Business Plan

Work-based assignment Business Plan
Farhana Imran 1
Title page
Submission for the Level 5
Diploma in Primary Care Management
City and Guilds/AMSPAR
‘Business Plan’
(Unit 505)
Programme presented by:
Cherith Simmons Learning and Development
In collaboration with
 I certify this assignment is my own work.
 I certify this assignment has not been previously submitted for assessment on this
course.
 I certify that where material has been used from other sources, it has been properly
acknowledged.
 I understand that any work submitted may be destroyed after assessment.
 I permit Cherith Simmons Learning and Development to copy and use my work for
academic purposes.
 I agree to complete combined ‘optional’ assignments and mandatory assignments.
Note: we are required to have your agreement to combine ‘mandatory’ and ‘optional’
assessments elements. This means fewer separate pieces of work for you to
complete.
Business Plan title:
Improving the Financial Position of the Practice by 20%
Centre Number: 065729 Cherith Simmons Learning and Development
Participant name: Farhana Imran
Registration number: VXV5320
Sponsor/programme location: Distance Learning
Submitted on (date): 2nd July 2012
Number of words: 5151
.

Work based-assignment Business Plan
Farhana Imran 2
Acknowledgements
I would like to thank Dr Ashraff at Healthway Medical Centre for giving me the
first glimpse of working in a primary care setting where I found my niche.
I am thankful to Dr Misbah Ul Haque for introducing me to the diploma in
primary care and inspiring me to put all my energies and focus in this area.
I am indebted to Drs Hamilton-Smith, Oladimeji and Imran for giving me the
opportunity to hold a key position of business manager at their practice and
thus providing me with access to all aspects of primary care work in a GP
setting. Without their permission, I would not have been able to produce this
business plan.
I am in awe of the Patient Participation Group (PPG) where I was nominated
as secretary. I found the team nothing short of amazing, they always come up
with excellent ideas and have so much enthusiasm. I have learnt that ordinary
people who have extraordinary vision can get their ideas implemented in
practices all over the UK.
I have so much admiration for the web team (webadmin@opg.co.uk, Tanya
Ranby) who helped me to improve the practice website. Their professionalism,
openness to ideas, suggestions and friendly approach has shown me how well
a team can work if they share common goals.
I would like to thank the Outer North East London (ONEL) team for answering
my many queries regarding the many different aspect of primary care work,
with special thanks to the Finance Department (Brigid Mallee, Mark Lockwood
and Lorna Hutchinson), Relationship Managers(Peter Clark, Bob Barr) and
Prescribing Team (Vicki Kong).
Finally I would like to thank my family, Asif, Saif, Zaira and Faiza. I need to
look no further than my own doorstep to find my heros.

Farhana Imran 3
Contents page
Business Case............................................................................................................................ 5
Executive Summary.................................................................................................................11
Organisational and Personal Background........................................................................12
Part 1 - The need for innovation...........................................................................................14
1.1 The importance of innovation .....................................................................................14
1.2 The importance of managing change........................................................................16
1.3 The present situation....................................................................................................17
1.4 The problem driving the change.................................................................................18
1.4.1 Financial implications of problem ...................................................................18
1.4.2 Legal framework for problem ..........................................................................18
1.4.3 Human Resource issues surrounding problem ............................................18
Part 2 - Innovative solutions for improvement.................................................................19
2.1 How the investigation was conducted .......................................................................19
2.2 Results............................................................................................................................22
2.3 Analysis and Conclusions ...........................................................................................24
2.4 Possibilities....................................................................................................................30
Part 3 - Leading Change.........................................................................................................32
3.1 Proposal and Recommendations ..............................................................................32
3.2 Managing change.........................................................................................................34
3.3 Quality assurance.........................................................................................................36
Part 4 - Appendices ................................................................................................................37
Appendix 1 Organisation Chart .......................................................................................38
Appendix 2a Invoice for chlamydia screening February 2012 ...................................39
Appendix 2b Chlamydia screening process for April 11 – March 12 .........................40
Appendix 3a Extended hours fax to recover money for work done from Apr
2011 – Mar 2012 .................................................................................................................41
Appendix 3b Extended hours payments for Apr 2011 – Mar 2012 ............................42
Appendix 4 General Practitioners Report Process .......................................................43
Appendix 5 Health check procedure ...............................................................................44
Appendix 6 Locum cover invoice.....................................................................................45
Appendix 7 Analysis of staff overtime from 2008 to 2011 ...........................................46
Appendix 8a Top 20 prescribing drugs for Apr 2011 – Mar 2012 ..............................47
Appendix 8b Prescribing meeting....................................................................................48
Appendix 9a Role of Business Manager........................................................................50
Appendix 9b Role of Administrative Manager...............................................................52
Appendix 9c Role of Information & IT Manager ............................................................56
Appendix 9d Role of Medical Secretary .........................................................................58
Appendix 9e Role of Senior Receptionist.......................................................................60
Appendix 10 SPECTRE analysis of issues affecting the practice..............................62
Appendix 11 GMS practice summary statement for Apr 2011–Mar 2012 ................67
Appendix 12 Outline Project Plan....................................................................................71
Appendix 13 Gantt Chart ..................................................................................................79

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Part 5 - Bibliography ...............................................................................................................81

Farhana Imran 5
Business Case
Improving the financial position of the practice by 20%
Background:
The vision statement of Chadwell Heath Health Centre states ‘We aim to
combine the best of traditional family practice with being modern and up to
date with advances in health care. This is reflected in our high performance in
clinical quality and patient satisfaction performance indicators. But it is not just
about performance indicators – what really matters to us is the satisfaction we
get from doing a good job, building our relationships with patients and feeling
that we are helping people both to stay healthy and to cope better with any
illnesses or health problems they have.’
In theory with a list size of 6,240 patients, 3 full time doctors, two Nurse
Practitioners and a full complement of support staff, the practice should easily
be able to help the patients cope better with illnesses. In order to meet this
mission, the doctors and nurses prescribe the medicine which best suits the
patient to overcome their illness. The patients are therefore satisfied with this
service. The Practice has however been told by the Primary Care Trust (PCT)
they are the second worst prescriber in the area and, from the PCT’s point of
view, currently prescribing too many high cost drugs. There is an urgent need
to look at the alternatives.
Staffing has also recently become an issue. There has been an increase in
the number of days staff are taking off sick. The medical secretary has been
signed off for six weeks and the senior nurse has taken 30 days leave in the
last 4 months. This is an obvious and growing cost to the Practice.
The Practice Manager has handed in her notice and due, to financial
constraints, the practice has decided not to replace her. The current roles and
responsibilities of practice staff therefore will need restructuring to spread the
current Practice Manager’s duties amongst the remaining staff. Although this
will bring new opportunities to staff and may help improve their motivation
levels it will also affect the cost to the Practice as some staff may be promoted
whilst others may increase their hours.
Every month the Practice has to use its overdraft facilities which costs the
Practice money. Improved book keeping techniques and revised accounting
methods need to be explored.
A good earner for the Practice is the NHS Health Check which has not been
carried out during the lead nurse’s absence. This directive states that for all
patients aged between 40 to 74 who are not on the register, a health check

Farhana Imran 6
must be done every 5 years. Each health check brings in £21.10 to the
Practice.
The partners spend a considerable time and effort filling in medical forms for
insurance companies, department of health and social security and taxi
companies which should generate income for them. At the moment the money
is either very slow in coming in or not coming in at all. Currently no one knows
where the problem occurs in the process or how to resolve it.
Another area of concern is the extended hours Directed Enhanced Service
(DES) which the Practice has signed up for. The Practice has been approved
to provide three sessions every week, three weekday sessions, with an
average of twenty-seven appointments over each cycle. Each session brings
in £225. At the moment only doctors are providing this service however nurses
can also be involved. The directive states that 25% of the patients can be
seen by nurses. There is also issues around protected time initiatives (PTI)
and bank holidays as full usage of this DES is not happening at this Practice at
the moment. The Practice is not offering this service on alternative days when
there is PTI or bank holidays and is therefore losing money.
The business side has in the past been neglected by this Practice. Fortunately
this is being reviewed by a free external consultant who is studying for her
Primary Care Diploma. This was a four month contract which started in
October 2011 and finishes at the end of January 2012. The Primary Care
student is happy to stay on at the Practice but wants a salary which will have
obvious financial implications for the Practice.
The Practice has signed up for the Patient Representative Group Directed
Enhanced Service which will bring in £1.10 for every patient who is a member
of this group. The directive states that the Practice must show the methods
used to get patients on this register, produce two surveys each year and
publish the result of these surveys on the Practice website in order to claim the
money. The previous survey showed a 95% lack of response from the
patients. There is a Practice website which needs to be further developed to
incorporate this DES.
Aim:
This report will investigate the current issues concerning finances at the
Chadwell Heath Health Centre. It will research ways to improve, implement
and structure the finances of the Practice and introduce accountability and
independent checking techniques at every level.

