Maximise your premises to boost surgery income and enhance patient experience… James Williams BSc (Hons) MRICS Principal Surveyor RICS Registered ValuerRegulated by RICS T: 0845 143 0019 I E: firstname.lastname@example.org I W: www.gpsurveyors.co.uk I
GP Surveyors: UK’s leading Chartered Surveyors for GP Surgeries Our primary aim is to gain financial benefits for doctors Worked with over 1,900 surgeries nationwide Notional rent reviews, market valuations, developments, pharmacies, sale & leaseback RICS registered "Before being contacted by GP Surveyors we were not aware of this service being available. The service was extremely efficient and you won us an upward valuation to boot!" Kathy Shipp, Maidstone Road Surgery, Chatham
… AND ensure essential standards of premises quality and safety Mark Dean - Director MCIAT email@example.com| t 0113 3917570 | f 0113 3917571 | Leeds + Skipton + Delhi Toronto Square · Toronto Street · Leeds · LS1 2HJ
Bowman Riley Healthcare team have over 16 years experience in the healthcare sector providing specialist architectural design services . We deliver comprehensive packages of design, architectural and project management to the healthcare sector for GP Practices, NHS Trusts, Framework Partners, Contractors, Developers and Aged Care providers architectural design master-planning interior design listed building and conservation work ADB 3D Room Generation BIM Modeling project management health facility co-ordination 6 Facet Surveys| t 0113 3917570 | f 0113 3917571 | Leeds + Skipton + Delhi Toronto Square · Toronto Street · Leeds · LS1 2HJ
The Changing Environment • CQC Essential Standards • Health & Social Care Bill • NHS: Patient choice & experience Service enhancement & diversification Greater space requirements Quality of premises
Care Quality CommissionBackground independent regulator of all health and social care services in England set up in 2009. care provided meets government standards of quality and safety (GP’s April 2013) Standards treating people with dignity and respect. making sure food and drink meets people’s needs. making sure that the environment is clean and safe. managing and staffing services Enforcement Issue fines, warning, stop admissions, suspend or cancel services Insist on improvements and check they have been made
Care Quality CommissionReality Economy The Health and Social Care Bill Over 60% of premises will not meet the standards CQC Registration by April 2013 CQC to inspect 10% of practices from April 2013 Premises not fit for purpose
Care Quality CommissionOutcome 10 - Safety and Suitability of PremisesWhat do the regulations say?15.—(1) The registered person must ensure thatservice users and others having access to premiseswhere a regulated activity is carried onare protected against the risks associated with unsafeor unsuitable premises, suitable design and layout; appropriate measures in relation to the security of the premises; adequate maintenance and, where applicable, the proper— operation of the premises, and use of any surrounding grounds, which are owned or occupied by the service provider in connection with the carrying on of the regulated activity.
Care Quality CommissionOutcome 10 - Safety and Suitability of PremisesWhat should people experience?Safe, accessible surroundings that promote wellbeing the design and layout of the premises being suitable for carrying out the regulated activity appropriate measures being in place to ensure the security of the premises; the premises and any grounds being adequately maintained compliance with any legal requirements relating to the premisesTake account of any relevant design, technical and operational standards andmanage all risks in relation to the premises. Are premises fit for purpose!
How are Surgeries funded?• Premises Reimbursement • NHS Premises Costs Directions 2004 Notional Rent Cost Rent
Maximising Surgery Income • Notional Rent Premises Improvement Patient Experience Value / Income Stream Enhancement Capital Value • PCT Funding – ‘NHS Capital’ (Abatements!)
Can your premises work harder? Pharmacy “Implantation” New Development Internal Re-Development Extension Letting Out Surplus Space
Feasibility Study / Business Plan All development work requires PCT approval!
