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@robertvarnam #GPdev @NHSIQ
Releasing time in general practice
Dr Robert Varnam PhD MRCGPClinical lead, CCG transformational change delivery, NHS Improving Quality
Head of general practice development, NHS England
GP, The Robert Darbishire Practice, Manchester
slidesha.re/1cyDzWS
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@robertvarnam #GPdev @NHSIQ
Releasing time in general practice
The issue The Productive General Practice Examples Deployment Top tips
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@robertvarnam #GPdev @NHSIQ
Releasing time in general practice
The issue The Productive General Practice Examples Deployment Top tips
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@robertvarnam #GPdev @NHSIQ
The issue
£
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@robertvarnam #GPdev @NHSIQ
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@robertvarnam #GPdev @NHSIQ
Releasing time in general practice
The issue The Productive General Practice Examples Deployment Top tips
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@robertvarnam #GPdev @NHSIQ
The Productive General Practice
VisualManagement
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@robertvarnam #GPdev @NHSIQ
The Productive General Practice
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@robertvarnam #GPdev @NHSIQ
The Productive General Practice
Comprehensive lean-based redesign
for busy general practices
Practical, guided, supported
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@robertvarnam #GPdev @NHSIQ
The Productive General Practice
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@robertvarnam #GPdev @NHSIQ
The Productive General Practice
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@robertvarnam #GPdev @NHSIQ
The Productive General Practice
• 12 modules packaged in a box set• Manageable, easy to follow, self-directed modules• A large range of supporting resources – spreadsheets, documents,
eLearning and guidance films
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@robertvarnam #GPdev @NHSIQ
The Productive General Practice
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@robertvarnam #GPdev @NHSIQ
The Productive General Practice
• Support packages from expert teams• Options for sharing & collaboration between practices• Aligned with strategic commissioning priorities
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@robertvarnam #GPdev @NHSIQ
Typical results
• Extra nursing capacity identified, providing extra capacity worth £11k
• More accurate staff planning resulted in the cancellation of planned appointment of staff – avoiding £15k of staff expenditure year on year
• Time taken to retrieve prescriptions requests reduced by 82%, releasing 12.5hrs of staff time per week
• Turnaround time for medical reports reduced by 43%
• 14% reduction in stationary costs
• 57% reduction in blood test resource costs
• 82% reduction in nurse sickness and absence
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@robertvarnam #GPdev @NHSIQ
‘I seem to manage to get home on time much more often than I used to … It makes a big difference to my work-life balance.’Dr Knut Schroeder, Bristol
“Led to changes that were really life changing for me. Improvements mean I do not stay late evenings and this means I am not making mistakes because I am tired.” Dr Angela Bradley, Leamington Spa
Our list size has started to grow for the first time in a good while … the practice is more efficient, friendly, flexible and productive. Dr Paul Cook, Bolsover
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@robertvarnam #GPdev @NHSIQ
Releasing time in general practice
The issue The Productive General Practice Examples Deployment Top tips
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@robertvarnam #GPdev @NHSIQ
Examples
1. Reduced hassle & time
2. Better care & reduced costs
3. Improvement & transformation
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@robertvarnam #GPdev @NHSIQ
eg 1. Reduced hassle & time
Sort
Set
Shine
Standardise
Sustain
Remove non-essential things
Organise necessary thingsAssign each object a place
Regularly clean & maintain the area
Develop procedures, arrange similar areas in similar ways, use colour codes
Use regular audits and embed 5S in the everyday routine
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@robertvarnam #GPdev @NHSIQ
eg 1. Reduced hassle & time
Sort
Set
Shine
Standardise
Sustain
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@robertvarnam #GPdev @NHSIQ
eg 1. Reduced hassle & time
Sort
Set
Shine
Standardise
Sustain
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@robertvarnam #GPdev @NHSIQ
eg 1. Reduced hassle & time
Sort
Set
Shine
Standardise
Sustain
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@robertvarnam #GPdev @NHSIQ
eg 1. Reduced hassle & time
Sort
Set
Shine
Standardise
Sustain
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@robertvarnam #GPdev @NHSIQ
eg 1. Reduced hassle & time
Sort
Set
Shine
Standardise
Sustain
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@robertvarnam #GPdev @NHSIQ
eg 1. Reduced hassle & time
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@robertvarnam #GPdev @NHSIQ
eg 2. Better care & reduced costs
Handling of repeat prescriptions• source of “near-constant frustration for
staff”• already looked at several times
small, short-lived improvements
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@robertvarnam #GPdev @NHSIQ
eg 2. Better care & reduced costs
PGP Prescribing Module saved 12 hours of receptionist time per
week• ‘script hunt’ reduced from 118 to 21 seconds• less time waiting for GPs• happier staff, less stressed
75% reduction in interruptions for GPs• happier GPs, feeling safer
50% drop in ‘urgent’ requests• less sense we’re working ‘on the brink’ all the
time
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@robertvarnam #GPdev @NHSIQ
eg 3. Improvement AND transformation
Improving today’s practice
Process redesign• “given us a structured approach to
making improvements”
reduced the number of calls GPs have to make by 80% and released time for an extra 2 patients to be seen each day
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@robertvarnam #GPdev @NHSIQ
eg 3. Improvement AND transformation
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@robertvarnam #GPdev @NHSIQ
eg 3. Improvement AND transformation
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@robertvarnam #GPdev @NHSIQ
eg 3. Improvement AND transformation
Shaping our future practice
Radically re-thinking & transforming• focus on self-care, group
consultations, technology
patient-led design approach segmentation of high profile patient
groups proactive multiple LTC review clinics
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@robertvarnam #GPdev @NHSIQ
Releasing time in general practice
The issue The Productive General Practice Examples Deployment Top tips
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@robertvarnam #GPdev @NHSIQ
Deployment
• Appealing & relevant to wide variety of practices
• Most are doing PGP in collaboration with others
• Attractive in supporting CCGs’ system transformation strategies
• Time & commitment are essential
• Support is highly valued
• Additional training in improvement tools is helpful
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@robertvarnam #GPdev @NHSIQ
NHS England’s strategic framework
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Aug 13• Call to action on general practice.• Strategic framework for commissioning general practice. • 9 workstreams.
Mar 14• Emerging Findings
Apr 14• Phase Two
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Learning networks
4. Business developmentLegal
Financial
Management
3. Capability-buildingService improvement
Leadership
1. Innovation spreadPeer networking
Innovation hub
National Coordinating Centre
Development advisers
Strategic leadership
Development advisers
National guidance
PMO support Evaluation
2. Release capacity
Bureaucracy
Clinical ‘clutter’
Internal productivity
General practice development programme
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Release capacity
BureaucracyAdministrative pressures on practices originating within the NHS, particularly through contracting.
Clinical ‘clutter’Potentially avoidable demand for consultations created outside the practice.
The Productive General PracticeImproving efficiency in practice systems and processes.
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@robertvarnam #GPdev @NHSIQ
Releasing time in general practice
The issue The Productive General Practice Examples Deployment Top tips
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@robertvarnam #GPdev @NHSIQ
Top tips
Prepare, engage, explain, collaborate, support
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@robertvarnam #GPdev @NHSIQ
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@robertvarnam #GPdev @NHSIQ
Top tips
Create strategic alignment Create a values-based shared purpose
Do it collaboratively Engage, engage, engage
Be realistic about time commitment Build local support resource Use it as it is meant to be used
bit.ly/1hD0GCD
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@robertvarnam #GPdev @NHSIQ
www.nhsiq.nhs.uk/capacity-capability/productive-gp.aspx
bit.ly/1hD0GCD
slidesha.re/1cyDzWS