EMS Plus : Is your Practice in Crisis now - what you need to do?
The following guide has been put together CLICK HERE please use this if you need to
Managing your Situation
Knowing your Triggers helps to identify the types of crisis that a Practice can experience. Next stage is knowing what your options are should you experience one of these triggers. How would you "manage your situation" if one of those triggers materialises.
This section explores the "Options" that are available to you should your Practice face that crisis.
This section also explores if your Practice is in an Immediate Crisis and what you need to think about? EMS Plus
Workforce is of course our main asset in the NHS. We need to recruit and retain staff.
Workforce Options
Recruitment:
a) Hire for potential, not experience if you can avoid it. Sometimes its necessary as you need someone to hit the ground running.
b) Recruiting from your local community can be hugely beneficial in tackling supply issues.
c) Use many and varied recruitment media such as
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NHS Jobs
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Social Media (Facebook, Instagram, Twitter, Threads, Linked in)
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Practice Website
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ICB
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Deanery
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Newspapers / journals e.g. HSJ
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Open Days / Events
NHS Employers is an excellent site for both inspiration and information www.nhsemployers.org/inspire-attract-and-recruit
Retention:
a) Ask your employees what makes them happy (staff survey)
b) Ensure each role desciption providers variety where you can (mixed portfolio of work)
c) Develop your Staff - make training available
d) Tell staff when they are doing a good job - staf morale is so important to foster good working relationships.
e) Allow staff to speak their minds and contribute to the future development of your Practice and PCN
f) Communicate well and lead a positive organisation
Principles of Practice Mergers
Mergers traditionally involve two or more neighbouring practices confronted with similar limitations: for example the desire for larger, better equipped premises or the opportunity to increase their patient list sizes and practice income. The benefit of sharing staff can also be a significant factor.
These potential benefits continue to be relevant but practices are now also considering how a merger might put them in a stronger position to exploit opportunities or respond to the potential challenges.
A partnership agreement between the partners of the practices will usually be sufficient for a merger to take place, but this may eventually be replaced by another structure, e.g. a company limited by guarantee or a company limited by shares
What are the Considerations
- Premises (lease/owned)
- Impact on Staff
- Will additional benefits be realised through this?
- How does this fit with PCN strategy / practice strategy?
- Are there any financial impacts of merging?
- Will there be any efficiency savings?
- Full merger means no return to previous situation (i.e. contracts close permanently)
- Protects contracts in perpetuity.
Who to Contact
Practice Mergers can be complex and therefore if you are considering this please seek further information either from your Primary Care Leads by initially contacting the Primary Care Inbox at lscicb-bl.healthierlsc.scnlbprimary@nhs.net . Any Practice Merger must be agreed by NHS England and ICB.
Alternatively please contact the Delivery Assurance Team on england.lancsat-medical@nhs.net
For Further Information
Please see a link to Primary Care Support England on Practice Mergers Practice Mergers & Closures - Primary Care Support England
We have also attached the link to a reference document published by NHS England South West guide-mergers-gp.pdf (england.nhs.uk) and by the BMA Guidance: Practice Mergers (bmalaw.co.uk)
Principles of a Novation
When one contract holder is substituted wholesale for another, this is known as a ‘novation’ and technically involves the termination of the existing contract and award of a new contract. Usually this involes incorporation.
Contract Novation could happen for a number of reasons e.g. Improved Quality Provision or Financial.
A novation should be undertaken through a novation agreement, which involves an agreement to terminate and to sign up to a replacement contract. This agreement can make clear the terms of the contract, which usually means the partners will want it to be substantially the same. However, the partners may be asked to guarantee the obligations of the company for a period of time.
NHS England / Commissioners will need to approve this and will want to satisfy themselves of their procurement obligations in such a situation and whether any exemptions apply.
NHS England guidance under the Practice General Medical Policy & Guidance Manual Appendix 17 : Novation Agreement pgm-annex-17-template-novation-agreement.docx (live.com)
Who to Contact
Novations can be complex and therefore if you are considering this please seek further information from your Primary Care Leads by initially contacting the Primary Care Inbox at lscicb-bl.healthierlsc.scnlbprimary@nhs.net .
Alternatively please contact the Delivery Assurance Team on england.lancsat-medical@nhs.net
There are a number of options that can be explored to bring an additional partner onto the contract bringing stability to current situation (e.g GP Federation, Trust Partners etc).