Farhana Imran 7
The report will also research the sickness issues and staff re-organisation and
take account of any legal implications.
Recommendations will be made which will benefit patients, Partners and staff
and reduce costs without adversely affecting the provision of clinical care.
Objectives:
1. To research and investigate the following:
To investigate the current financial issues and research alternatives by:
a) Carrying out interviews with the following groups:
 Clinicians
o To identify all the DESs the Practice is contracted for
o To identify all the Local Enhanced Services (LES)
o To identify and assess priorities for improvement by
brainstorming
 Reception and Administrative Staff to identify
o How the petty cash register is set up
o Training opportunities and methods
o Reasons for time off for sickness
o Their roles, what they are doing, what they would like
to do
b) Reviewing the current processes for:
 The extended hours rota system by auditing last financial
years claims made by the practice
 Claiming overtime by analysing overtime paid to staff from
2008 to 2011 to determine the trend
 Chalmydia claims by liaising with the practice nurse to
determine the number of claims made in the last financial
year
 Travel clinic by liaising with the practice nurse and analysing
the figures to determine how much money came in through
this medium in the last financial year
c) Carrying out

Farhana Imran 8
 A SWOT analysis of the major sources of income and items
of expenditure with the doctors, nurses and staff of the
Practice
 A SPECTRE analysis with regards to future practice growth
and challenges with the management team
 Prescribing audit to see how many prescribed drugs are high
cost and what are the alternatives
 Analysis of health checks done on patients aged 40 – 74 who
are not on the register
 An audit of the medical forms processing system
 The patient participation DES which must be published and
on the practice website by 31st March 2012
d) Calculating
 Costs of current systems
 Costs of alternative proposals
 Costs of staff sickness
 Costs of overtime
e) Researching legal aspects to ensure that:
 Processes are compliant with the NHS contract
 Proposed changes to staff roles and responsibilities are
reflected in their contracts
 Risk assessments are carried out where necessary and any
actions implemented
 All aspects of Clinical Governance are considered
2. To analyse and evaluate:
To analyse information from the research and investigation processes and
present relevant statistical data in graphs and charts as appropriate for ease of
understanding.
To agree with the partners the criteria to be used for evaluating any
improvements.
To consider a range of alternative systems for improving the financial position
of the Practice taking into account the agreed criteria to include:
 Effectiveness in solving the problems

Farhana Imran 9
 Clinical governance and risk
 Ease of implementation
 Acceptability to Partners, staff and patients
 Human resource implications
 Training needs
 Costs
3. To conclude and draw up recommendations:
To draw conclusions from the evidence compiled during the research, analysis
and evaluation processes and make recommendations which:
 Reflect the views of all stakeholders
 Are supported by a full cost benefit analysis
 Identify proposed changes to processes and roles if appropriate
 Gives the opportunity for staff to be involved in the decision making
process
 Uses tried and tested change management and marketing tools
4. To plan to implement the recommendations by:
 Producing a written report for the Partners’ consideration to be
circulated in advance of a formal meeting
 Discussing the report at a scheduled Partners’ Business Meeting by
preparing a PowerPoint presentation of the key points in the report
 Obtaining an agreement to proceed
 Drawing up a plan to implement, monitor, review and evaluate any
changes
 Communicating with key stakeholders through a series of meetings and
presentations
 Drawing up a risk assessment to identify major issues in the
construction and implementation of the plan

Farhana Imran 10

Farhana Imran 11
Executive Summary
Present Position
In the last 15 years the NHS has been through major reorganisation changes
in the way it provides services. With the country going through serious
financial crisis, the NHS has had to impose severe austerity measures. This
has led to the NHS having to save 20 billion pounds by 2015.
In primary care, this has meant that GP surgeries have to provide more
services with either the same budget or reduced budget.
Problems
There are many services which the practice has provided for which it has not
received the income.
There are DESs and LESs which the practice has signed for which it has not
completed.
The skill mix of staff is the greatest challenge for the practice. Several support
staff and at least one doctor are obstructing progress.
Procedures and processes need to be updated which the practice needs to
address.
Proof
All processes which have a financial bearing has to be reviewed to ensure the
practice is optimising its income without compromising its duty of care to the
patients.
Possibilities
The practice can choose to maintain the status quo and continue as before,
implement part of the proposal such as the roles of staff but not do any
analysis or fully implement the proposals which involves analysis, audits and
revised roles.
Proposals
The proposals will generate an income of £82,606.32 which is detailed in the
cost benefit analysis(section 3.1).
Plan
By applying Kaizen five S’s, the practice will be well placed to share their work
ethics with other practices and help to move primary care forward. The
partners will see financial rewards, a more productive staff and most
importantly a higher quality of patient care.

Farhana Imran 12
Organisational and personal background
We are a small, friendly Practice and the doctors, nurses and staff are
dedicated to providing high standards of health care, offering personal care
and attention to our patients, with a comprehensive range of facilities.
The Practice has a list size of 6,200 with 3 partners, 2 nurses, 1 part-time
business manager, 1 administrative manager and 12 support staff (Appendix
1).
The purpose of the practice is to provide a full range of high quality primary
healthcare services to the patients through the GPs and nursing staff, and to
facilitate access to appropriate secondary care when required.
The Practice offers several clinics such as counselling and well woman.
We provide services in one of the most diverse communities in London.
Our practice area lies between A12/Eastern Avenue, Romford Greyhound
Track, Barley Lane (Chadwell Heath side) and Green Lane, Whalebone Lane
End. Patients can be registered in surrounding areas by arrangement after
discussion with the doctor.
My role
I support the doctors in the delivery of high quality primary care by analyzing all
systems and processes which impact the finances of the practice (Appendix
9a).
Financial Management
To provide all financial papers to the accountant in good time for the
preparation of practice accounts.
Attend all internal financial meetings and any other meetings which
the partners feel would be appropriate.
Attend external meetings which may affect the finances of the
practice.
Maintain an efficient filing system.

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Personnel Management
Arrange training opportunities for staff as appropriate.
Fill in a daily to do list outlining own duties for the day.
To ensure confidentiality at all times.
My responsibilities for quality
‘’An empowering point of view occurs when I accept responsibility for my
thoughts, feelings, actions and the overall tone and outcome of the situation.
When I take an accountable position, I focus on actions and feelings that will
bring about success in my projects and my relationships.’’
Quality is very important to us. We have a Practice Co-Ordinator and an
Information Officer who work closely with the Havering Primary Care Trust
(PCT) and the practice clinicians. They are responsible for monitoring statistics
to help us assess the quality of our services. We always strive to attain the
best.

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Part 1 – The need for innovation (1355 words)
1.1 The importance of innovation
In the last 15 years, since the last labour government was in power, the NHS
has been through reorganisation and changes in the way it provides services.
Although there has been lots of investment put in the NHS, with the country
going through serious financial crisis, many austerity measures have also been
imposed. This has led to the NHS having to save 20 billion pounds by 2015.
The NHS brought out a white paper in 2010 and they passed the NHS bill in
2012 for a major change in the way NHS works, with the core of NHS funding
going through primary care and GPs.
Multiple layers of management have been abolished to decrease the spend on
administration.
Every GP surgery now has to be part of the new clinical commissioning group
(CCG) where every practice will be accountable for the money it spends on its
patients.
It is important for the organisation to innovate as GP practices have to provide
more services at lower cost, this puts financial burden on GP practices.
Listed below are some examples of this financial burden:
Rise in unemployment level leads to an increasing need of Primary Care due
to depression, stress, poor nutrition, lack of exercise.
Aging Population has led to more home visits and more use of additional
services such as district nurses.
High levels of obesity has led to more cases of diabetes management within
primary care.
High levels of alcohol abuse has led to more counselling needs within a
Primary care setting.
Increase in mental problems has led to more counselling needs within a
Diverse population means there is a need to have translators and Practice
booklets in different languages in a Primary care setting.
Primary Care plays an important role in Primary Prevention. Decrease the
burden of chronic illness by doing all the things for primary prevention
opportunistically and in a target way.
The government faces a considerable challenge to convince doctors that the
reforms proposed in the White Paper will improve patient care.

Farhana Imran 15
Clinicians are also concerned that the reforms risk distracting the NHS from
making the necessary efficiency savings.
As GPs get financial control, this has the potential to lead to chaos as GPs are
not businessmen, their primary role is to provide the best clinical care for their
patients.

Farhana Imran 16
1.2 The importance of managing change
The Practice needs to take a pro-active approach to manage change. One of
the ways this can be done is through the PPG. This group, if given time and
respect by the Practice, can be a powerful resource for the Practice in the
improvement of patient care. This group can also raise money for the practice
through its fund raising activities.
Another aspect of change which needs to be addressed quite urgently is the
role and responsibilities of staff. As the practice manager has left and it has
been decided that she will not be replaced, her duties which have evolved
considerably in the last financial year, must be filled completely by existing
staff. To do this successfully the practice has to consult their staff on how
best to achieve this goal. The practice manager has to be financially literate to
survive in the current climate, if the Practice does not look at this aspect, this
may lead to gross inefficiency and the practice will not be able to cope with the
many changes which are presently taking place in the NHS.
If the Practice does not budget this may lead to overspend.
If the Practice overlooks some of the enhanced services it signed up for, this
will lead to loss of potential income for the Practice.

Farhana Imran 17
1.3 The present situation
The Practices vision is to provide the best healthcare to its patients. In order to
meet this mission, the doctors and nurses prescribe the medicines which best
suit the patients but the Practice has been told to cut back on the high cost
drugs as it is too expensive. This has led to a gross overspend in the financial
year 2011/2012. The prescribing team at ONEL has been very proactive in
helping the practice to keep the cost down. The doctors and the ONEL team
hold regular meetings to address this issue.
There are three underlying staff issues which were inherited when the
partnership was formed in 2006. The first is the skill mix of the staff, the
second is the sickness issue and finally the overtime issue.
The skill mix is the greatest challenge for the practice to address. Several
support staff and at least one doctor are obstructing progress. Restructuring
has become apparent as the Practice Manager has left and cannot be
replaced due to financial constraints. This means the roles and responsibilities
of the current staff needs to be looked at and revised to ensure all work is
covered. The Practice needs to consider if it can afford a business manager.
There is a grave concern that if this practice does not bring in the right staff to
address this issue it will not meet its contractual obligation.
The second issue arises as a direct result of the first. Once the roles of staff
have been agreed and established, sickness may become negligible. There
are no data of prior years sickness records which means this area cannot be
analysed for trends.
The income streams have never been analysed such as the directed enhanced
services (extended hours, PPG, health checks etc) and the General
Practitioners Records (GPRs). There does not appear to be procedures or
structures around these processes.
There is a practice website but it seems to have been neglected as has the
PPG. Fortunately both of these have now been addressed but the challenge
for the practice is to make sure they build on the foundations and go with the
impetus.

