmes.

£170k full year savings.

Efficiency – Improvement activities that have enabled us to increase output from the same input resources A. Operational team performance management initiatives

As a result of the introduction of a standard set of measures the operational teams have been given the opportunity to focus consistently on a number of key performance indicators. Improvements have been identified across the directorate but as an illustration in both EEA and IMG we have seen significant improvements in the average time it takes to close an application and the age profile of the open applications we have

See graphs.

B. Not Right First time registration application referrals from application teams to Complex casework teams

In 2008 the Complex Casework team were experiencing significant delays in dealing with cases because of the variation in the consistency, timeliness and completeness of the information being received from the operational teams. 92% of cases referred to the team had insufficient information to enable them to deal with the referral and therefore had to be referred back to the team. By involving people from both teams in identifying the root cause of the problem (a lack of any structured guidance on transferring cases between teams), this has been reduced to 16%, with further improvement work already planned for 2009.

Drop in number of NRFT referrals by 76%. Any reduction in rework gives those involved in the process the opportunity to work on other ‘value adding’ activity.

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Initiative

Overview Quantifiable benefits

C. Fees paid but no ARC project 27% of Fees related calls to the Contact Centre were complaints regarding the length of time it took for doctors to receive their Annual Registration Certificate (ARC) after paying their Annual Retention Fee (ARF). It was taking an average of 23 days. By identifying the root cause of the problem we reduced the percentage of calls regarding ARCs to 0.5% of Fees related calls. ARCs are now despatched daily.

Reduction of approximately 6170 calls per year, equating to around 670 hours work or £12,500.

D. Reducing calls to the Contact Centre by improving access to MyGMC

In 2008 we conducted analysis on call and activity volumes and identified that issues concerning MyGMC made up 15% of the Contact centre team’s workload. In March 2009 we introduced a range of changes to our website and MyGMC.

A reduction of 14,000 calls per year which equates to about 60hrs adviser time per week (£38k fy effect) or at £4 a call equals £57,200 per annum. In addition we have saved about £9000 / year on PIN production and distribution costs.

E. LID Application processing costs In 2006 the time for processing Low Income Discount Scheme (LIDS) applications was equivalent to one full time fees adviser. By eliminating the waste in the process and introducing new standard template letters and emails, the process time was reduced by 80%.

Saving of approx £20k per annum.

F. Improving our Death Erasure process

In March 2009 there were 265 death erasure applications on hold due to insufficient evidence to erase, with 98 new applications pending. There is no process for rejecting death erasure applications, so applications can sit on hold indefinitely. The oldest application currently on hold is 183 days. We also received a significant number of complaints regarding the efficiency of the process and our insensitivity in demanding a certified copy of a death certificate as the only acceptable evidence for amending the register.

We have streamlined the process, reducing the average processing time from 80 minutes to 20 minutes. Lead time for completing applications without a death certificate is down from 3 months to 5 days. No longer a requirement to send 2 letters. Projected labour efficiency saving equivalent to £28,600 per year.

G. Siebel operating enhancements In 2007 Registration directorate went live with its new operating system. One of its great advantages is that it is highly configurable. Through analysis of transactions we have been able to reduce the time it takes to complete a number of transactions, thus saving operator time.

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Initiative

Overview Quantifiable benefits

H. Processing of EEA Italian PMQ Removed unnecessary data fixes from process for registering Italian doctors.

Saving of ten minutes per application. Based on 2008 figures, would work out at 78.5 hours work saved per year (cost equivalent around £1500).

I. CCE / P&P address change project.

Procedure changed so that contact centre staff could carry out a request for a certified copy of entry in the register or for a MyGMC PIN and password in the same call as an address change.

Expected saving of around 200 hours per year (cost equivalent around £3700). Benefit to doctors of not having to make separate second call.

J. EICS verification Changed to using automated CGS instead of special letter when verifying a doctor’s status for the Educational Commission for Foreign Medical Graduates International Credentials Services (EICS).

Saved 16 hours work per year (cost equivalent around £300). Reduced time to send letter from around a week to same day.

K. Postbox procedure changes Procedure for forwarding mail to doctors to be replaced in September 2009 with a more streamlined procedure in which we pass on contact details.

Expected savings of 77 working days, cost equivalent around £10k, and £6600 in stationery per year.

L. GMCToday change of address form.

Change of address form supplied with GMC Today changed to include statement saying the doctor needs to sign the form to authorise changes.

Expected reduction in workload arising from having to contact doctors who have failed to sign the form.

M. PCGS procedure Review and revision of procedure for producing past certificates of good standing (PCGS), to reduce administrative time.

40 improvement opportunities identified. Could save time on 660 activities per year.

N. EEA country specific email templates

Country specific first assessment email templates produced by EEA team, to reduce time taken to carry out assessments.

Currently being introduced, so no measure of impact yet.

O. BMA opt out Investigating why we supply addresses to the BMA, and whether advisers need to continue querying doctors’ decisions to opt out of this.