There are also options to consider when integrating with other partners around shared working e.g. back office functions, shared HR, shared or joint contracts, lead arrangements etc).
Formal List Closure
Under GMS and PMS contract regulations a Practice is able to request permission from its commissioner to close its list to new patients (Paragraph 33 of Schedule 3, Part 2 of the NHS (GMS Contracts) Regulations 2015.
This option exists to give practices a degree of workload control over the management of their services, particularly when there is unusual and sustained demand from patients or in situations of workforce or recruitment difficulties that affect a practices ability to provide services to an acceptable and safe standard.
Commissioners will agree what length of the closure is applicable and the conditions that would need to exist to trigger a re-opening of the list. This is usually between 3 - 12 months; not less than three months. An approved closure notice must specify the time period.
Before applying for formal closure, the following should be taken into account.
- Is there an opportunity to negotiate with the ICB for staffing support with other services?
- There will be a responsibility on both the practice and the ICB to ensure that all options other than closure have been considered.
- Document what options you have considered in trying to address the problems and any outcomes, e.g. rejected or implemented, and why.
- Discuss your individual practice problems at the earliest opportunity with your LMC which will provide you with support in line with the rules and regulations.
- Consider possible impact on neighbouring practices and meet with them with LMC representation to discuss the problems that the practice is facing.
- Could your PCN and neighbouring practices help in some way? Document the outcome of the discussions for future use.
- Request a meeting with the ICB and let them know you will be with an LMC representative.
- Discuss with your patient participation group to explain how and why you have come to this decision and to listen to any suggestions they may have to ease the pressures.
Temporary or Informal List Closure
While the GMS and PMS contracts does not allow for a ‘temporary’ or ‘informal’ list closure they do allow for a practice to refuse individual patient applications providing there are reasonable non-discriminatory grounds to do so (paragraph 21 of Part 2 of Schedule 3). See appendix A.
Practices are advised to contact their Primary Care Leads in the ICB in the first instance and discuss the options with them
Who to Contact
Please seek further information from your Primary Care Leads by initially contacting the Primary Care Inbox at lscicb-bl.healthierlsc.scnlbprimary@nhs.net .
Alternatively please contact the Delivery Assurance Team on england.lancsat-medical@nhs.net
Is Capacity and Space an issue?
Has the Practice considered relocating to larger / smaller premises?
Principes of Practice Boundary Changes
A GP Practice will consider a change to their main practice boundary to either expand or contract the practice area for new registrations due to new redevelopment, local authority compulsory purchase schemes and/or road developments for example.
Most practices will also have within their contracts a defined outer boundary to allow those patients, who move home a relatively short distance outside of the main boundary and who would prefer to stay with their existing practice with whom they may have a well-established relationship, to remain registered
Changes will be managed under a Contract Variation
Process
The Practice must notify the Commissioner of its intent to change its boundary area in writing setting out the reasons for the change and full details of the proposed practice area, with any supporting evidence. There is a template application notice to complete.
For further details see Guidance Practice Mergers & Closures - Primary Care Support England
Who to Contact
Please seek further information from your Primary Care Leads by initially contacting the Primary Care Inbox at lscicb-bl.healthierlsc.scnlbprimary@nhs.net .
Alternatively please contact the Delivery Assurance Team on england.lancsat-medical@nhs.net
Practice Split
Where on the GMS contract there is a partnership and the partnership dissolves due to an internal partnership dispute, the contract will terminate unless the parties agree for the contract to continue with one partner .
The Commissioner may have little time to make arrangements to ensure service continuity.
Ideally it is of course desirable that the GP partners are able to resolve disputes internally where possible, with the support of the LMC and/or mediation services.
However if this is not possible and the breakdown is interminable, then the GP Partners will need to terminate on notice, which must not be less than six months unless agreed by the Commissioner. Failure to give six months’ notice of termination would be a breach of contract otherwise.
It is advisable therefore that when setting up a partnership that a Partnership Agreement is written and in place which can open correct any disputes between the partners.
The Commissioner would not get involved in endeavouring to resolve the dispute between GP Partners, but should be notified of their final decision when it is reached. GP Partners are advised to liaise with the LMC for such matters.
Who to Contact
GP Partners are advised to contact their Local Medical Committee ..............