Wilson Family Wealth Goal Achiever - InKnowVision Advanced Estate PlanningInKnowVision
Each month we looked at a specific situation taken from the InKnowVision case files. We review the facts and circumstances, the Family Wealth Goal Achiever Process, and the solutions used in the case.
Learn more at www.inknowvision.com
Wilson Family Wealth Goal Achiever - InKnowVision Advanced Estate PlanningInKnowVision
Each month we looked at a specific situation taken from the InKnowVision case files. We review the facts and circumstances, the Family Wealth Goal Achiever Process, and the solutions used in the case.
Learn more at www.inknowvision.com
Rowena Crawford: NHS and social care funding: the outlook to 2021-22Nuffield Trust
In this slideshow, Rowena Crawford, Senior Research Economist at the Institute for Fiscal Studies, provides the outlook for NHS and social care funding over the next decade and examines the trade-off between English NHS spending and other public service spending during this period.
The slideshow is related to: NHS and social care funding: the outlook to 2021/22 (July 2012 ), an Institute for Fiscal Studies (IFS) report by Rowena Crawford and Carl Emmerson, funded by the Nuffield Trust. More information can be found on our website: www.nuffieldtrust.org.uk.
Rowena presented at the Nuffield Trust and Institute for Fiscal Studies event: NHS and social care funding: the outlook for the next decade.
Presentation given at the San Diego County Water Authority's Special Board of Directors' Meeting on Nov. 8, 2012. To view agenda visit www.sdcwa.org/meetings-and-documents
April 2009 Philadelphia Housing MarketRajeev Sajja
Philadelphia Housing Market - Should I Buy?
By Kevin C Gillen Ph.D
Kevin Gillen is a respected source of real estate information for the Philadelphia area, was asked to prepare a report on the Philadelphia housing market for Mayor Nutter. It will be used at a city-wide housing fair. His report was made available to Prudential Fox & Roach, Realtors
It's an A.R.M.'s Race (Acquisition, Retention and Monetization in Mobile Gaming)Betable
Tapjoy's Brian Sapp gave this presentation at the SF Game Monetization meetup. If you're in San Francisco, join the meetup to see more presentations like this:
http://www.meetup.com/SFGameMonetization/
Be sure to thank Brian for letting us publish this by tweeting him at @sappalicious (http://twitter.com/sappalicious)
Rowena Crawford: NHS and social care funding: the outlook to 2021-22Nuffield Trust
In this slideshow, Rowena Crawford, Senior Research Economist at the Institute for Fiscal Studies, provides the outlook for NHS and social care funding over the next decade and examines the trade-off between English NHS spending and other public service spending during this period.
The slideshow is related to: NHS and social care funding: the outlook to 2021/22 (July 2012 ), an Institute for Fiscal Studies (IFS) report by Rowena Crawford and Carl Emmerson, funded by the Nuffield Trust. More information can be found on our website: www.nuffieldtrust.org.uk.
Rowena presented at the Nuffield Trust and Institute for Fiscal Studies event: NHS and social care funding: the outlook for the next decade.
Presentation given at the San Diego County Water Authority's Special Board of Directors' Meeting on Nov. 8, 2012. To view agenda visit www.sdcwa.org/meetings-and-documents
April 2009 Philadelphia Housing MarketRajeev Sajja
Philadelphia Housing Market - Should I Buy?
By Kevin C Gillen Ph.D
Kevin Gillen is a respected source of real estate information for the Philadelphia area, was asked to prepare a report on the Philadelphia housing market for Mayor Nutter. It will be used at a city-wide housing fair. His report was made available to Prudential Fox & Roach, Realtors
It's an A.R.M.'s Race (Acquisition, Retention and Monetization in Mobile Gaming)Betable
Tapjoy's Brian Sapp gave this presentation at the SF Game Monetization meetup. If you're in San Francisco, join the meetup to see more presentations like this:
http://www.meetup.com/SFGameMonetization/
Be sure to thank Brian for letting us publish this by tweeting him at @sappalicious (http://twitter.com/sappalicious)
Reshaping the healthcare workforce - Candace imisonNuffield Trust
For the Nuffield Trust Health Policy Summit 2016, Candace Imison talks about what steps would be necessary to develop and reshape the health care workforce.
Our July 2012 Monthly Report includes details on everything happening in Columbus region economic development, including major projects from MSC Industrial, Sarnova and AutoTool.
Team presentation at Leadership 2.0, University of the Aftermarket, Northwood University, April 15, 2010.
This presentation outlines a roadmap for international growth, with a general matrix for market entry decisions.
Wellness & Consumer Driven Health Careguest00dbec2
See how oer 12,000 other businesses across the U.S. areusng Wellness & Consumer Driven Health Plans as an effective business strategy. How does your company compare?
Wellness & Consumer Driven Health Careguest00dbec2
Learn from what over 12,000 other businesses are doing across the U.S. with Wellness and Consumer Driven Health Plans as a business strategy. How does your plan compare?