Farhana Imran 18
1.4 The problem driving the change
The practice lacks structure, there are little or no procedures, staff have little
direction. As a result some audits and DESs have never been done. This lack
of initiative will affect patient care.
1.4.1 Financial implications of problem
There are many services which the practice has provided but has not received
the income. Past analysis must be done to ensure the practice gets all the
income it is owed. Some examples of pending payments are:
 Locum cover payment of £12,714 agreed to be paid by the PCT
 The practice has freed up resource of £48,000 confirmed by the PCT
 The practice has done extended hours for which it has not been paid
 The practice has provided medical reports for which it has not been paid
The practice has provided health checks for which it has not been paid
 The practice has provided chalmydia kits for which it has not paid
 The overtime claims year on year has increased which the Practice was
unaware of
 There is disparity year on year on the claims made for extended hours
1.4.2 Legal framework for problem
The Practice needs to consider any legal implications resulting from role
restructuring to ensure any proposed changes to staff roles and responsibilities
are reflected in their contracts. Peninsula will be able to assist the practice in
these matters.
1.4.3 Human Resource issues surrounding problem
The Practice needs to consider how the gap left by the Practice Manager will
be filled, will staff be happy with their new roles, will they expect more pay, can
the practice afford a pro active business manager? Will they be able to take
direction from someone who wants to address the staffing issues facing this
practice? There are many analysis and audits which the practice is not doing
which will impact patient care. Can the existing staff cope with the workload in
an efficient and effective manner is a serious issue facing this practice. This is
an issue which unfortunately is relevant to both support staff and clinical staff.
This report only covers the support staffs work and even then it is restricted to
key support staff. Another report needs to be written to address the issues
facing the clinical staff.

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Part 2 – Innovative solutions for improvement (2989 words)
2.1 How the investigation was conducted
The partners were concerned that at any point in time they did not know what
their income and expenditure streams were. This conversation led to the
investigation of the current financial issues by various means as outlined
below:
Interviews were carried out with the doctors to find out what DESs and LESs
the Practice has signed up to so it will be possible to determine how much
income can be generated from these sources. The Outer North East London
team were also contacted to verify the partners statement.
Interviews were also conducted with the administrative and reception staff.
Questions were asked about how the petty cash register was set up as this
contained monies from the travel clinic. It was important to determine if this
was a viable clinic for the practice so the involvement of the Practice nurse
was also vital during this interview. Liaising with the practice accountants also
became very important at this stage as the staffs answers could be verified by
numbers and figures prepared by the accountants in prior years.
The previous appraisals showed gaps in staffs understanding of their duties
which led to interviews about training needs of staff to improve efficiency,
productivity and morale of all staff, this led directly to the sickness issues
currently affecting the practice.
All current processes which have a financial bearing was reviewed to ensure
the Practice was optimising its income without compromising its duty of care to
the patients. The areas looked at were:
Locum Cover
It was necessary for the practice to use locum for a three month period. The
practice had liaised with ONEL where an agreement had been reached that
ONEL would pay £12,714 to cover this period. Six months later the practice
had not been able to claim the money so an analysis was done to attempt to
retrieve the money. The practice interacted with the locum agency Beacon
Care Services (BCS) whose locum doctors were used during this period.
Extended hours
The finance department at ONEL provided invaluable feedback on the claims
made in the last financial year, the Practice managed to get an agreement
from ONEL that back dated claims from the 2011/2012 financial year would be

Farhana Imran 20
approved. This led to a full analysis from April 2011 to March 2012 to
determine if the Practice had made correct claims.
Overtime
The partners were unaware of both the pay scale of their staff and the
associated overtime. An analysis was conducted to determine staff cost to the
practice. The accountants unaudited financial statements was used to verify
the analysed figures.
Chalmydia claims
The Practice did not have any process in place so meetings were set up with
ONEL to start this process as the Practice had been issuing chalmydia kits but
had not been making the claims.
Travel clinics
The Practice did not know how much profit was being generated by the travel
clinic as there was no process in place. Meetings were arranged with the
Practice nurse and the administrator who was responsible for handling the
money so month on month it would be clear to see if the income exceeded the
expenditure.
Key audits and analysis were carried out to ensure all financial streams were
captured. These were:
A SWOT analysis of the income and expenditure was carried out with the
doctors, nurses and staff to enable the practice to expand on its strength and
improve on its weaknesses.
A SPECTRE analysis with regards to the future practice growth and
challenges was carried out to enable the practice to deal with the many
changes it faces by putting in place all the structures and processes in
advance.
Prescribing audit was carried out with the help of the ONEL prescribing lead.
This was done in several stages with meetings and analysis using EMIS LV.
The Practice has been told to reduce the number of high cost drugs which it is
currently prescribing by looking at cheaper alternatives. ONEL has told the
Practice that it has exceeded the budget and must now be in line with its
spending as this is putting a strain on other practices.
Health check analysis has been carried out on all patients registered with the
Practice who are aged between 40 and 74 but are not on a disease register.
This is a very good way of capturing any underlying conditions which may have
been missed and this has been incentivised by giving the Practice financial
reward for each patient who satisfies the criteria who is seen once every five

Farhana Imran 21
years. A process has been written for the Practice using material provided by
the NHS.
General Practitioners Report (GPRs)
Other ways in which income is generated in a GP Practice are by filling in
different type of forms required by various companies. An analysis of this
processing system has been conducted to ensure the Practice receives
monies for work provided.
Patient Participation DES was prepared and published on the Practice
website. This is part of a two year DES which will bring in an income of £1.10
for each patient registered with the Practice. More importantly, it provides a
valuable resource for the Practice in the improvement of patient care as the
best ideas usually are from the patients on how to improve services and
processes to bring about increased efficiency and productivity.
Practice Website was further developed by looking at what other practices
were doing with their websites, during PPG meetings and suggestions from
one of the doctors.

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2.2 Results (findings)
The table below is divided into 5 columns, the first column gives the name of
the process looked at, column 2,3 & 4 highlight the amount of work carried out.
The figures are either the income or expenditure amount which the practice
has got/will get if it carries out the necessary work. Finally column 6 shows
where the details of the analysis can be found.
Name Not Done
Potential
Income
£
Partially
Done
Fully Done
Income
(Expenditure)
£
Appendix
Alcohol
Related DES
X
Chalmydia
Claims
72.00 2
Extended
Hours
reclaimed
7,200.00 3a
Freed up
resource
48,000.00
GPRs 4,969.22 4
Health Check
reclaimed
2,489.80 5
Learning
Disabilities
DES
715.12
Locum cover
recovered
12,714 6
Osteoporosis
DES
2,003.00
31/07/12
Overtime
analysis
(12,370.00) 7
PP DES claim
for one year
6,864.00 www.upstairs-
surgery.co.uk
Petty Cash X

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Register
Prescribing
Audit
X 8
Roles of staff X 9(a-e)
Sickness
Issues
X
SPECTRE
Analysis
X 10
SWOT
Analysis
X
Training Needs X
Travel Clinics X

Farhana Imran 24
2.3 Analysis and conclusions
Interview with the clinicians revealed:
The practice had signed up for the following DESs and LESs which was
confirmed by ONEL.
A B C D E F G H I J K
1
Practice
Code
Polysyst
em
Practice
Name
Alcohol-
Related
Risk
Reduction
Scheme
Learning
Disabilities
Health
Check
Scheme
Osteoporosis
Diagnosis and
Prevention
Scheme
Patient
Particip
ation
FLU
D
ES
FLU
L
ES
Health
Checks
IUD
2 F82019
North
Romford
Chadwell
Heath Health
Centre (Dr
Hamilton-
Smith) √ √ √ √ √ x √
The Alcohol Related Risk Reduction DES was not looked at by the practice.
The deadline for submission was 28th April 2012.
The Learning Disabilities Health Check Scheme DES has 7 patients on the
register. If this DES had been followed through, then for each patient on the
register the practice would have received £102.16 with a potential income of
£715.12. The deadline for submission was 28th April 2012.
The Osteoporosis Diagnosis and Prevention Scheme DES has 10 patients on
the register. A maximum payment of £200.30 is available per patient this
makes a potential income of £2,003.00. The deadline for submission is 31st
July 2012.
The patient participation DES was completed and published on the website
www.upstairs-surgery.co.uk
There is a payment over a two year period of £1.10 for each patient registered
with the practice. This is worth £6,864.00 to the practice.
The practice has held regular internal meetings to improve the website, other
practices websites have been analysed, and the PPG have also provided
valuable insight. This has led to changes constantly being made to the
website with the practice looking into the benefits of online prescribing and
appointment system.

Farhana Imran 25
There are 1,793 patients who qualify for health checks of which 118 patients
have had a health check but the money has not been claimed.
Date Number of health checks
1st April – 30th April 15
1st July – 30th Sept 2010 43
1st Jan – 31st Mar 2011 21
1st Jan – 31st Mar 2012 39
Each health check brings in £21.10. The 118 health checks which is owed to
the practice is worth £2,489.80.
The total potential earnings from health checks is £37,832.30. A procedure
has been written using NHS guidelines. (Appendix 5)
Interviews with reception and administrative staff revealed:
Lack of ownership with regards to the maintenance of the petty cash register,
no reconciliation of the figures on a regular basis, missing data from the
register.
Lack of both formal and informal training of staff.
Low morale, stress at work, favouritism, dislike or indifference to work were the
main reasons for time off for sickness.
To reduce the above issues a revised set of job description for key staff
members have been written based on current roles and taking account of no
practice manager.(Appendix 9a Business Manager, Appendix 9b
Administrative Manager, Appendix 9c Information & IT Officer, Appendix 9d
Medical Secretary, Appendix 9e Senior Receptionist). Return to work
interviews have also started to attempt to control sickness times.
The practice needs to decide if there is a need for a business manager. The
cost to the practice will be:
12 hours a week at £20 per hour
Annual cost 52 * 12 * £20 = £12,480
The business manager can attempt to train existing staff for roles which the
partners want them to fill as it is very clear that there are skill mix issues in this
practice. This could be a fixed term contract for one year.
The cost to the practice of promoting the receptionist to a senior receptionist
will be:
Receptionist works 14 hours a week at £7.70 per hour.

