We took part in our joint HSJ Awards - Best Consultancy Partnerships interview with one of our clients this week, as we come towards the end of a 3-year programme. As one of the original gang at Redmoor Health, it was nice for me to reflect on the successes of a strong relationship, developed to deliver a long, multi project programme aimed at increasing digital access, improving patient communications, upskilling the workforce and supporting the Digital First team to deliver their aims. I took a moment to consider this strategic partnership against the current climate of change and chaos in Primary care and thought I’d share some musings with you. BTW, its 8mins long so get yourself a brew and ponder with me.
Finances
Its that’s time of year, when in the last quarter, there is traditionally a frenzy of activity in General Practice. Teams are chasing patients and are working hard to recoup any finances earned throughout the year to maximize payments, following delivery through QOF and the Primary Care Network contract. With only 7 weeks to go to the new financial year, uncertainty over pay and contract negotiations is making next year’s planning harder than usual.
Throughout 2023, there was a raft of new guidance, contract and service changes that managers needed to understand. ICBs and Regions are now comparing progress against targets and seeking assurance or evidence of improvements against new criteria before they can release payments. Some are excelling at this, others finding it hard work. That’s on top of the usual round of ‘heck, we have to spend this money before year end’ last minute decisions. Previously, we’d agree with our clients to receive and hold this year’s £s, then together work up a more detailed scope for delivery into the new financial year, when their priorities are a bit clearer and they can engage properly when primary care have more time. With the reorganisation and requirement for a 30% reduction in costs across NHS Regions and ICBs, some people are facing redundancy or moves to other jobs, consequentially, loss of local organisational knowledge and decision-making inertia is becoming clear. Also, the combining of primary care transformation and digital budgets is affecting financial flows and prioritisation of projects. Clawbacks on unspent budgets are being mentioned in dark corridors and on socials, which is a sad reflection both on the plans and especially when primary care need the funding right now.
Primary care contracts
One element of the PCN contract is the capacity access and improvement payment. Unsurprisingly (clue is in the name) this is largely about improving patients experience and access, with payments linked to improved appointment recording. As part of our Digital Managed Service, our team have been supporting PCNs to deliver this guidance, contract changes and ‘new models of care’, so my super colleague Dillon Sykes and I thought this might be a topic for discussion at our session at Best Practice, London on 28 & 29th February. We’ll explore some of the headlines, overlaps and gaps, ponder a little around the various checklists and criteria to be met, then hopefully share some practical steps to help.
We are seeing lots of angst that the General Practice Appointment Data (GPAD) dashboard still seems to contain inaccuracies and a lack of clarity over what is counted, and how to make historic changes etc that will impact on payments. New to the ‘additional roles’ stables are the Digital &Transformation Leads and alongside PCN Managers, both are still trying to understand appointment mapping guidance released in 2021. Clinical system providers have released workarounds in the last couple of months as temporary fixes. Frustrations are appearing between General Practice and PCNs as the data is held and configured at practice level, but the impact is felt in the PCN.
It’s great to hear that some ICBs are supporting well, providing datasets throughout the year to keep an eye on progress. We are sincerely hoping that ICBs take a pragmatic approach to releasing the final 30% payment, whilst the data is still ‘more than a bit flaky’ (technical term).
To help with GPAD, our team ran webinars and held 1-1 sessions with practices or new D&T Leads to go through their configuration and data. We produced a simple GPAD tool to help navigate the guidance and we’ve also asked passed on quite a few questions to people in NHSD/E to gain clarity.
Procurement of new digital solutions
This last year’s quarter is also a little bit different though, for many suppliers of services and products to the NHS. It’s not unusual for slippage in the NHS, but some of the key elements of the Delivery plan for recovering access to primary care that slipped or were reprioritised, will have knock-on consequences for many colleagues in the product and supplier landscape. This will also affect practice teams and inevitably, on patient services.
Many commissioners were getting ready to re-procure their digital tools to support Modern General Practice Model, but the Digital Pathways Framework on the Digital Care Solutions buying catalogue due in Aug 23, then moved to Dec 23, still isn’t released for commissioners to purchase from.
I’m fortunate to occasionally take part in user research and know the NHS team are working hard to make the experience of the buying catalogue better, but this delay has impacted on ICBs, PCNs, Practices, Product suppliers and support organisations like Redmoor. Part of my job is to seek out new partnerships and products that will help to improve General Practice, and I love chatting with new suppliers to find out how their solution will help. There are a few with products that will knock your socks off but are not available to purchase from the existing procurement frameworks. Some PCNs are bravely buying directly, as they can already see the value, but many are nervous or don’t have the finances to buy direct, especially if their local ICB is expected to and will fund (or even part fund), once the new buying catalogue is available.