Mercer Capital’s Asset Management Industry Newsletter | Q4 2012 | Focus: Trus...Mercer Capital
Mercer Capital’s Asset Management Industry newsletter is a quarterly publication providing perspective on valuation issues pertinent to asset managers, trust companies, and investment consultants.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Effectiveness of the current dominant approach to integrated care in the NHSNuffield Trust
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Lisa Annaly, Head of Provider Analytics at the Care Quality Commission, discusses lessons learned from the CQC as they have worked to monitor care quality over time.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Monitoring quality of care: making the most of dataNuffield Trust
Chris Sherlaw-Johnson, Senior Research Analyst at the Nuffield Trust, introduced the Monitoring quality of care conference and gives an overview of some of the approaches that we've been using at the Trust to identify where care quality has been improving, especially for frail and older people.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
New Models of General Practice: Practical and policy lessonsNuffield Trust
Nuffield Trust policy researchers Rebecca Rosen and Stephanie Kumpunen present findings from our upcoming report on large scale general practice models.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lawrence Casalino: what GP consortia might learn from the US
1. What GP Commissioning Consortia might learn from
the development of physician groups in the US: a
synthesis of 20 years experience to avoid failure
Lawrence Casalino MD, Ph.D.
,
Livingston Farrand Associate Professor of Public Health
Chief, Division of Outcomes and Effectiveness Research
We Co e
Weill Cornell Medical College
ed ca Co ege
New York City
The John Fry Lecture Nuffield Trust
October 18, 2010
2. Today’s talk
1. Two organizing frameworks for
thinking about GP commissioning
g g
consortia
2. U.S.
2 U S experience with “consortia” and
consortia
commissioning
3.
3 Seven theses on GP commissioning
4. Suggestions from an outsider
3. Two views of quality
• the individual physician view
• the organized process view
h i d i
4. Two types of things that must be
created
• incentives
• capabilities
• performance = f(i
f f(incentives +
i
capabilities)
5. Exhibit 12. Premiums Rising Faster Than Inflation and Wages
Cumulative Changes in Components of Projected Average Family Premium as
U.S. National Health Expenditures and a Percentage of Median Family Income,
Workers’ Earnings, 2000–2009 2008–2020
Percent Percent
125 25 24
23
Insurance premiums 22 22
108% 21 21
Workers' earnings 20 20
20 19 19 19
100 18 18 18 18 18
Consumer P i I d
C Price Index 17
16
15 14
75 13
12
11
10
50
32%
5
25
24%
0
2011
1
1999
9
2000
0
2001
1
2002
2
2003
3
2004
4
2005
5
2006
6
2007
7
2008
8
2009
9
2010
0
2012
2
2013
3
2014
4
2015
5
2016
6
2017
7
2018
8
2019
9
2020
0
0
2000 2001 2002 2003 2004 2005 2006 2007 2008* 2009*
Projected
* 2008 and 2009 NHE projections.
Data: Calculations based on M. Hartman et al., “National Health Spending in 2007,” Health Affairs, Jan./Feb. 2009;
and A. Sisko et al., “Health Spending Projections through 2018,” Health Affairs, March/April 2009. Insurance
premiums, workers’ earnings, and CPI from Henry J. Kaiser Family Foundation/Health Research and Educational
THE
Trust, Employer Health Benefits Annual Surveys, 2000–2009. COMMONWEALTH
FUND
Source: K. Davis, Why Health Reform Must Counter the Rising Costs of Health Insurance Premiums, (New York:
The Commonwealth Fund, Aug. 2009).
6. Exhibit 1. National Health Expenditures per Capita, 1980–2007
Average spending on health per capita ($US PPP)
$
8000
United States
7000 Canada
France
6000 Germany
Netherlands
5000 United Kingdom
4000
3000
2000
1000
0
1980 1984 1988 1992 1996 2000 2004
THE
COMMONWEALTH
FUND
Data: OECD Health Data 2009 (June 2009).
7.
8. Quick summary: history of U.S.
US
“commissioning”
• Anticipated move to “full-risk” contracting did not
occur.
• Most physician organizations created to engage in
risk contracting failed
– ~ 2000 IPAs created
– ~ 200 IPAs successful (at the most)
• High profile failures of large fund-holding IPAs.
• There is now little or no risk contracting in most of
the U.S.
• In California and pockets elsewhere, risk
contracting persists in modified forms.
9. Why did risk contracting fail,
fail
overall, in the U.S.?
• policy failures
• organizational failures
i i l f il
10. Policy failures - failure to:
• risk-adjust
• balance incentives
– physicians and patients perceived risk contracting to be
h i i d i i d ik i b
about reducing costs
– not about improving quality or patient experience
• provide timely, accurate, transparent information to
id i l i f i
the “consortia”
• recognize how difficult it is to build competent
g p
physician organizations
• reduce incentives for specialists and hospitals to
churn high profit services
11. Organizational failures - failure to:
• invest in:
– physician leaders
– skilled managers
kill d
– IT
– adequate staff (e.g. nurse care managers)
(e g
• adequately analyze the level of risk
• track IBNR (incurred but not reported)
( p )
• motivate/coordinate their physicians
• g
gain specialist/hospital cooperation
p p p
12. Flow of funds?
NHS
GP Consortium
Hospital
GPs
Consultants
13. Thesis 1
It will be extremely difficult to create
high-performing GP
g p g
commissioning consortia. The
g
government should not expect that
p
large numbers of high performing
g ,
consortia will be formed overnight,
or even within 3-5 years.