Farhana Imran 26
Annual cost 52 * 14 * £7.70 = £5,605.60
Senior Receptionist will work 23 hours a week at £8.80 per hour.
Annual cost 52 * 23 * £8.08 = £9,663.68
The cost to the practice will be £4,058.08.
The practice has to decide if there is a need for a medical summariser. The
savings to the practice will be:
5 hours a week at £5 per hour
Annual savings 52*5*£5 = £1,300.00
The practice has to decide if there is a need for an administrator assistant.
The savings to the practice will be:
16.5 hours a week at £6.71 per hour
Annual savings 52*16.5*£6.71 = £5,757.18
Reviewing the current processes showed the following:
The extended hour analysis revealed the following claims were missed:
August 2011 claim of £2,250.00
September 2011 claim of £2,475.00
April 2011 to March 2012 claim of £2,475.00 (Appendix 3a)
These were subsequently recovered.
In the last financial year, the income generated from extended hours was
£31,750.00 (Appendix 3b).
In any financial year, there are potential earnings of £46,800.00 from extended
hours if nurses are also involved in this process.
4*52*£225 = £46,800.00
Analysis of staff overtime revealed the following:
A 52% rise in overtime claim from 2008 to 2009
A 16.30% fall in overtime claim from 2009 to 2010
A 73.25% rise in overtime claim from 2010 to 2011
The staff wages have been averaged out to work out the cost to the practice in
the last financial year due to overtime claims, this came to £12,370 (Appendix
7).
Meetings were held with the Practice nurse with regards to chalmydia claims.
The result of the meeting revealed no claims have ever been made by this
practice in the last financial year or prior years for chalmydia as the nurse was
unaware of the process. There was no procedure and the practice could not
produce any data for analysis. In February 2012 the first claim was made of
£72 (Appendix 2a). Procedures have been written (Appendix 2b).

Farhana Imran 27
Meetings were held with the nurse and administration team to determine if the
travel clinic was making a profit for the practice. Neither the nurse nor the
administration team were aware of how much this clinic was generating. The
following was determined:
 The nurse sets up her clinics every two weeks
 The nurse pre orders the medicines required
 The receptionist at the desk takes the money from the patient
 The receptionist makes a note of it in the petty cash register
 The receptionist puts the money in the cash box
No analysis could be prepared as the register is incomplete and does not state
if the money came from the travel clinic or some other source. This needs to
be addressed.
An analysis of the major sources of income and items of expenditure with the
doctors, nurses and support staff revealed the following:
GMS statement provides the main income sources(Appendix 11 ) which
generated an income of £541,958.12 for the financial year 2011/12. This
includes:
 Global sum
 Aspiration
 Seniority
 Immunisation
 Extended Hours
 Flu
 Gold Standard Framework
 Minor Surgery
 IUCD
The other main income source is the general practitioners reports.
This showed that from December 2011 to May 2012, the practice received
cheques of £3,347.61
Monies from the Department of Works and Pensions came to £1,158.36
Fortyone non payment chaser letters were written worth £2,470.99 of which
£463.25 were recovered which is 19% (Appendix 4).
A SPECTRE analysis with regards to future practice growth and challenges
was conducted with the team (appendix 10). This highlighted a need for audits
to improve patient care.
A prescribing audit of high cost drug was conducted with the prescribing lead
from ONEL (Appendix 8a) which revealed £463,785.53 had been spent on
medicines for the last financial year. Meetings have been held with ONEL to

Farhana Imran 28
look at the alternatives(Appendix 8b). The practice is looking at reducing this
figure by 20%.
Conclusion
Actual income recovered
Name Amount (£)
Extended
Hours
7,200.00
Locum
Cover
12,714.00
Chalmydia 72.00
GPRs 4,969.22
TOTAL 24,955.22
Potential additional income
Name Amount (£)
Osteoporosis
DES
2,003.00
PP DES 6,864.00
Health Check 37,832.30
Prescribing 92,757.11
Freed up
Resource
48,000.00
Medical
Summariser
1,300.00
Administration
Assistant
5,757.18
TOTAL 194,513.59
Actual expense
Name Amount (£)

Farhana Imran 29
Overtime 12,370.00
TOTAL 12,370.00
Potential additional expense
Name Amount (£)
Business
Manager
12,480.00
Senior
Receptionist
4,058.08
TOTAL 16,538.08

Farhana Imran 30
2.4 Possibilities
Based on the findings and conclusions there are three possible solutions which
the practice team has come up with after group discussions. Each will be
considered in turn with its strengths and weaknesses. The team considered
the following range of criterias when coming up with possibilities:
 Practicality of the solution
 Financial benefits
 How it will affect staff
 How it will affect the practice and primary care
 How acceptable the solution is for all stakeholders
The solutions are:
Do nothing
The practice continues as it is with little structure and incomplete knowledge of
income and expenditure streams
Strength
The staff remains unaffected
Weakness
There will be uncertainty on whether optimal income level has been achieved
There will be uncertainty on whether all tasks are being done
There is uncertainty if the practice can survive the rules to be imposed by the
CCG eg the continuation of the PPG
The practice remains low profile
The morale of the practice may be low
Expansion opportunities may be missed
This is not a practical solution. The cost to the practice will be great as seen
earlier from the SPECTRE analysis as patients needs will not be met if key
audits are not performed. Staff will remain demotivated as there will not be
clarity in their roles and responsibilities. There will be a possibility that the
practices management will be taken over by ONEL as the contractual
obligations may not be met.
Apply short-term solutions
The practice adopts some of the analysis and audits such as extended hour
submissions and revised roles of staff
Strength
There will be a feeling of achievement
Staff morale will be improved as there is more structure

Farhana Imran 31
Immediate financial benefits from monthly extended hour submissions
Weakness
There will be uncertainty on whether optimal income level has been achieved
Staff do not want to reduce staff numbers
Staff do not want to bring in external business manager
Staff feel threatened
This is not a practical solution. The team are not keen to bring in an external
business manager but prefer the information officer to be trained up to this
level. Unfortunately this is not a viable option as the information officer does
not have the correct skill mix. This option will not be able to address the issues
facing this practice.
Apply long-term solutions by addressing the root cause
The roles and responsibilities of staff are fully addressed and implemented with
regular feedback in the first year
All the processes and procedures are being followed
The business manager is appointed for at least one year to ensure
accountability
Strength
Optimal level of income will be achieved
Staff aware of their roles
Staff take ownership for their work
Staff take accountability for their work which leads to efficiency and productivity
Teamwork
Practice can become more innovative by participating in ground breaking
audits which serves the wider population and other practices
Reduce wastage
The profile of the practice goes up
Weakness
Steep learning curve for staff
Feeling of insecurity amongst long serving staff and clinicians as they struggle
to cope with their revised roles
Training cost increased
This is a practical solution from the patients perspective and for the financial
wellbeing of the practice. Some members of the current staff do not want any
external staff as they feel the workload is immense. The practice should reach
a compromise by employing the business manager for a fixed term contract
where this person can attempt to train existing staff to roles which the partners
want them to fill as it is very clear that there are skill mix issues in this practice.

Farhana Imran 32
Part 3 – Leading change (801 words)
3.1 Proposal and Recommendations (including benefits for stakeholders)
The cost benefit analysis prepared below shows the value in monetary terms
of implementing the proposal.
All the monies owed to the practice would have been lost if the analysis had
not been done.
£7,200.00 extended hours amount would have been lost.
£12,714.00 locum cost would have been lost.
£37,832.30 health checks which the NHS is promoting would have been lost.
£48,000.00 freed up resource (details can be found in the action plan at
www.upstairs-Surgery.co.uk) is worth pursuing as this money will be used to
bring in a part time female GP which is what the patients want.
The project plan (Appendix 12) provides details of the proposals with
timeframes. A Gantt chart has also been prepared (Appendix 13).
The revised roles and responsibilities (Appendix 9a – 9e) will help staff to learn
the importance of being part of a team with shared goals, it will also keep them
focused and motivated.
The partners will see financial rewards by implementing the proposals. They
will see happy and productive staff and most importantly they will see a higher
quality of patient care. By doing the DESs and LESs, performing the audits, the
practice will be well placed to share their work ethics with other practices and
help to move primary care forward.
Cost Benefit Analysis of the proposal
Alcohol related DES (estimate 100 patients) 23.80
Chalmydia (£72 per quarter) 288.00
Extended hours reclaimed 2011/2012 7,200.00
Extended hours 2012/2013 46,800.00
Extended hours 2011/2012 (31,750.00)
Freed up resource 48,000.00
Freed up resource used to bring in part time female GP (48,000.00)

Farhana Imran 33
GPRs (estimate £800 per month) 9,600.00
Health Checks 37,832.30
Learning Disability DES 715.12
Locum amount recovered from ONEL 12,714.00
Osteoporosis DES 2,003.00
Overtime savings 12,370.00
Overtime savings used to employ part time Business
Manager
(12,480.00)
Petty Cash (estimate £100 per month) 1,200.00
PP DES 6,864.00
Staff roles cost of senior receptionist (4,058.08)
Staff role saving on Medical Summariser 1,300.00
Staff role saving on Administrator Assistant 5,757.18
Travel Clinic (estimate profit £50 per month) 600.00
Income generated for the practice 82,606.32

Farhana Imran 34
3.2 Managing change
The force field analysis below highlights the main challenges in implementing
the proposal. The biggest challenge will be to get the current staff to do the
work in an accountable way.
Force Field Analysis
Driving Forces Restraining Forces
(positive forces for change) (Obstacles to change)
Positive attitude of doctors Reducing cost by redundancies
Discipline in the work place Insecurity among long serving staff
Staff loyalty to senior partner Inadequate skill set of staff
Kotter’s simplified 4-step change management framework will address the
challenges which the practice faces in implementing the proposal.
Pressure for Change
Staff are aware that the practice is not efficient and change is imperative, they
are happy to have revised roles and responsibilities to incorporate these
changes but feel threatened by how much is expected of them.
Clear, shared vision
The mission statement of the practice is clear to staff.
Capacity for change
Current Situation:
The practice is not optimising its
income
Desired Situation:
The practice does all the work
to optimise its income

Farhana Imran 35
The practice will be successful in implementing the change if they bring in an
external business manager as the skill of the current staff is not adequate at
the moment. The practice needs to let go of some of its staff whose work can
easily be done by other staff.
Action
Kaizen’s ( continuous improvement) five S’s
1) Sort
Do all the analysis, past and present
2) Set in order
Do a timetable of the activities resulting from the analysis
3) Shine
Review the activities every quarter to make sure they are still relevant
4) Standardize
Set a procedure or process for each activity
5) Sustain
Review the procedure or process every quarter for accuracy and update
as required