First StepsThe Journey!Step 2 - How to meet the CQC Requirements?Business Case and Feasibility Study Develop a robust business case Issues highlighted by the 6 facet survey Service led Look at the asset you hold What do your require? What are the benefits? How much will it cost? Additional services Feasibility Study Identify potential sites Initial Proposals: Plans Land Take Budget Cost Potential increased income
Letting out surplus space Sports injury specialists Opticians Eye clinics Always seek advice Chiropodists on usage and terms! Dentists Masseuse Physiotherapists Counselling services
Asset Management• Proactive Management• Maintenance – Program of Planned Maintenance (PPMs) – Defect Diagnosis and Costings• Budgetary planning – Prevent a small cost spiralling into a major financial liability!
Maximising PremisesThe Journey!Refurbishing Existing Premises Why? Compliance with CQC and statutory regulations Infection Control Accessibility Comply with current HTM’s Internal Environment Functionality – Better use of Space Potential Additional Services Energy Efficiency and Savings Improvement Grants/Rent Reimbursement? Self-Funding? Professional Team to Oversee Project Phased Works
Maximising PremisesThe Journey!Extend Existing Premises Why? Site Constraints Like your existing location Potential Additional Services Pharmacy, Dentist Collaboration Improvement Grants/Rent Reimbursement? Self-Funding? Appoint a Professional Team
Maximising PremisesThe Journey!New Build Meets all the requirements of the CQC and future proofed Find a Site in the right location? Size of premises Additional Services can be incorporated Local Authority Dentists NHS Services Physiotherapy Collaboration/Mergers Efficiency Savings on space Funding Capital Cost – Bank, Investor 3PD Joint Ventures Appoint a Professional Team
New Build ExampleImages courtesy of The Ridge Medical Practice
ProcurementThe Journey! Appoint a Professional Team Architect Quantity Surveyor Mechanical Consultant Electrical Consultant Structural Engineer CDM-Coordinator Other specialists Statutory Approvals Type of Contract Appoint a Professional Team
SummaryIs doing nothing an option?Appoint experienced healthcare professional at an early stage
Remember!• Notional Rent or Cost Rent?• When was your last review?• PREM1 Forms!• PCT Approval• Business Plan• Patient Experience• Seek Advice!
For additional information and free advice contact: GP Surveyors 0845 143 0019 / firstname.lastname@example.org www.gpsurveyors.co.uk & Bowman Riley Healthcare Architects 0113 391 7570 / email@example.com www.bowmanriley.com
People Management and CQC Ruth Ingman firstname.lastname@example.org
In Context• It will happen ... February start planning• July 2012 Registration opens• September 2012 Assessment begins• April 2013 Registration complete• Time• Money• Responsibility
CQC Compliance• This is not – A box ticking exercise• This is – Embedding processes within your practice – Seeing organisational change – Demonstrating compliance – “Prove It”• This is not – As scary as you thought – probably!
What do you need?• Contracts and Staff Handbook• Documented Processes and Procedures – Recruitment Procedure – Induction Process – Performance Management System – Discipline, Grievance and Appeal Processes• Archive Appropriate Documentation• Sound Communication Protocols
People Management and CQC Ruth Ingman email@example.com
NCSEM - SheffieldTransforming Sheffield into The City of Physical Activity
Vision To be recognised as the City that created a Culture of Physical Activity within itscommunities, workplaces and people through the Legacy of London 2012 Olympic and Paralympic Games.
Mission Through a unified and city wide approach we will support evidence based initiatives that;• seek to reduce the burden of disease across the City,• promote economic growth through a sports culture,• improve the health and productivity of the Citys workforce and• facilitate more active lifestyles for the population of Sheffield as a whole.
Measures of success• To bring benefit socially & economically we are aiming for: • 1% stepped change in physical activity at a population level year on year • 15% Reduction in back pain related absenteeism in 5 years • 15% reduction in back pain referrals in 5 years • 2-3% reduction in CVD risk factors at population level over 5 years• These changes are challenging but evidence based• Represent a significant attempt at a cross population implementation project.