14. Necessary capabilities for GP
consortia
• leadership
• organized processes to improve care (not
g p p (
just to commission it)
• sophisticated information collecting and
processing
– and people with the time and skills do do
something with the information
thi ith th i f ti
– sophisticated financial capabilities, including
both accounting and modeling
g g
15. Necessary capabilities for GP
consortia (more)
• ability to create and manage
relationships with many external
entities
• ability to pay claims??
• a culture of cooperation and quality
improvement
– not only within the GP consortium, but
with outside entities as well
16. Even with perfectly designed incentives,
incentives
the risk of failure is high
• inadequate supply of GP leaders
• GP consortia likely to underinvest in
management
• takes time to develop culture
• may b very diffi lt t gain cooperation
be difficult to i ti
from consultants and hospitals
• GP consortia will be more like IPAs than
multispecialty medical groups or integrated
systems
17. Thesis 2
It will be necessary to create
incentives for cooperation at
multiple levels within the health
care delivery system.
- GP consortium
i
- GP practice/individual GP
- consultant/specialist physicians
- hospitals
- and others
18. To gain support from rank and file
GPs:
• GPs must believe that changes will
significantly improve some or all of
g y p
the following:
– quality of care for their patients
– quality of their workday
– respect from their peers
– physician income
19. Ways to influence physicians within
an organization
• develop an organizational culture
• include only physicians compatible with the desired
culture
• educate/persuade/develop guidelines
• show physicians in the organization data on:
– the organization’s performance
– the performance of practices/individual MDs within the
organization
• choose payment methods to reward desired
behavior
• require prior approval for certain
referrals/procedures (for some physicians?)
20. Thesis 3
Incentives should not focus primarily
on generating savings/reducing the
g g g g
cost of care. They should be
balanced among quality, p
gq y, patient
experience, and cost-control.
22. Should have:
• risk-adjustment
• moderate upside and smaller downside risk,
p ,
gradually increasing over time
– threat to close a consortium not likely to be
enough when consortium membership i
h h i b hi is
required for GPs
• risk modifiers - e g stop-loss insurance for
e.g. stop loss
outlier patients
23. Thesis 5
It will be critically important to find
ways to foster collaboration among
y g
GPs, specialist physicians, and
p
hospitals.
24. What’s in a name?
• GP Commissioning is likely not an
ideal name
• Why not call it “GP Dominance?
GP Dominance?”
25. Other barriers
• basically impossible to form a
multispecialty group
p yg p
• incentives not aligned: Payment by
Results
26. We ll
We’ll know the system is working
when:
• GPs and consultants frequently discuss
p
patients on the telephone
p
• Phone conversations often replace
visits to consultants
28. Management costs
• critical to have:
– skilled clinical and lay leaders
– infrastructure support (people and data)
– data in itself is useless
• th must be leaders whose only or main job is to
there tb l d h l i j bi t
help the GP group improve the care provided
• left to themselves, GPs will under-invest in
,
management
– (at least until they see a reliable ROI)
29. Thesis 7
• GP commissioning is likely to result in
the transfer of a large amount of NHS
g
funds to the private sector
– (for better or for worse)
30. UK advantages (1)
• “single payer” gives the opportunity to:
– collect comprehensive data
– risk adjust
– balance incentives (cost, quality, patient
experience)
i )
– invest in the development of physician leaders
– invest in management costs in GP consortia
31. UK advantages (2)
• public acceptance of GPs
• savings perceived as going to NHS,
not to corporate executives and
shareholders
32. UK advantages in developing
physician leaders
• NHS can pay GP leaders
• NHS can provide training for GP
leaders
• NHS can provide an attractive career
track for GP leaders
33. Suggestions (1)
1. anticipate failures; don’t overinflate
expectations for rapid, widespread change
2. b d f gradual performance
budget for d l f
improvement by GP consortia
- provide upside and downside incentives
- with incentives increasing over time
3. balance incentives: cost, q
, quality, p
y, patient
experience
34. Suggestions (2)
5. make it possible for GP consortia to have
financial leverage vis-à-vis member
physicians/practices
6. seek ways to create substantial financial
incentives for hospitals and consultants to
cooperate with GP consortia
7. seek ways to make it attractive for
consultants to join with GPs in creating
multispecialty medical groups
35. Suggestions (3)
8. provide substantial ring-fenced
management funds to GP consortia for 4
years,
years then blend into their budget (and ?
reduce the funds)
9. consider a name other than “GPGP
commissioning”
10. invest in developing GP and consultant
leadership