Neil Turton, Chief Executive of SHM, describes the information systems underpinning its public health activity as ‘high quality’. The public health department of the local council has helped SHM identify pockets of deprivation and high need. SHM has then profiled the population in those areas and designed services to meet the needs of those people, from social prescribing to health awareness campaigns.
An evaluation of the social prescribing service has demonstrated positive outcomes for 260 people seen: 76% increased well‐being, with a reduction in depression; 64% reduced their prescriptions and 55% reduced their use of GPs; 30% decreased or quit smoking and 20%
decreased alcohol consumption; 31 people entered into voluntary work and 64 people into training courses.
The organisation has also seen significant improvements in quality metrics, with an increase in Quality and Outcomes Framework (QOF) scores from 53% to 93% over 18 months.
Improvements in access to primary care are also reported, with increased appointments, appointment times, and extended opening hours. Patient satisfaction scores have also increased.
Key advice
‘When it comes to public health, the skill mix of staff needed to deliver the model of care needs a lot of thinking through’, reflects Mr Turton.
He also advises GPs wishing to develop public heath activity on a federated basis ‘to be really honest about what you believe a GP practice should be all about. You need to explore alignment in terms of values, culture and practice’.
PUBLIC HEALTH – CASE STUDY 2
PATHFINDER HEALTHCARE DEVELOPMENTS, Smethwick
Pathfinder Healthcare Developments has worked with local community groups to respond to those in greatest need. They are planning a healthy living centre as a focus for their public health activity.
Key characteristics
A provider organisation that grew out of a ten‐year partnership between two inner city partnerships in Smethwick, West Midlands. One of the two GP partnerships, Smethwick Medical Centre, now owns Pathfinder Healthcare Developments (PHD).
Set up in 2008, as a Community Interest Company (CIC), it is a social enterprise organisation – ‘this means we reinvest our profits and assets for the public good’.
Covers a population of 12,000; one of the most deprived areas outside London, with a high minority ethnic population.
PHD is comprised of three practices. It is led by three GP directors, a nursing director, business director and a non‐executive director. They are supported by a business manager and a financial manager, as well as staff running specific projects (such as its asylum seeker and refugee service).
For more details see www.path‐finderhd.com Learning – public health
PHD has been influenced by national and international research evidence showing that the most effective way to combat poverty and poor health outcomes is to combine services and activity ‘and offer a quality of life solution’. It therefore decided to develop Smethwick Wellbeing Centre, a health and wellbeing centre to serve the needs of Smethwick
community. ‘We’ve been working in this community for so long but health inequalities are increasing’, says Dr Niti Pall about PHD’s motivations to embark on a project of this scale.
The Centre is designed to build on learning from investment in Healthy Living Centres, initiated by the Department of Health in 2007. It is PHD’s intention that the Centre will be a sustainable, landmark building, made using innovative sustainable materials so that it creates a carbon neutral footprint. ‘It will be a thriving, healthy environment serving the needs of the local community’.
PHD is working with two partners to establish the Centre: Sandwell Asian Family Support Services, and the Director of the Public Health Institute in Sandwell. A social enterprise bid raised £500,000 to cover the project management costs. The cost of the total project is estimated to be in the region of £15 million. PHD is seeking funding from the NHS, local authorities, charities, retailers and commercial banks. The aim is to have the Centre up and running within three years.
Dr Pall maintains that the Centre will be a success if it is used, if general practice is put at the heart of it, and if the community feels a sense of ownership.
Key advice
‘Be brave, don’t get scared by the numbers’, is Dr Pall’s advice to GPs considering embarking on an initiative like this. ‘There will be people in your area who can be partners. You have to go and find them’.
10. SHARING BACK OFFICE FUNCTIONS
INTRODUCTION
In this section we look at the opportunities for Federations to share back office functions. Despite the opportunities for practices to make savings through sharing functions this was an area where we struggled to identify many case studies.
In vision and overview we lay out the main opportunities to share back office functions and the key learning from the case studies. In resources we provide a link to the LMC Buying Groups Federation which helps GPs negotiate discounts on goods and services.
VISION & OVERVIEW
Sharing back office functions across a number of practices provides opportunities to improve the quality of support available to practices and save money. As the administrative burden within practices grows there is increasing value in a central business function serving a number of practices.
Bulk purchasing, shared staffing and other overhead costs also provide opportunities for practices to make savings without compromising patient care.
The vision in practice
Our two case studies offer two different approaches to sharing back office functions.
Badger has created distinct organisations to provide shared services, for example, one that provides an estates management function.
Salford Health Matters has set up a central business unit to provide support for human resources, information technology, finance, contracts and performance, and patient involvement.
Case studies advice on sharing back office functions
Don’t forget that people and relationships are central to whether this works or not ‐ invest time in developing a shared culture and trust between practices.
It is important to hold onto a common vision of what the practices are trying to achieve.
Agreements should also be formalised and written down. Legal advice can be useful here.