Investigation underway – no quantifiable benefits yet.

P. EEA bundling Changes to the bundling of documents from the EEA team for ID checks, saving on time and stationery costs.

Saving around 44 hours of adviser time per year, equivalent cost saving, together with stationery costs, of around £850.

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Initiative

Overview Quantifiable benefits

Effectiveness – Improvement activities that have helped us deliver outcomes that match their objectives A. Improving the accuracy of our Registers.

During the 12 months to March 2006 post was returned from the registered addresses of 1,685 doctors. Our process for dealing with returned post was only successful in obtaining an effective address 32% of the time for these doctors. As a consequence a large number of doctors did not receive the ARF reminders and were erased for non-payment, resulting in complaints and emergency restorations. Our method of trying to obtain an effective address was to write to the doctors on up to three occasions, before eventually erasing then from the register. Although it is the doctor's responsibility to notify us of any address change, by using other methods of contact such as e-mail, telephone or text message, we were able to increase the effectiveness of our returned post process.

In 2008 we obtained an effective address for 99.1% of doctors who were subject to the returned post process.

B. Increasing use of VE and reducing unintentional admin erasures

In 2007 we had a number of complaints from doctors who had intentionally allowed their registration to lapse and were unaware that they had to pay a restoration fee, equal to the annual registration fee, and obtain evidence of their fitness to practise, before being allowed to rejoin the register. We amended our website to inform doctors of the facts, and the benefits of Voluntary Erasure (VE). We also amended our ARF notices to clearly state the options available should the doctor choose not to remain on the register

This has resulted in an increase in the number of applications for VE, a significant reduction in the number of second fee reminder letters being sent and a reduction in the number of doctors choosing to be erased for non-payment of the annual registration fee.

C. Improving the accuracy of our Registers.

Since the implementation of Siebel we have been able to quickly create and run exception reports, with the aim of identifying errors in the data we hold and correcting these errors as they are identified.

Half of the fixes were completed systemically by resolving data lookup issues, the others were completed manually by resource from a number of areas, with the contact centre providing the majority.

Since January 2009 we have secured resource to complete approximately 30,000 data cleanses. The majority of the fixes have revolved around the doctors name and contact details. This activity is ongoing and we believe will lead to an overall enhancement of our reputation as an effective regulator.

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Initiative

Overview Quantifiable benefits

D. Complex casework application granting.

Complex Casework team have changed their procedure for processing an application after it is granted in line with other application teams, to facilitate Reception’s work need in carrying out ID checks.

E. CI Communications There was no up to date source of information on CI in the GMC which contained the information required to: Suggest improvement ideas and monitor their progress, view current and completed projects, access the tools and techniques used in CI, monitor CI involvement, understand the various routes from which CI projects can come.

We introduced the ‘Ideas’ scheme, providing a directorate wide vehicle for improvement suggestions, the ‘CI Log’ which enables us to track and communicate progress, involvement and benefits.

All in Registrations now have a vehicle for improvement ideas, supported by the HoS and managers. In the 8 months since its introduction we have had 142 improvement ideas, resulting in 23 completed projects and 30 underway or sponsored.

F. Checking contact details Changes made to procedures and internal QA to ensure that contact centre staff check a doctor’s contact details are up to date when they call in about another issue.

G. Cross skilling A number of Registration staff have been trained on core operational transactions outside of their core role.

In 2008 over 100 various applications were processed during peak by existing staff that may either have failed SLA or incurred additional cost in processing had we not delivered this level of flexibility. In addition we have found that this training has provided us with flexibility to deal with any unpredicted demands, a positive indicator to help with succession planning and a clear opportunity for individual development and involvement. This is a very positive message to be able to send to staff.

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3. Achieving improved economy, efficiency and effectiveness within the Registration and Resources Directorates

Planned Initiatives Initiative

Overview Quantifiable benefits

Economy – Improvement activities targeted with reducing the cost of acquisition of the various resources we need A. Further distribution and fulfilment cost reductions

To continue to review our annual spend on postage and distribution to ensure value for money. We will in particular look at how we may reduce the weight of our welcome to register pack.

To be identified.

B. Further analysis of calls into the Contact Centre to establish opportunity to remove workload

To address the root causes of ‘failure demand’ calls into the contact centre. Failure demand calls are calls that have been generated because another part of our process or system has not worked as well as it could have. They are not complaints but are requests for assistance where guidance is not clear or use of a contact centre call because an automated channel has not been effective.

To be identified.

Efficiency – These are improvement activities that have enabled us to increase output from the same input resources A. Unnecessary documents Project to assess the causes of doctors sending in unnecessary

documents as part of applications and to reduce these, with the aim of reducing administrative costs.

To be identified.

B. Review of AR referrals Review most common types of assistant registrar referrals and create templates to reduce time producing these.

To be identified.