Modest - Invest to save• If the average risk factors across Sheffield were reduced by 2% - 3% over five years this could: • reduce annual admissions by up to 1,235 per year, • prevent up to 426 premature deaths per year and • save up to £3.7 million per year on acute hospital costs alone • Non-recurrent cumulative savings over the five year period could be as high as £11.2 million. Based on Whitfield et al., 2008
Optimistic - Invest to save• If the average risk factors across Sheffield were reduced by 5% - 6% over five years this could: • reduce annual admissions by up to 1,984 per year, • prevent up to 640 premature deaths per year and • save up to £5.9 million per year on acute hospital costs alone • Non-recurrent cumulative savings over the five year period could be as high as £17.7 million. Based on Whitfield et al., 2008
Three Interconnected Themes Physical Workforce Sporting Activity Wellness Economy• Ecological model of physical activity• Provide targeted and universal support• Focus on Musculoskeletal (MSK) conditions & mental health• A whole city approach to establishing legacy• Connected through one brand, one message.
Physical Activity• Promotion of ‘physical activity’ at an individual, group, community and population level in a wide range of settings across the City• This bespoke physical activity comprises two forms: – ‘primary prevention’, increasing physical activity in people with no health restrictions to activity – ‘secondary prevention’, tailored physical activity for people with some health restrictions to activity.
Physical Activity• Guided by current literature, there will be a particular emphasis on; • developing an environmental infrastructure that facilitates physical activity • challenging and changing the culture around physical activity/inactivity • promoting physical activity among disadvantaged groups who may not have access to activity/sport or sport and activity-related facilities.• The process of delivering a physical activity legacy is not one of investing solely and immediately in interventions• Pilot programmes and allow the evaluation/research evidence to inform any potential roll out.
Workforce Wellness• Harnessing workplaces in the promotion of healthy living at an individual, group, community and population level in a range of settings across the City (i.e. workplaces, schools, homes)• Evidence based approach to interventions with a focus on musculo-skeletal conditions (MSK) & mental health and wellbeing• Embedded within organisational culture, business owning the bottom line benefits• Reduced absenteeism and increasingly more productive workforce (presenteeism).
Sporting Economy• The development of a sporting economy in Sheffield through the NCESEM and associated projects• Unlike the physical activity and workforce wellness themes, the evidence for leveraging a sporting economy through interventions is limited• Programme of in-depth stakeholder consultation and real-world research to inform interventions later in the programme (years 3-5).
Sporting Economy • How can the NCESEM help create a reputation for Sheffield as an international City of Sport?WP - 1 • How can the NCESEM be used to strengthen links between events, sporting participation and sportingWP - 2 economy? • Can we develop an economic model for Sport to demonstrate cost-effectiveness (cost to save)WP - 3 benefits for the NHS and health sector?
What does NCSEM mean for you and for Joe? • A physical activity solution for Sheffield • Clinical impact and evidence-driven • Embedded into communities • Support for you and for Joe
Thank you for Listening Dr Robert Copeland C.Psychol Principal Research Fellow firstname.lastname@example.org 0114 225 5635
Paul HudsonEnglish Institute of Sport - Sheffield
Lloyds Banking Group Healthcare Yorkshire Area Your local specialists cover the following sectors: CARE HOMES OPTICIANS DENTISTS DENTISTS VETERINARY PRACTICES PHARMACIES GENERAL PRACTIONERS LEARNING DIFFICULTY CHILDRENS NURSERIES Craig Bennett Graham Scott Steve Midgley Senior Manager Key Markets Commercial Healthcare Banking Consultant Healthcare Relationship Manager 14 Church Street, Sheffield 5 St Helen’s Square, York 20 Market Place, Dewsbury Mob: 07595 124404 Mob: 07921 105405 Mob: 07725 426639 Craig.email@example.com graham.scott1@lloydstsb firstname.lastname@example.org Lee Rycraft Stephen Denham Healthcare Relationship Julian Blythe Wendy Ramshaw Healthcare Banking Consultant Manager Healthcare Relationship Manager Healthcare Relationship Manager 14 Church Street, Sheffield6/7 Park Row, 1st Floor, Leeds 14 Church Street, Sheffield 2 Pavement Branch, York Mob: 07738 311942 Mob: 07725 426655 Mob: 07825 111188 Mob: 07725 email@example.com steve.denham@lloydstsb Jjulian.firstname.lastname@example.org Wendy.email@example.com
Completed and Work in Progress Projects in Last Two Years• South Yorkshire – 3 New Surgery Developments• South Yorkshire – 2 New Projects• West Yorkshire – 1 New Development• West Yorkshire – 2 New Projects• North Yorkshire – 2 New Projects• Lancashire – 1 New Surgery Development• Lancashire – 2 New Projects• Yorkshire – 7 Projects at Early Stage DiscussionsThese are all active examples and we are actively looking for more business. Yours could be the next one!!!