As a consequence of the delay, it looks like many commissioners have little choice but to extend existing digital solution contracts for another year. This can leave practices with products that they didn’t choose or don’t use and patients don’t like to use, so stick with the conventional methods of access (Telephone). So, in ‘kicking the can down the road’, existing suppliers breathe a sigh of relief and new products don’t get into the market, leaving us all feeling just a little bit frustrated at what might have been for another year. Do we invest time and energy trying to optimise solutions that we know don’t fit the needs of our staff and patients?
Suppliers tell me they have lots of interest from ICBs and PCNs but can’t recruit to scale up delivery until they know the contracts have landed. There will be a rush at the end, and we know deployment and implementation will suffer. These tools are essential to deliver high quality 21st century primary care. Having been through this process with one of our strategic clients last year, we have experience and are well positioned to support suppliers and ICBs with market and practice engagement, early implementation, adoption and spread. So, if you want to plan early, drop us a line and we’ll walk you through how we can help.
Research
In addition to user research for products, I also contribute to research for new services in development and I’m delighted that NHS are developing a guide to improving messaging. This has become such a complex area, since the inclusion of messaging as a requirement for all online consulting tools. The NHS is paying twice for quite a few functionalities and the holy grail for practices was always to have digital solutions in just one platform. There are a couple of suppliers doing this extremely well, and with the increasing desire to reduce SMS costs, data messaging is the way forward for many. One super research project that I’ve had a small involvement as part of their Expert Advisory Group is the Remote by Default project from the teams at University of Oxford and Nuffield Department of Primary Care Health Sciences. They’ve released some great resources following a 2 year study into remote care. We’ll be helping to push these out to patients in over 700 practices via our Social Media managed service, and will build the training competencies into our programmes, so we are confident that our work is grounded in rich research. What is interesting, is the different approaches across the Nations. Scotland have procured one video consulting platform for the whole nation to use, with a contract to 2026. This means they have one set of patient facing resources and one training platform for all practices and users. Very different to our market place approach in England and probably a lot less confusing.
Now – lets’ talk telephones
As another example of what I’ve just described in the procurement section, lets have a look at the requirement for Advanced Cloud Based Telephony. Seen by some as the panacea to ‘the 8am rush’ and made a requirement in the GP Contract by end of 2025. The Better Purchasing Framework was issued, some ICBs took advice and started to plan the ‘at scale approach’, working out whole system requirements, engaging with practices and PCNs to gain advantages of greater purchasing power, optimise local infrastructure and achieve some consistency of service offer – great stuff! Then a letter appeared late Nov, expecting all practices to sign up by 15th Dec 2023 or they would miss out on the funding opportunity. Thankfully, someone realised the well-earned Christmas and New Year holiday was looming and the deadline to select a supplier was moved to 15 January 2024, with a signed contract by 2 February 2024 and go-live by 25 March 2024, with all features in place by April 2024 at the latest. Just another added pressure in the last quarter of the year.
Now there is anxiety over where the costs will land, and we had a flurry of requests to help people make a choice urgently, so they didn’t lose out on funding. We had others that had already moved to cloud telephony before the contract requirement was released, but had chosen suppliers not on the framework, so maybe didn’t have all the features mandated in the new contract. Some practices had been earlier adopters, made the investment then found that there was support to buy out of existing analogue contracts. Or course, anyone that has ever implemented new technology knows you can’t do it in a rush without good planning. Then after deployment comes the real fun – how to make it work for you. We saw this happen during the pandemic with the necessary but rushed roll out of online consultations.
Our team have been delivering workshops, listening to and improving auto attendant messages, optimising call flows, aligning with online service options, all to ensure fair access to services and an improved experience for patients. And then of course we threw in a Digital Journey Planner module around planning and optimising Telephony.
This is just a flavour of our support on offer to help the NHS at all levels in primary care to navigate the noise, help with the priorities, support the providers to deliver, optimising the solutions available. We hope you can come and see us at Best Practice at the end of the month, we’ll be at Stand D45 talking all things primary care improvement.
Book here: https://ow.ly/Tf6050Qz6sE
If you cant make it, drop me a line or get in touch hello@redmoorhealth.co.uk because we love to help and know a bit about your world right now.
What Lisa did next..... 