Farhana Imran 36
3.3 Quality assurance
The main risks are:
The staff and doctors at this practice are not keen to bring in external staff.
There are many long standing staff who do not want the status quo disturbed
so new staff have not been able to stay for long at the practice. It will be a
challenge to employ an external business manager. The doctors at this
practice have a very relaxed attitude, if support staff apply enough pressure,
the doctors will submit under pressure and not employ an external business
manager.
The doctors may not see the benefit of doing work for small financial return
such as the alcohol DES which pays £2.38 for each patient on this register.
Staff may resent the loss of overtime.
Staff may be overwhelmed by the revised roles and responsibilities, they may
feel they are being asked to do too much with little financial benefit.
Some of the audits may highlight clinical weaknesses which will anger the
doctors.
Staff may resist the use of to do list where they have to account for their time.
The model below can help to put contingency plans in place by ensuring work
is checked by another person and the processes are up to date. Unfortunately
no contingency plan can take the place of key personnel.
Continuous Improvement
Plan
Do
Act
Set up timetable for
analysis
Write the
procedures
Review
the processes
regularly

Farhana Imran 37
Part 4 – Appendices
Appendix 1 Organisaion Chart …………………………38
Appendix 2a Invoice for chlamydia screening February 2012 ...................................39
Appendix 2b Chlamydia screening process for April 11 – March 12 .........................40
Appendix 3a Extended hours fax to recover money for work done from Apr
2011 – Mar 2012 .................................................................................................................41
Appendix 3b Extended hours payments for Apr 2011 – Mar 2012 ............................42
Appendix 4 General Practitioners Report Process .......................................................43
Appendix 5 Health check procedure ...............................................................................44
Appendix 6 Locum cover invoice.....................................................................................45
Appendix 7 Analysis of staff overtime from 2008 to 2011 ...........................................46
Appendix 8a Top 20 prescribing drugs for Apr 2011 – Mar 2012 ..............................47
Appendix 8b Prescribing meeting....................................................................................48
Appendix 9a Role of Business Manager........................................................................50
Appendix 9b Role of Administrative Manager...............................................................52
Appendix 9c Role of Information & IT Manager ............................................................56
Appendix 9d Role of Medical Secretary .........................................................................58
Appendix 9e Role of Senior Receptionist.......................................................................60
Appendix 10 SPECTRE analysis of issues affecting the practice..............................62
Appendix 11 GMS practice summary statement for Apr 2011–Mar 2012 ................67
Appendix 12 Outline Project Plan....................................................................................71
Appendix 13 Gantt Chart ..................................................................................................79
Check
All work 2nd checked

Farhana Imran 38
Appendix 1 – Organisation Chart
ORGANISATION CHART
DRS HAMILTON-SMITH,OLADIMEJI & IMRAN
Partner Partner Partner
Dr Hamilton-Smith Dr Oladimeji Dr Imran
Administrative Manager Business Manager
Lorraine Stebbings Farhana Imran
Senior Receptionist Information Officer Senior Practice Nurse
Angie Conroy Diane Maskell Margaret Byers
Receptionist Medical Secretary Practice Nurse
Michelle Jackson Anne Mantripp Susan Oldhamstead
Receptionist Medical Summariser
Val Mattock Bosie Oladimeji
Receptionist Medical Secretary
Marilyn Abramov Theela Bourne
Receptionist
Sue Day
Receptionist
Jan Maggs
Receptionist
Barbara Quinton

Farhana Imran 39
Appendix 2a – Invoice for Chlamydia Screening 2012
Havering PCT CA4
Payables 6725
Shared Business Services
Phoenix House
Topcliffe Lane
Wakefield
WF3 1WE
XXDHOWLETT
Surgery Name: Drs Hamilton-Smith, Oladimeji & Imran
Lead GP: Dr Hamilton-Smith
Surgery Address: Upstairs Surgery
Chadwell Health Health centre
Chadwell Heath
Essex RM6 6RT
Invoice Number: CS1
Month: February 2012
Total Number of Screens: 9
TOTAL INVOICE AMOUNT: £72.00
Please Pay: Drs Hamilton-Smith & Partners
Sort Code: xx xx xx
Account No. – xxxxxxxx
Bank: - HSBC
Or send a cheque to:

Farhana Imran 40
Appendix 2b – Chlamydia Screening Process for 2012
Drs Hamilton-Smith, Oladimeji & Imran F82019
 The Practice orders Chlamydia kits from:
Chlamydia Screening Office
Terence Higgins Trust
20 East Street
Barking IG11 8EU
Telephone: 0208 591 2561
Contact name: Anastasia
Email: simon.cordon@tht.org.uk
 The patient fills in a test request form and takes the kit which has a
unique reference number
 The patient fills in the label and sticks it on the smaller bottle
 The patient free posts this to Terence Higgins Trust
 When the lab results are complete, the Terence Higgins Trust gives
ONEL the number of screens for the month for the practice
ONEL contact:
Dawn Howlett
Email: dawn.howlett@havering.nhs.uk
Telephone: 01708 431809
 Terence Higgins Trust should provide this same number to the Practice
so we know how many screens to claim for – at the moment this part of
the process is missing
 I have requested this information to be sent to us on a monthly basis, it
will be addressed to me, awaiting confirmation from Simon Cordon

Farhana Imran 41
Appendix 3a – Extended Hours Fax to recover money for work done for
Apr 2011 – Mar 2012
PRIVATE & CONFIDENTIAL
FAX MESSAGE
To: Mark Lockwood From: Farhana Imran
Fax: 020 8926 5005 Senders Fax: 020 8597 7819
Cc: Senders Phone: 020 8590 1461
Re: Extended Hours Date: 02.02.12
Number of Pages (Including cover sheet): 13
Urgent Please Comment Please Reply For Review Please Recycle
Message:
This relates to extended hour session for Jan 2012. There are four 30
minute sessions done by the nurse to cover the bank holiday period.
Please confirm £3,375 for Jan 2012.
Please confirm £2,250 for Aug 2011 and £2,475 for Sept 2011 sessions
will also be paid with Jan 2012
Also attached are the back dated claims for 2011. There are 33 thirty
minute sessions done by the nurse. We are claiming £2,475 for 11 back
dated sessions for 2011.

Farhana Imran 42
Appendix 3b – Extended Hours Payments for Apr 2011 – Mar 2012
F82019
April 2011 to Mar 2012
Date Extended Hours
23/03/12 3,375.00
29/02/12 10,825.00
31/01/12 5,400.00
30/11/11 2,025.00
31/08/11 2,475.00
31/07/11 2,475.00
30/06/11 2,475.00
28/04/11 2,700.00
TOTAL 31,750.00

Farhana Imran 43
Appendix 4 – General Practitioners Report Process
DRS HAMILTON-SMITH, OLADIMEJI & IMRAN
Chadwell Heath Health Centre
Ashton Gardens
Chadwell Heath, Romford
Essex, RM6 6RT
20th January 2012
INTERNAL MEMO
MEDICAL RECORDS INVOICE
We have reviewed our procedure and have made some alterations in our
process. Copies of medical records will only be made available after we
receive the correct fees.
All cheques must be made to the Practice and not to individual doctors. We do
not accept cash.
From a risk and control perspective, cash is not an acceptable method of
payment as there can be a loss of audit trail.

Farhana Imran 44
Appendix 5 – Health Check Procedure
Background
A list has been produced by Margaret Byers. There are 1,793 patients who
qualify for health checks. The patient can be invited once every 5 years for a
health check.
For a five year programme, the practice needs to do 358 health checks every
year.
Therefore, every quarter, 90 health checks need to be done and claimed for by
the practice. Margaret Byers wants to do the submission.
Therefore, every month, 30 health checks need to be completed by the
clinicians. If each doctor does 5 a month and Margaret does 15 a month this is
a very achievable target.
As the practice is two years behind, an agreement has been reached with
ONEL that the practice can submit as many health checks as it can.
Procedure
 The patient must have a blood test within 6 months of the health check
Eg If the patient comes in for a health check in June 2012, he/she must
have had a blood test from Jan 2012 to June 2012.
 With the patient, fill in a ‘General Practice Physical Activity
Questionnaire’ (see attached)
 Fill in ‘Minimum Data Set ‘ (see attached)
 At the end of each month, give a copy of the General Practice Physical
Activity Questionnaire and Minimum Data Set to Margaret.
 Every month please provide the Business Manager with an update.

Farhana Imran 45
Appendix 6 – Locum Cover Invoice
Dr J A HAMILTON SMITH & PARTNERS INVOICE NO.
Chadwell Heath Medical Centre 1/JHS/FI1
Ashton Gardens
Chadwell Heath
Romford
Essex RM6 6RT DATE: 05.10.11
Comments or special instructions:
ACCOUNT
NUMBER
P.O. NUMBER REQUISITIONER DELIVERY
NOTE
TERMS
XXLHUTCHINSON
QUANTITY DESCRIPTION UNIT
PRICE
AMOUNT
24 Locum cover for Dr xxx while on
suspension
Period from 7.4.11 – 16.6.11
Back up papers from Beacon Care
Services Ltd
N/A £12,714.0
Bank Details: Sort Code xx xx xx
Account Number: xxxxxxxx
Please make cheques Payable to: Dr J A
Hamilton Smith & Partners
Practice Code: F82019
Remittance Address farhana.imran@nhs.net
SUBTOTAL
DISCOUNT
HANDLING
VAT
TOTAL DUE £12,714.00

Farhana Imran 46
Appendix 7 – Analysis of staff overtime from 2008 to 2011
DRS HAMILTON-SMITH, OLADIMEJI & IMRAN – F82019
Overtime in hours
Name of Staff 2008 2009 2010 2011
A 80.5 41.5 9.5 76
B 17 35 10
C 41.5 29 37.5 4
D 55 51 63.5 172
E 66.5 53.5 70.5 90
F 90 81 62 132
G 116.5 127 118 116
H 27.5
I 18 30.5 79 86.5
J 67 90.5 38 186
K 19.5 19 33.5 98
L 300.5 164.5 235
M 5.5 12.5 3 4
560 853 714 1237