Healthcare Index Wave 2 - All Sectors In the future would you like to be involved in premises ownership? GPs35 % 29 % 30 % Pharmacists30 % 27 % 28 % 26 % 25 % Dentists25 % 23 % 21 % 19 %20 % 17 % 16 % 16 %15 % 9% 10 %10 % 4% 5% 0% Definitely Probably Probably not Definitely not Don’t know Why are you likely to move to a new business/practice premises within the next 5 years? 47 % GPs50 % 44 %45 % 38 % Pharmacists40 % 31 % 33 %35 % 30 % Dentists30 % 24 % 25 % 23 %25 % 19 %17 %20 % 13 %15 % 9% 11 % 6% 7%10 % 3% 4% 5% 0% Expansion Required Relocating Merging Improve Other of business by to new with facilities regulation area another
Surgery Developments – Why Ownership • Do you own your own house? • Do you have a mortgage? • Who pays your mortgage? • Tax Relief • Pension?
Surgery Developments – the starting point …What stage has been reached??? • Do you own the building you are currently in and does the scheme refer to this building. • Is the PCT aware of scheme and support obtained. • Who will we be lending to? - Prop Co / Op co? Structure? • Has Business Case been produced • Has a Financial Case been produced
Surgery Developments – the starting point …Gaining an understanding • Has Notional Rent been agreed by DV / PCT. • Are there any key dates that need to be met besides a start and completion date • Has the scheme been submitted before to PCT, planners, professionals etc. If so what was outcome/decision. • Have any professionals already been appointed? Who are they? • Is there any information available on the scheme – drawings, plans etc.
Surgery Developments – the next steps …Funding commitment • Agreement in Principle – issue of Indicative Terms. • Professional Valuation appraisal. • Formal commitment – with full supporting information. • Appointment of Professionals:- – Monitoring Surveyor – Bank Solicitor • Funding for the land acquisition • Funding for the development • Agreement on the long term funding
Surgery Developments – the next steps …Specialist Team • Architect / Project Manager • Surveyor/ QS • Solicitor • Accountant • Bank • Capital Allowance Expert • VAT Expert
Surgery Developments – the next steps …Moving through the project • Protecting your Risk:- - Hedging options - Protecting the Partners • Monitoring and drawdown - The role / responsibilities of the HBC and Relationship Manager - Early discussion on variances • Drawdown on the Commercial Mortgage - Interest only option - The start of the hedging strategy
Surgery Developments – summary checklist …………. • Buy or Rent? • Who is going to own? • Who is going to be responsible within the practice? • Have we got our team together? • Who else do we need to speak to?
