Mary Toomey, of PracticeManager.ie looks at how medical professionals can improve the efficiency of their practice, improve the level of care provided to patients and staff and generally increase productivity.

1. 8th June 2013

2. PRACTICE MANAGEMENT
Tools, Tips & Techniques
8th June 2013

3. Today’s Talk
Practice Management - Patients First
Risks in General Practices
Measuring Practice Performance
Practical Problems : Debts, Well-Being
8th June 2013

4. Our Responsibility
To enable our team to
provide timely, safe,
effective and respectful
care - and to ensure
this is consistently and
compassionately given
to all our patients.
8th June 2013

5. Stafford Hospital
Francis Report (Feb 2013)
“put corporate self-interest and cost
control ahead of patients and their safety”
- Robert Francis QC
Focus on systems - not outcomes
Focus on data - not people
Lack of listening to patients and families
Lack of risk assessment
Lack of leadership or urgency about decision making
Lack of management and follow up
8th June 2013

6. Patients “First And Foremost”
8th June 2013
 Put the patient’s needs first
 Working to agreed standards
 Working together
 Openness and transparency about matters of concern
 All those who provide care for patients – individuals and
organisations must be properly accountable
 Measure, understand and improve the performance of
individuals, teams and your whole clinic

7. Primum non nocere
“It may seem a strange
principle to enunciate as the
very first requirement in a
hospital that it should do the
sick no harm”
– Florence Nightingale
8th June 2013

8. Top Risks – MPS (UK, 2012)
99.1% Communication
95.7% Confidentiality
95.7% Prescribing
95.7% Record keeping
94.0% Health and safety
87.9% Test results
84.5% Infection control
8th June 2013

9. Communication - Difficulties
Patient / External
• Unrealistic / differing
expectations
• Rigid beliefs
• Personality traits
• Chaotic lifestyles
• Multiple complaints
• Chronic pain
• Addictions
Clinic / Internal
• Previous experiences
• Degree of training
• Personality traits
• Time pressures
• Interruptions
• Limited resources
• Third party pressures
8th June 2013

10. Dealing with Difficult Interactions
Support
• Active listening
• Empathy
• Open approach to
problem solving
• Suggest the patient
and you might find a
mutually acceptable
solution
Tension
• Summarise the
interaction so far
• Acknowledge the real
problem
• State the boundary
• Encourage patient to
come up with solution
options
8th June 2013

11. Confidentiality
Overhearing conversations especially at reception
Viewing patient-identifiable information left out at reception
Patient-identifiable information left out on desks in the
surgery room
Lost or misplaced post-its and pieces of paper
Interruptions during consultations
Unsecure filing cabinets or unrestricted computer records
8th June 2013

12. Prescribing
• Have a robust repeat prescribing protocol
• Make sure every staff member knows the protocol
• Best practice is that only GPs should add medications
to the prescription list
• GPs should review medication lists regularly
• Be especially vigilant about toxic medications
• Ensure patients are uniquely identified to make sure
they are not confused with similarly named others
8th June 2013

13. Record Keeping
• Ensure contemporaneous notes are kept of all contact including
home visits and telephone contact
• Scan all incoming letters / faxes / results
• Use aide-memoirs to follow up test results
• Ensure allergies are accurately recorded on patient files
• Encourage patients to keep their details correct on your files
• MPS recommends keeping files for a minimum 8 years after
last treatment or death for adult and longer for maternity
records, children’s records, or patients with mental disorders
8th June 2013

14. Access to Medical Records
Freedom of Information Act (Amendment) 2003 applies to records held by GPs in
relation to patients who are medical card holders. It does not apply to the
records of private patients. An application for a copy of the records is made to
the head of the public body. In the case of FOI, the request for access must be
made in writing to the head of the public body concerned which in the case of a
GMS medical record is the HSE.
The Data Protection Act, 1988 (Amendment Act, 2003) gives a person a right of
access and right to correct/delete errors. The current fee that a person can be
charged for the provision of a copy of their medical records under the auspices of
the Data Protection Act is €6.35. Such records should be provided within 40 days.
No medical report or copy records should be provided by the doctor to any third
party other than with the consent of the patient or otherwise as required by law or
directed by an Order of the Court.
8th June 2013

15. Health and Safety
• Undertake risk assessments as needed, and prepare or
update your practice’s Health and Safety statement
annually or more often if needed (see www.hsa.ie and
www.besmart.ie for assistance).
• Keep MSDS information, details of all safety checks, drills,
and equipment services with the H&S statement.
• Nominate staff safety representative(s).
• Ensure sharps, chemicals, gases and clinical waste are
safely used, stored and disposed of.
• Check your security – cctv, panic buttons
8th June 2013

16. Measuring Practice Performance
Good information is the best management tool.
You can measure almost any aspect of your
practice.
Measurements need to be accurate and up to date
in order to be most relevant and useful!
8th June 2013

17. Financial Monitoring
Have a proper recording and reporting system for all practice
income and expenditure. Use regular, clear reporting to evaluate
• Income
• Expenditure
• GMS claims
• Cash flow / bank balance
• Drawings
Review year to date & compare with target / last year’s figures

18. Capitation Payments
Practice IT and PCRS patient listings (“Blue Books”) match (Use Importer)
Newborn babies added to panel and deceased patients removed from panel
Private residents in nursing homes (intending to stay periods of greater than
5 weeks) registered and coded correctly (903/906) if over 70 years
Temporary Visitors attending > 3 months
Visitors with medical cards held by GPs elsewhere in your local area
Cards expiring on 16th Birthday