Farhana Imran 47
Appendix 8a – Top 20 Prescribing drugs for April 2011 – March 2012
Drs Hamilton-Smith,Oladimeji & Imran
BNF Name Total Act
Cost £
Cost per
item £
Fluticasone/Salmeterol_Inh 250/25mcg 120D 18,209.15 93.38
Pregabbalin_Cap 75mg 11,580.63 74.23
Atorvastatin_Tab 20mg 10,072.86 30.25
Budesonide/Formoterol Inh B/A 200/6 120D 9,883.34 61.77
Sitagliptin_Tab 100mg 9,673.19 44.99
BuTrans_Transdermal Patch 20mcg/hr 9,606.04 55.53
Pioglitazone/Metformin HCI_Tab 15mg/850mg 9,252.86 49.75
Donepezil HCI_Tab 10mg 8,568.60 64.43
Tiotropium_Pdr For Inh Cap 18mcg 8,530.66 50.48
Spiriva Respimat_Inha 2.5mcg 60D+ Dev 7,728.48 42.46
Influenza_Vac Inact 0.5ml Pfs 7,295.36 6.07
Qvar 100_Inha 100mcg 200D 7,180.43 26.02
Candesartan Cilexetil_Tab 4mg 7,167.21 18.52
Ezetimibe_Tab 10mg 6,965.09 49.40
Candesartan Cilexetil_Tab 16mg 6,919.65 17.21
Rosuvastatin Calc_Tab 10mg 6,914.69 25.14
TOTAL COST 463,785.53

Farhana Imran 48
Appendix 8b - Prescribing Meeting
29/11/11 12:45 – 13:35
Present: Dr Hamilton-Smith Vicky Wong
Dr Francis Farhana Imran
Dr Imran
Item Action
by who
Action
by
When
1 Reason for visit by Vicky:
Projected overspend by this Practice is £136,000
GOAL: The Practice needs to cut back by 20%
Feb
2012
2 Inhaler review to carry out an audit for Seretide 250
(500)
It is our 1st, 3rd & 5th high costing drug
Dr AI Feb
2012
3 Diabetes – Sitagliptin_Tab 100mg
It is our 4th high costing drug
Who is monitoring this? Nurse
Monitoring HBA1c
Margaret
Dr AI
Dr JAH
Feb
2012
4 Pregabalin 75mg
It is our 2nd highest costing drug
Audit the use of this drug
Dr
Francis
Feb
2012
5 SIP FEEDS
Dietician Raveena will come to help audit this
(Ensure, Peptamen, Fortisip extra)
Dietician Feb
2012
6 SPECIALS
Levothyroxine capsules cost £100
Check which patients are using, to be changed to
tablets
Dr JAH Feb
2012
7 BuTrans Patches all strengths
Need to reduce use
Dr
Francis
Feb
2012
8 QIPP Score Cards
Quick Wins:
Dr AI Feb
2012

Farhana Imran 49
Prednisolone EC to be changed to normal
Ferrous Sulphate change to Ferrous Fumarate
Naproxen EC changed to normal
Glucosamine & Clopidogrel - ok
9 QP2
Felodipine to amlodipine
Target:less than 10% of all felodipine to amlodipine
Dr AI Feb
2012
10 QP2
Generic bisphosphonates
Currently 78% need to get to 90%
Dr JAH Feb
2012
11 QP2
Blood Glucose Testing Strips
Current £140 should be under £110
Dr
Francis
Feb
2012
12 ACE Inhibitors
Current 64% should be 75%
Dr JAH Feb
2012
13 In general:
Havering underspend is under 1 million but there are
2 reasons for concern for Vicky:
1) FLU season
2) Report runs 2 months behind
14 Vicky will give us a copy of Epact data Vicky
15 AIM OF PRACTICE: 20% savings Drs
Nurses
Feb
2012

Farhana Imran 50
Appendix 9a – Role of Business Manager
JOB DESCRIPTION
Job Title: Business Manager
Responsible to: The General Practitioners in the Partnership
Grade: Administrative and Clerical Grade
Aim of Post:
To support the doctors in the delivery of high quality primary care by
analysing all systems and processes which impact the finances of
the practice. To consider a range of alternative systems for
improving the financial position of the Practice taking into account the
agreed criteria to include:
 Effectiveness in solving the problems
 Clinical governance and risk
 Ease of implementation
 Acceptability to Partners, staff and patients
 Human Resource implications
 Training needs
 Costs
Financial Management:
1. To research and investigate
Bank statements
Extended Hours DES
Health checks for 40-74 year olds
Medical Reports required by insurance companies
Patient Representative Group DES
Practice website development process
Prescribing habit
Sickness policy
Staff contracts
Staff roles and responsibilities

Farhana Imran 51
LES which the practice has signed up for
DES which the practice has signed up for
Audits
Health Analytics
Chalmydia Screening – write the procedure
Travel Clinic –write the procedure
Repeat prescribing protocol – write the procedure
Liaise with MDU –can practice members be patients of their practice?
Recommend cost saving ideas
Introduce accountability – daily to do list to be completed by staff
Health & Safety Issues
2. To provide all financial papers to the accountant in good time for the
preparation of practice accounts.
3. Attend all internal financial meetings and any other meetings which the
partners feel would be appropriate.
4. Attend external meetings which may affect the finances of the practice.
5. Maintain an efficient filing system.
1. Arrange training opportunities for staff as appropriate.
2. Fill in a daily to do list outlining own duties for the day.
3. To ensure confidentiality at all times.
This job description may need to be reviewed from time to time
as the practice develops.

Farhana Imran 52
Appendix 9b – Role of Administrative Manager
JOB DESCRIPTION
Job Title: Administrative Manager
Aim of Post:
managing the day to day administrative systems within the practice.
General Administration
Register new & temporary patients ensuring the appropriate forms
are completed and forwarded to the Health Authority.
Patient List reconciliation. Check the number of new patients. Check
the patients are shown on the quarterly GMS total.
Ensure all new patients are offered a new registration health check.
Check patients who have not had doctor contact for 18 months. They
need to be contacted to check details are up to date eg phone
number, address, still alive etc
Supervise the repeat prescription process in the surgery, preparing FP10s for
the doctor’s signature.
Liaise with Diane to ensure statistical information relating to asthma,
diabetes and CHS for inclusion in the Annual Report are up to date
(QOF).
Liaise with Diane & oversee the practice computer system and the
development of its use.

Farhana Imran 53
Monitor security of the premises.
Ensure stationery, equipment and medication stock is available.
Ensure the extended hours rota has four sessions each week
irrespective of clinicians holidays, bank holidays and protected time
initiatives.
Ensure the health check rota is maintained and agree a minimum
number to be booked in each day to be seen by the healthcare
assistants and the nurses. Ensure that there is one evening slot
each week for working age patients who cannot come in at any other
time.
Ensure all complaints are handled appropriately and documented as
outlined in the complaints procedure.
Ensure all Practice procedures are up to date and all staff are aware
of them. Make the procedures accessible to all staff.
Ensure that all practice staff maintain patient confidentiality at all
times.
To be responsible for all day to day personnel management at
the surgery.
Arrange training opportunities for all staff as appropriate. To
arrange training, internal and external, for new members of staff. To
provide new staff members with an induction pack.
Arrange work and holiday rotas to ensure adequate cover at all times.
Maintain a Staff Appraisal System within the practice.
Implement the practice disciplinary and grievance procedures where
necessary.
Encourage good team working.

Farhana Imran 54
Ensure the absent doctor has a Locum Cover. To provide locum
pack to the locum doctor. To ensure the locum doctor uses the end
consulting room and not the partners room.
Fill in a daily to do list outlining own duties for the day. Ensure all staff comply
to this and hand the sheet to her .
Financial Management
Liaise with the Health Authority and ensure documentation relating to
new patient registrations, Deductions from the practice list and all
item of service payments are despatched promptly (e.g. Maternity,
Temporary Residents, New Registration Health checks etc.).
Operate an efficient stock control system for clinical and non clinical
items e.g. stationery and vaccines.
Set up meetings for the year
Weekly QOF update for the months of February and March with
the partners and administrative manager otherwise monthly
Monthly financial meetings with partners and business manager
Monthly meeting with partners and reception manager
Monthly meetings with administrative manager and her staff
Monthly clinical meetings with partners and nurses
QOF Work
Be responsible for the yearly QOF submission report
Preparation – new and old changes
Organisation – allocation for QOF work
Implementation – Setting up clinics, audits, telephone
Meetings Significant Event
Palliative Care
Practice Meeting
DES/LES
Ensure the work has been done and the claim is made for:
Extended Hours – person responsible Farhana Imran
Alcohol
Learning Disability

Farhana Imran 55
Osteoporosis – person responsible Farhana Imran
PRG – person responsible Farhana Imran
Health Checks –person responsible Farhana Imran
Audit
A&E audit as advised by all three doctors

Farhana Imran 56
Appendix 9c – Role of Information & IT Officer
JOB DESCRIPTION
Job Title: Information & IT Officer
Aim of Post:
managing the day to day information and IT systems within the
practice.
IT Administration
Update and manage all IT related issues on a day to day basis
Liaise with EMIS/PCT if there are any problems
QOF – update, analyse and organise activity on a weekly basis
Liaise with Lorraine to ensure statistical information relating to
asthma, diabetes and CHS for inclusion in the Annual Report are up
to date (QOF).
Liaise with Lorraine to update QOF on a weekly basis
Liaise with Practice team on monthly basis with QOF and IT related
issues
Liaise with Lorraine regarding the practice computer system and the
development of its use
Read code all important data from patient letter/communications for
QOF/summary update of computer records
Blood test results - update, call and recall
Communicate with patients via email/letter for call/recall as advised
by the doctors
Answer calls for patient queries regarding blood test and various
other investigations once approved by the doctors
Ensure patient confidentiality at all times

Farhana Imran 57
Fill in a daily to do list outlining own duties for the day. Give this to
Lorraine at the end of each day.
Audit
Prescribing audit as advised by Dr Imran

Farhana Imran 58
Appendix 9d – Role of Medical secretary
JOB DESCRIPTION
Job Title: Medical Secretary
Responsible to: Administrative Manager
Aim of Post:
managing the day to day secretarial duties within the practice.
Do all referral letters for the doctors, patients referrals via choose and
book, standard referrals and online referrals within 48 hours of the
referral being created, 2WW referrals, liaise with choose and book
Answer calls and queries regarding referrals
General letters to whom it may concern as and when required by the
Doctors
Private medical records, maintain a database, ensure the money is
received in the name of Drs Hamilton-Smith & Partners before
sending off the patients records. Provide a list to the Business
Manager on a monthly basis of all monies which has come in and
what is outstanding
Fill in a daily to do list outlining own duties for the day. Give this to
Lorraine at the end of each day.