Surgery Developments – the next steps…Thanks for listening – any questions??????? Graham Scott ACIB Senior Healthcare Banking Consultant, Lloyds TSB Bank PLC Email firstname.lastname@example.org Telephone - 07921 105405
GP Hot TopicsLegal Issues in Primary Care Michelle Hayward and Mark Serby
Significant Change• Registration of Primary Care providers with CQC – 1 April 2013• Industrial action re pension changes• Health & Social Care Bill
Outline• The importance of Partnership Agreements• Retirement• Some CQC issues• New developments applicable to Primary Care• Employment Law
The Importance of Partnership Agreements CQC impact: A partnership is a practice that has “arrangements in place for joint and several liabilities which all members of the partnership agree to”.• But a written agreement is not a pre requisite to registration• Is there a Partnership Agreement? If so, is it up to date? New and retiring partners Unsigned Agreements - acting in accordance with the unsigned Agreement
The consequences of not having an express Partnership Agreement: The Partnership Act 1890 applies Dissolution• S26 - any partner can dissolve the entire partnership by notice with immediate effect.• PCT has ability to terminate S560.10.2 if “an event happens that makes it unlawful for the business of the partnership to continue or for members of the partnership to carry on in partnership together”.• Breach of CQC requirements and PCT requirements to give advance notice of changes
Expulsion:• S25 - the partnership has no ability to expel under Partnership Act 1890• Must have express provision to expel• Partners could be breaching CQC outcomes and/or GMS/PMS contract with no ability to oust defaulting partner• But PCT’s often require notices of partnership changes to be signed by all partners. How likely in the case of expulsion? Include Power of Attorney.• Dovetail expulsion events with breach of CQC outcomes and events whereby the PCT can terminate the contract.
Death and Bankruptcy• S33 – death and bankruptcy dissolve the entire partnership• PCT has the ability to terminate (for GMS S560.10.2) but contrast S540 which suggests that the contract can continue with the remaining partner, (if a general medical practitioner). Profits• S24 equal entitlement
Legal/Practical Issues on Retirement• How many months’ notice?• That death/retirement of 1 partner does not dissolve the partnership;• Property – key asset: provision for valuation. Who is it owned by? Any outstanding loans/mortgages?• Does incoming partner have funds to buy into the property?• Payment terms for outgoing partner• Indemnity• Default retirement age?• Restrictive covenants• Run off cover: e.g. MDU – claims made basis but discretionary cover only for claims once no longer a Member
CQC Issues - Timetable• Online registration – July 2012• Application submission – from September 2012• Practices pick 28 day window for submission, applications processed – September 2012 – March 2013;• Registered Manager – day to day control of regulated activities: CQC states a partner will be most appropriate.
Outcome 10 – safety and suitability at premises• Where will financial assistance come from if non-compliant?• Pulse foresee sale and leasebackOutcome 12 – requirements relating to workers:• Effective recruitment procedures to ensure: ~ Of good character; ~ Has the qualifications, skills and experience necessary for the work to be performed; ~ Is physically and mentally fit for the work; ~ Relationship with Equality Act 2010 – only allows you to ask candidates about health/disability after job offer and then make reasonable adjustments.
Employment Law Reform• Increase the minimum qualification period for an unfair dismissal claim from one year to two• Introduce fees to lodge a tribunal claim and to progress it to hearing• Introduce a compensated no-fault dismissal for micro firms (those employing ten or fewer employees)• Introduce a “rapid resolution” scheme for simple tribunal claims, which could involve an independent legal expert reaching a decision on written evidence.
Employment Law Reform• Oblige all Claimants to submit their claim to ACAS before it can be taken to tribunal, in order to give conciliation a chance.• Introduce a system of “protected conversations” to allow employers to raise issues with employees free from the worry that this will later be used in tribunal proceedings.• Extend the right to request flexible working and modernise maternity leave so it becomes shared and flexible parental leave.
Legal/Case Update• RCN limit nurses indemnity cover in general practice;• Fixed share partners• Tiffin v Lester Aldridge – recognised a fixed share partner as self employed• Flasz & others v Greenwich and Havering PCT
Legal Issues in Primary Care Michelle Hayward & Mark Serby Partners at Wake Smith LLP 0114 266 email@example.com | firstname.lastname@example.org
Ask the Experts: Michelle Hayward – Wake Smith LLP Graham Scott – Lloyds TSB Ruth Ingman - UtiliosMark Dean – Bowman Riley Healthcare James Williams - GP Surveyors