C. A strategic review of our application process to establish opportunity to reduce double or duplicate handling of inbound evidence or applications

Seibel offers the organisation a sophisticated work flow management system, which if configured correctly reduces duplication, increases visibility of transaction progress and enables automated responses and progress tracking. To enable this we need to conduct process re-engineering projects and system configuration, training and release.

To be identified.

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Initiative

Overview Quantifiable benefits

D. Absorption of relocated Clinical Assessment Centre running costs by Manchester Contact centre team

The Registration Enquiries and Support team will be responsible for managing the CAC when it moves to Manchester. They will need to recruit a team to run it. As a result of ongoing efficiencies two of these posts will be sourced from the existing Contact centre headcount.

An avoided cost of two Level 5 advisers. Over £50,000 per year.

E. Implementation of Siebel system enhancements with v3.0

We have built a number of system enhancements that have enabled us to pre populate response emails and other time saving initiatives

Release 3 – Total of 2011 hours per annum. Based on £30K per year fully loaded cost, we believe this will result in about £34k avoided costs. See initiative D.

F. Introduction of an automated fee payment line

Currently we can only accept payment of Annual retention fees by credit or debit card direct to a customer services adviser. The introduction of an automated payment line will reduce demand on contact centre adviser time

To be identified.

Effectiveness –Improvement activities that have helped us deliver outcomes that match their objectives A. Registration panel process review.

Establish acceptable criteria for each stage of the Registration Panel referral process to ensure consistency and quality.

Ongoing reduction to reputational risk through loss of Appeals panels and judicial review.

B. ISO9001 certification Carry out Assessment of Registration’s fitness for ISO9001 quality assurance certification, and carry out activities to meet this standard.

Enhanced customer perception and internal quality performance.

C. Complaints process Ongoing review and revision of procedure for administering and responding to complaints, to ensure quality and timeliness of responses and reduce administrative time.

Quicker response times to customer and an opportunity to divert significant writing and communication skill onto other areas were our current tone of voice can be improved.

D. Complex casework handovers Ongoing review of the handover of cases from application teams to the complex casework team, to reduce delays in processing applications.

To be identified.

E. Delays in supplying evidence Ongoing investigation into why there are delays in doctors supplying evidence and information relevant to their applications

A reduction in the time it takes to complete processing an application.

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4. Supporting Graphs

a. EEA June 2008 – July 2009 – Average throughput time of Application

Avg days to close

55 43

0

25

50

75

100

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June July

NB: Figures represent applications closed in that month

b. EEA June 2008 – Applications work in progress age profile EEA July 2009 – Applications work in progress age profile

0

10

20

30

40

50

1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 151

No

of A

pplic

atio

ns

01020304050

1 11 21 31 41 51 61 71 81 91 101111 121131 141151No

of A

pplic

atio

ns

D18

c. IMG June 2008 – July 2009 – Average throughput time of Application

Avg days to close

50 42

0

25

50

75

100

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul

NB: Figures represent applications closed in that month

d. IMG June 2008 – Applications work in progress age profile IMG July 2009 – Applications work in progress age profile

0

10

20

30

40

1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 151

No

of A

pplic

atio

ns

05

101520253035

1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 151N

o of

App

licat

ions

D19

e. Siebel V2.4 release benefits:

f. Siebel V3.0 predicted benefits

D20

5. Savings recorded in the Resources Directorate savings log

Initiative

Overview Quantifiable benefits

Since its inception in 2004 we have recorder in excess of £5.5M in savings in the Resources Directorate Savings Log. In the main these savings have been achieved through straight negotiation on price or through pro-active cost avoidance initiatives. Examples of recent achievements include: A. Rail Fare Reduction- more for less.

Going back to 2004 the default rail ticket type for staff, associates and panellists was a “First Class Open Return”. Through successfully changing our buying patterns and restricting the use of fully flexible tickets our average ticket price has fallen from £140.33 in 2008 to £110.74 in 2009. According to a recent report from Virgin trains, our principle rail travel provider our traffic is up by 8% whilst our spend is down by 15%.

Circa £300,000 in 2009.

B. VAT Mitigation on invoices for temporary and contract workers.

In February 2007 we instigated a scheme with our key HR Employment Agencies that allowed us to legitimately avoid VAT on the labour element of temporary employee charges. The scheme which ran until the end of March 2009 when the loop hole was closed by the Government involved us working closely with our preferred suppliers to ensure that invoices were presented in such a way that we could legally avoid the VAT on the labour element and only paid VAT on the service charge

This resulted in a realised saving of some £472,000.

C. Review of Bank Charges

During Spring this year the Finance Team instigated a review of our bank charges. After several meetings with our Bankers we managed to extract lower rates than we had previously been paying in many areas.

A saving of £43,481 this year. The budget has been cut accordingly.

D21

Initiative

Overview Quantifiable benefits

D. Renegotiation of rent as St James’s Building

Whilst exercising our lease breaks on SJB and negotiating an extension until December 2009 our Facilities team achieved a rent reduction against the original proposals by Bruntwood our Landlords.

£146,292 for the whole of 2009.

D22