Farhana Imran 59
Audit
Palliative Care audit as advised by Dr Francis
Referral audit as advised by Dr James
Meetings
Liaise with Lorraine to set up in house clinical meetings
Take minutes of the meetings

Farhana Imran 60
Appendix 9e – Role of Senior Receptionist
JOB DESCRIPTION
Job Title: Senior Receptionist
Responsible to: The Administrative Manager
Aim of Post:
managing the day to day reception duties within the practice.
Reception Administration
Organise the following reception activity:
Telephone
Scan
Appointment booking
Organise rota for each activity and staff member. Liaise with Lorraine
and get it approved 4 weeks in advance
All activities linked to reception:
Handling of information
Petty Cash
Fax
OTC – request
Prescription & repeat prescription
Ensure the reception area and the waiting room is clean and tidy, the

Farhana Imran 61
posters on display are relevant and up to date
The LED screen is constantly updated with relevant news
The TV monitor is used in a more appropriate way with relevant
medical information
Fill in a daily to do list outlining own duties for the day. Ensure all staff comply
to this and give this to Lorraine at the end of each day.

Farhana Imran 62
Appendix 10 - SPECTRE analysis of issues affecting the practice
Factors The trends expected
Social
The demographics of
society and how
people behave
Rise in unemployment level
This leads to an increasing need of Primary Care due
to depression, stress, poor nutrition, lack of exercise.
Aging Population
This has led to more home visits and more use of
additional services such as district nurses.
High levels of obesity
This has led to more cases of diabetes management
within primary care.
High levels of alcohol abuse
This has led to more counselling needs within a
Increase in mental problems
This has led to more counselling needs within a
Diverse population
This has led for the need to have translators and
Practice booklets in different languages in a Primary
care setting.
Primary Prevention
Primary Care plays an important role in Primary
Prevention. Decrease the burden of chronic illness by
doing all the things for primary prevention

Farhana Imran 63
opportunistically and in a target way.
Eg
Screening, Health Checks
Political
What political
initiatives or
aspirations might
affect us?
Government White Paper
The government faces a considerable challenge to
convince doctors that the reforms proposed in the
White Paper will improve patient care.
Clinicians are also concerned that the reforms risk
distracting the NHS from making the necessary
efficiency savings.
End of PCTs and SHAs.
Implementation of Practice Based Commissioning
GPs believe that they have the capacity to lead
commissioning.
When the Consortia is up and running this may be an
advantage as the services can be tailor made for our
Practice population.
Design care pathways.
Choice of which GP Practice to choose
This can lead a GP Practice to levels of insecurity as
competition is introduced.
This can increase the doctors workload by having to
travel longer distances to do home visits.
Economics
The health of the
economy, spending
patterns and the
availability of funds
Recession
GP Practices have to provide more services at lower
cost, this puts financial burden on GP Practices. It is
more important now to have business plans in place.
GPs to get financial control
GPs are not businessmen, their primary role is to
provide the best clinical care for their patients. Has the

Farhana Imran 64
potential to lead to chaos.
Identify training Needs
The Practice Manager must be financially literate.
Increase in training costs.
Income Earned in GP Practice needs to be activity
based
The NHS was not designed as an efficient model in
respect of the level of activity in a GP Practice ie how
many times a patient is seen and the financial benefit
derived from that.
Procurement issue
PFI disaster which is a very expensive way to fund
building projects in a Primary Care setting as payments
can hit the roof.
Decrease Spending
Already told to decrease spending by 15-20%. Must be
judicious.
Access
Patient access of secondary and tertiary care.
Emergency will be closely monitored.
More services will be made available in Primary
Care settings
More will be done in the community which will be
cheaper.
Local clinics such as
podiatry
physiotherapy
Diabetic specialist nurse led clinic
Leg ulcer clinics
Customer
How are customer
PRG
This group, if given time and respect by the Practice,
can be a powerful resource for the Practice in the

Farhana Imran 65
needs, wants or
expectations
changing?
improvement of patient care.
Patients expectation
As patients become more demanding this can put a
strain on the Practice. People are less keen to do
things at home or self-care. They land up in A&E or
GP surgery.
If the people attending A&E are analysed, many did not
need to be there.
Lifestyle choices
A sedentary lifestyle leading to obesity and diabetes
can increase the demands on GP Practices.
Access
Access has increased but this has led to patients
becoming more dependant on their doctors.
Patients have choice who they register with
The Constitution's inclusion of rights for members of the
public to choose their GP practice and a specific doctor
within that practice will be welcome news for patients.
However, it will have repercussions for PCTs and
doctors' practices, and the appropriate funding and staff
levels will need to be in place to ensure that this can be
made to work.
Patients as consumers are assuming a more active role
in their medical care decision-making, which has been
prompted by better access to medical information.
Patient use of medical information may affect physician
practice incentives to provide care, which critically
depends on the agency relationship between physician
and patient. If patient use of medical information
improves communication and understanding,
physicians may need to spend less time explaining
what treatments are needed and convincing patients
about the appropriateness of their recommendations,
increasing incentives to provide care. If patients use
information to demand treatments and procedures that
are at odds with what the physician would recommend,
this might lead to a contentious relationship, making it

Farhana Imran 66
more difficult to agree upon any course of treatment.
Technology
What will changing
technology do for
your team or
service? What will
you be able to do
that you cannot do
now? What will be
cheaper or faster?
New telephone system to be installed
This will allow more patients to get through to the
Practice in busy times as more lines will be available.
Using skype for patient consultation
This will help patients who find it hard to get to the
Practice due to ill health, mothers with young children,
the very old. Face to face consultation without patient
coming to the surgery. At the moment they come, but
once the web has been developed and is secure –
patients accept that form of treatment from the comfort
of their home. This will save time, money and is
convenient for both patients and doctors.
Remote Access
Consideration should be given to remote access to non
front line staff so they can work from home.
The level of engagement between technology
suppliers and the NHS
The commissioning process within the NHS is seen as
fragmented and complex, and varies between
commissioning groups. Every commissioning group
has a different set of requirements against which it
assesses new business cases for technologies.
Awareness of technology and understanding of the
benefits that it can bring
Consumer demand is an important driver for the
adoption of technology as consumers become more
empowered and more demanding about the kinds of
treatment they want.
Concerns about confidentiality and usability How
safe are the data held on computers?
Government policy
Policy can have an impact on the adoption of
technology either directly, by setting guidance or

Farhana Imran 67
targets, or indirectly, by setting objectives that could be
met via technology.
Regulation
How will forthcoming
laws or regulations
affect us?
Government White Paper
Legal implications around changes to GP contracts for
working Practices.
Revalidation of GPs
The General Medical Council will be changing the way
doctors within the UK are regulated to Practice
medicine. Revalidation is the process by which
licenced doctors will demonstrate to the GMC that they
remain up to date and fit to Practice.
Privacy and confidentiality need to be secured.
Primary care Services will be asked to produce
Quality Accounts for 2011/2012 as set out in the
Health Act 2009
Practices will have to review the quality of service they
provide and they need to express this in terms of the
three domains of quality:
Patient safety
Clinical effectiveness
Patient experience
This will mean more work for the Practice.
Environment
How must we adapt
to changes in our
environment? What
might affect us?
Reduce waste, increase recycling
Practice need to work towards becoming paperless.
This can be achieved by using computer technology
more ie emails, fax, hardware and software storage
devices.
Consider remote access for non front line staff.
Extreme weather conditions
Flood or rain
Increasing pollution
More allergies
Aging population

Farhana Imran 68
Have systems in place, local governments will have to
be efficient and plan from before.
Seasonal affective disorder (SAD)
Depression with fatigue, lethargy, oversleeping,
overeating and carbohydrate craving recurring
cyclically during specific seasons, mostly in winter
months. This could result in a reduction in morale and
motivation of staff.
Appendix 11 - GMS Practice Summary Statement for Apr 2011 – Mar 2012
F82019
Date Global Sum Aspiration
Seniority
Superannuati
on
Prescribing
Immunisatio
n
Contract
Adjustment
Total
confirmed
checked to
Bank
Statement
23/03/12 33,235.68 7,788.22
2,639.57
(9,804.07)
2,629.80 2yr
859.98 5yr
2,899.67
made up of:
3,375.00 EH
99.32 Flu
-463.43 lev
-111.22 levy
40,248.85
21/03/12 1,212,33 1,212.33
29/02/12 33,235.68 7,788.22
(6,862.50)
10,825.00
made up of:
10,825.00 EH
44,986.40
21/02/12 1,387.62 1,387.62
31/01/12 33,235.68 7,788.22
(6,862.50)
9,759.80
made up of:
5,400.00 EH
389.64 Flu sep
909.16 Flu nov
1,530.50 GSF
1,530.50 2 HFC
43,921.20

Farhana Imran 69
23/01/12 3,403.71 3,403.71
23/12/11 10,273.78 10,273.78
22/12/11 33,297.51 7,788.22
2,616.50
(6,862.50)
2,878.59 2yr
836.43 5yr
-572.79 39,981.96
30/11/11 33,297.51 7,788.22
(6,862.50)
15,880.43
made up of:
157.52 IUCD
6,393.00 M/Sur
2,025.00 EH
7,173.96 Flu
130.95 Zoladex
50,103.66
22/11/11 1,210.22 1,210.22
31/10/11 33,297.51 7,788.22
(6,862.50)
9,627.16
made up of:
5,295.60 FO
0.03 FO
2,269.56 FO
908.79 FO
1,153.18 FO
43,850.39
21/10/11 981.74 981.74
30/09/11 33,633.23 7,788.22
2,585.28
(6,862.50)
3,034.95 2yr
779.40 5yr
-14,486.57
made up of
-463.50 Levy
-111.24 Levy
-2,618.46 FO
-2,705.26 FO
5,752.51 AI
-999.37 AI
-977.62 AI
-1,122.18 FO
-1,449.26 FO
2,465.38 AI
32.54 AI
-1,284.78 AI
-1,739.13 FO
26,472.01