19. STC / SS / Vaccinations
Ensure claims are completed and claimed for:
– Every special service consultation
– Every out of hours consultation
– Every emergency and temporary visitor
– Every NHS / EHIC visitor
– Flu and pneumococcal vaccinations
Submit claims online to PCRS
– Match claims to payments & follow up all queries

20. Practice Support
Actual GMS Panel must be 100 or more to qualify
Payments increase pro rata in bands of 100 to max. panel size 1200 based on
‘weighted panel’
All patients over 70 are given a weighting of 3:1 when calculating practice support
subsidy entitlement
Staff grade (nurse, practice manager, secretary) and relevant years experience are
taken into consideration
Hours worked and employer PRSI may reduce practice support subsidy payments -
top rate employer PRSI (10.75%) does not affect practice support.
In group practices, practice support may be collectively assessed
To apply for practice support, complete form PSN/1 & submit with copies of relevant
documentation to your local primary care office

21. Sick Leave
Sick leave allowance is based on a four year rolling period.
Panels of 100 – 700 : full capitation is paid for the first 6 months
and half capitation for the next 6 months. Locum is paid based on
the GMS doctor’s capitation payment for the month divided by the
number of days in the month (up to maximum €213.12 per day) and
multiplied by the number of days leave taken.
Panels over 700 : as above, but locum payment is at the maximum
€213.12 per day.

22. Annual Leave
# days annual leave depends on the size of your GMS list
Minimum 100 patients = 14 days annual leave
200 patients = 16 days leave
300 patients = 18 days leave
400 patients = 20 days leave
500 patients = 21 days leave
Every subsequent 100 patients = +1 days leave up to 1400
patients = 32 days leave
1500 patients + = 35 days leave

23. Study Leave
• Minimum panel size is 100
• Study leave is calculated in half-day
sessions up to a maximum of 10 days
• Certificates of attendance must accompany
ALF/1 form along with the name and
signature of the locum practitioner

24. Medical Indemnity Refund
Panel must be over 100 to qualify for medical indemnity refund
Refund is based on the size of the GPs panel
Refund is calculated as a percentage of the net premium paid by the
doctor (gross premium less the benefit which the doctor receives as a
tax rebate). Forward medical indemnity certificate showing full time
work to local primary care office
No. Patients on Panel % Net Re-imbursement
100 – 250 10%
251 – 500 25%
501 – 1,000 50%
1,001 – 1,500 75%
1,501 +
and Rural Practice Allowance GPs 95%

25. Once-Off GMS Grants
Nurse start up grant – to purchase equipment for first nurse
employed €3,809
Fridge grant – one per practice €1,270
Computer grant – one per GMS contract up to €2,539
Submit receipts to local primary care office

26. Maternity Fees
First visit & 6 week €41.53
Subsequent visits (incl. special visits) €29.91
Total for first pregnancy €262.52
Total for subsequent pregnancy €292.43
Emergency delivery €249.22
_______________________________________
Make sure all visits are entered on MSC report
Clearly identify any special visits
Check for past EDDs – miscarriages / movers

27. Childhood Vaccinations -
Maximum Fees (per child)
Registration € 37.78
V1, V2, V3 + MMR €125.86
PCV x 3 @ €18.82 € 56.46
Hib Booster € 18.82
Bonus (95% Uptake) € 60.00
Total €298.92
_____________________________________________
Use software reporting to follow up missed / late
vaccines & advise LHO of any patients
leaving your cohort

28. Other State Contracts
Palliative care payments (GMS & Private)
€212.48
Cervical Check €49.10
Social Welfare Certification Contract
€8.25 per certificate and €44.44 for a detailed
report

29. Socrates : Keeping Tabs on Claims
Claim Tracker
• Child Immunizations
• STCs (if printed)
• Forms (cervical check)
Ante Natal Reports
• Check Boxes in
Maternity Protocol
8th June 2013

30. Tips for Getting Paid On Time
Fee schedule and payment policy should be clearly displayed in
the surgery & on website
Be consistent - minimise ‘discretionary reductions’
Use practice software to generate invoices, receipts, debtors lists
and account statements
Follow up any “left without payment” accounts with a phone call,
ideally within 48 hours
Consider pay-on-arrival as an option if bad debts are a significant
problem for your practice
Don’t let debts spiral. Take a constructive approach support (e.g.
help to apply for a medical card, direction toward MABS services)
to patients in difficulty.

31. Debt Collection by Phone
• Pre-call preparation: have the facts to
hand.
• Open strongly: be clear about why you
are calling.
• Work through objections and agree a
commitment.
• End the call with a clear agreement.
• Follow up : check the agreement is
kept, or if not, react quickly with
another call.
8th June 2013

32. Problems with Staff Performance?
Address it directly, objectively, honestly
Meet the employee to discuss it
• Agree that the problem exists
• Identify cause(s) of the issue
• Agree a proposal to solve the problem
• Agree how you will review performance and what will
happen if the problem is not resolved
8th June 2013

33. Personal Well Being
Staying Safe - Crisis
• Avoid escalating anger
• It is safer to leave the room
than insist somebody else
leaves
• Call for help
• Take time out
• Debrief afterward with a
trusted confidante
Daily Grind Stressors
• Separate your emotions from
patients’
• Recognise your own emotional
responses
• Set realistic expectations of
yourself
• Share the load
• Develop and use support systems
8th June 2013

34. Thank You
Queries?
info@practicemanager.ie
087 178 4557 / 01 202 1070
8th June 2013