Farhana Imran 70
-0.04 AI AVC
-4,363.08 AI AV
-4,903.08 AI AV
31/08/11 33,633.23 7,788.22
(6,862.50)
2,517.00
made up of:
42.00 IUD
2,475.00 EH Jul
37,075.95
18/08/11 1,414.33 1,414.33
31/07/11 33,633.23 7,788.22
(6,862.50)
-35,311.22
made up of:
2,475.00 EH
-37,886.50 QOF
-15.60 Levy
115.88 PBC
35,997.41
19/07/11 1,165.36 1,165.36
30/06/11 34,226.19 6,086.97
2,526.7
(6,862.50)
43,525.18
made up of:
2,787.12 IMM
2,475.00 EH
941.19 BT
37,886.50 QOF
(452.33) Levy
(112.30) Levy
79,502.59
20/06/11 1,624.34 1,624.34
31/05/11
(6,862.50)
38,218.98
17/05/11 1,477.88 1,477.88
28/04/11 34,226.19 6,086.97
(6,862.50)
2,700.00
made up of:
2,700.00 EH
36,150.66
18/04/11 1,296.75 1,296.75
TOTAL 541,958.12

Farhana Imran 71
Appendix 12 - Outline Project Plan
Project goals
Who is your Project
Sponsor? (give name and
job title)
Drs Hamilton-Smith, Oladimeji & Imran
Who are your stakeholders
(clients/users, staff,
suppliers, financiers, those in
authority; are there others?)
and what do they say they
expect from the project?
Partners want increased efficiency and productivity
Staff want clear roles and responsibilities
Patients want the best health care
ONEL want correct submissions with back up papers
if required
Given the above, what will
the project achieve – what
are the benefits to the
stakeholders and to the
organisation?
Partners will have a clearer picture of how the
practice is progressing, they will be able to plan
better which will improve their morale, increase
motivation level, make the practice a good place to
work, improve quality control and reduce errors,
wastage, inefficiency and their associated costs
Staff will be in a position to ask for bonus, improved
morale, higher motivation level, good place to work,
increased job involvement and job satisfaction with
reduced absenteeism, grievances and staff turnover

Farhana Imran 72
Patients will receive better care which will increase
patient satisfaction and there will be greater
involvement of patients through PPG activities
ONEL can request to see paperwork which is
complete and error free
Accountants will not need to send out chasers for
documents as all paperwork will be complete and
ready in advance
Consultants in hospitals will receive clear, concise
records of patients when there are referrals which
will improve waiting times
When do your stakeholders
want the project to be
finished by?
31st April 2013
SMART Project deliverables
What exactly must the
project deliver to meet its
goals? (i.e. what does
“success” look like?). Be
specific! List them in
priority order if possible.
1. All income steams identified
2. All expenditure stream identified
3. All missing data found
4. All processes in place
5. All areas given to members of staff to take
responsibility for completing by a set time each
month
6. Each area to be checked by another staff
member
7. Everything filed in the correct place so easy to
find if needed

Farhana Imran 73
Project schedule
List the things that need to happen. Add as many rows as you need. You do
not need to list every single activity at the most detailed level - focus on
identifiable outcomes and key activities.
Project Schedule:
Task
Who
will
do it?
When
by?
Who must
they work
with?
What else will
they need?
A&E Audit LR 30.09.12
and
every
quarter
thereafter
Drs Record of all
A&E attendees
from April 2012
to March 2013
Alcohol related DES LR 28.04.13 Drs,
nurses
NHS directive on
this DES
EMIS LV for
number of
patients this
affects
Chalmydia Process SO 5th of
every
month
Dawn
Howlett
from ONEL
EMIS LV for list
of patients the
kit has issued to
Procedure
Invoice template
Extended Hours Process LR 5th of
next
month
Mark
Lockwood
from ONEL
EMIS LV
printouts on
extended hours
EH template
Chase freed up resource
of £48,000 until money
received by the practice
Drs 5th of
every
month
Jan Black,
Bob Barr
from ONEL
Proposal
document
agreed in
principal by
ONEL
GPRs RB Daily Drs Forms
completed by

Farhana Imran 74
Project Schedule:
Task
Who
will
do it?
When
by?
Who must
they work
with?
What else will
they need?
Insurance
companies
Solicitors
DWP
Taxi
companies
doctors
EMIS LV
records of
patients
Stamps
Envelopes
Health Check Process MB 30th June
2012 and
every
quarter
thereafter
Drs
Dawn
Howlett at
ONEL
NHS directive on
this LES
Learning Disabilities DES DM 28.04.13 Dr FO
Local
Authority
NHS directive on
this DES
EMIS LV set up
a health check
LD register
Locum Cover analysis to
recover funds of
£12,744.00
FI 30.11.12 Brigit
Mallee at
ONEL
BCS
Locum
agency
All paperwork
relating to the
locum period
Osteoporosis DES FI 31/07/12 Dr Imran
Lorna
Hutchinson
at ONEL
NHS directive on
this DES
EMIS LV to get
the number of
patients with this
condition
Palliative Care Audit RB 30.09.12
and
every
quarter
Dr FO
District
nurses
EMIS LV List of
all patients on
this register

Farhana Imran 75
Project Schedule:
Task
Who
will
do it?
When
by?
Who must
they work
with?
What else will
they need?
thereafter St Francis
Hospice
PP DES FI 31.03.13 Patients of
the
practice
PPG
Webteam
2 sets of
questionaires
Set up meetings
Petty Cash analysis AC 5th of
every
month
Reception
staff
Completed
sheets with
details of
payments
Prescribing Audit DM 30.09.12
and
every
month
thereafter
Dr Imran
Vicky Kong
from ONEL
List of high cost
drugs
Minutes of
meetings
Referral Audit RB 30.09.12
and
every
month
thereafter
Dr James EMIS LV list of
all patients who
were referred
Staff – roles, sickness
issues, training needs
LR 31.07.12 Drs
Nurses
Staff
Peninsula
Job description
for each staff
Record of time
taken off due to
sickness
Return to work
template
Previous
appraisals for
training needs

Farhana Imran 76
Project Schedule:
Task
Who
will
do it?
When
by?
Who must
they work
with?
What else will
they need?
Travel Clinic SO 31.07.12 VM
Drs
Attempt to
analyse last 3
months of travel
clinic
Set up a
procedure
Website development FI Every
week
PPG
Drs
Webteam
Other
practices
Read literature
from PULSE,
NHS, GP
magazines on
current themes
which practices
are employing
Resources Required
Person What do you expect from them?
What do they expect from you?
All support staff Accurate timely work
Updated procedures and processes
Partners Guidance
Regular updates
ONEL Updates on NHS changes which impact primary care
Item Where will you get it? What cost?
DESs literature ONEL to provide, contractual obligation

Farhana Imran 77
Item Where will you get it? What cost?
Audits Office computer
GPRs Request by insurance companies
Communications Plan
Who needs to know? What do they need to
know?
How will they be told?
Partners Is the work being
done
Meetings
Progress report
Nurses How many health
checks to do
How to analyse the
travel clinic
Meetings
Procedures
Administration Staff What work to do
How to do the work
When to complete the
work
Meetings
Procedures
On the job training
PPG Provide ideas to
improve patient
experience
Meetings
Website
ONEL Finance If there is missing
data, there will be a
need to request
duplicate
E mail
Accountant This is a financial
project so he may
have a lot of the
information needed.
Also in future he can
liaise with me when
he prepares the
Meetings/Letters

Farhana Imran 78
Practice accounts as I
will have the
information he needs
Risk management plan
What might go wrong? How might this be
prevented?
If it does happen, what
should you do?
Staff not keen to take
on an external business
manager
Doctors are united Train information officer for
this role
Doctors do not see a
good financial gain by
doing some of the
DESs
Reinforcing the
practice vision of duty
of care to the patients
Reinforce the qualitative
benefit to the practice
Staff resent loss of
overtime
Introduce bonus Introduce an overtime form
which must be signed by
the doctors to authorise
overtime
Audits may highlight
clinical weaknesses
Taking time and care
during and after
consultation. Good
note keeping.
Introduce good record
keeping gulidlines from
NICE
Staff not keen on ‘to do
list’
Highlight its
importance
Disciplinary procedures
Practice website
neglected
Highlight its value to
the practice
Regular meetings to
reinforce its importance

Farhana Imran 79
Appendix 13 Gantt Chart
Activities with completion dates
Activity Task Name Completion
Date
Completion
Date
Completion
Date
A A&E Audit 30.09.12 31.12.12 31.03.13
B Alcohol Related
DES
28.04.13
C Chalmydia
Process
05.07.12 05.08.12 05.MM.YY
D Extended
Hours
05.07.12 05.08.12 05.MM.YY
E Chase £48,000
freed up
resource
06.07.12 06.08.12 06.MM.YY
F Health Checks 30.06.12 30.09.12 30.12.12
G Learning
Disabilities
DES
28.04.13
H Osteoporosis
DES
31.07.12
I Palliative Care
Audit
30.09.12 31.12.12 31.03.13
J PP DES 31.03.13
K Petty cash
analysis
05.07.12 05.08.12 05.MM.YY
L Prescribing
Audit
30.09.12 31.12.12 31.03.13
M Referral Audit 30.09.12 31.12.12 31.03.13
N Staff roles etc 31.07.12
O Travel Clinic 31.07.12

Farhana Imran 80
Gantt Chart over 9 month period
Jul12 Aug12 Sep12 Oct12 Nov12 Dec12 Jan13 Feb13 Mar 13
A
B
C
D
E
F
G
H
I
J
K
L
M
N

Farhana Imran 81
O
Bibliography
Guidance and audit requirements for the alcohol-related risk reduction
scheme at http://web.nhs.net/WebReadyViewBody (accessed 23rd April
2012)
Guidance and audit requirements for learning disabilities health check
Scheme at http://web.nhs.net/WebReadyViewBody (accessed 23rd April
2012)
Guidance and audit requirements for the osteoporosis diagnosis and
prevention scheme at http://web.nhs.net/WebReadyViewBody (accessed
23rd April 2012)
Impact of the health White Paper
www.kingsfund.org.uk
Cherith Simmons Learning & Development (2011)
Project Management Workbook
Leadership, supervision & team building information pack
Motivation information pack

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