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Bury GP Practices Ltd Appointment of Chief Officer Information Pack for candidates Company Number 8291762 January 2015 Letter from the Chairman January 2015 Dear Colleague, Thank you for asking for further information regarding our vacancy for a full-‐time Chief Officer to lead the company over the coming years. This is an exciting opportunity for someone to be at the forefront of developing new models for the delivery of general practice and primary care and the realisation of the NHS England “Five Year Forward View” This information pack aims to give you an insight into the company as well as providing the Job Description and Person Specification for the role. Although we are a private company we hold a strong affiliation to the NHS, its constitution and guiding principles, but with an organisational structure and framework which allows us to act more rapidly and flexibly than some elements of the NHS. If you would like to speak informally about this opportunity please do not hesitate to contact me to make arrangements to do so. With very best wishes. John Boyington CBE Chairman [email protected] 2 INFORMATION PACK Introduction: Bury GP Practices Ltd was registered at Companies House and incorporated on 13th November 2012 with the first substantive Director appointed in November and the full Board in place from February 2013. The Company trades as “Bury GP Federation” and was created to provide high quality, cost-‐effective health and care services to the population of Bury and provide a financial return to shareholders. During its first full year of operation the Board focused much of its early priority around organisation establishment and the creation of effective governance and management systems. In our second trading year we have developed our company infrastructure and focused on delivery of our Healthier Radcliffe project, the Prime Minister’s Challenge Fund and our bid to provide anticoagulation and wound care services to the local population. In the first full 12 months of operation the Company secured contracts with NHS England and with Bury CCG for business totalling over £4.75m. The financial forecast for this year predicts that the Company should make a surplus of around £90 -‐ £100k in the 12-‐month period to the end of March 2015. Company Structure: Bury GP Practices Ltd was registered with Companies House on 13th November 2012 as a Company Limited by Shares. 26 of Bury CCGs General Practices opted to be initial shareholders and loaned the Company £0.99 per share owned. Share distribution was calculated on numbers of registered patients on each shareholder practice list. Payments were made in a number of instalments to September 2013. In March 2014 four of the remaining seven non-‐member practices in Bury opted to become members and their membership was approved by the existing shareholders. Their membership was on the same basis as initial shareholders although they are not entitled to any benefits derived by the Company prior to them joining on 1st April 2014. Despite repeated invitations and disappointingly the 3 other practices have consistently declined membership and have now been informed that another opportunity will not now be available until early 2015. Organisational framework: The Shareholder Agreement, based on the agreed Articles of Association, vests the authority for day-‐to-‐day running of the organisation in a Board of Directors. The Board is accountable to shareholders through an Annual General Meeting or through Extraordinary General Meetings called by the membership. The shareholder agreement governs major issues of governance within the organisation whilst the governance framework sets out the day-‐to-‐
day requirements and detail. Our Articles of Association and other governing documents are currently under review led by Hempson’s Solicitors who are reporting to shareholders with a view to changes being sought by April 2015. 3 Composition of the Board: The Board is currently composed of 4 members: a Chair independent of the shareholders, a Clinical Vice chair and an Organisational Medical Director, both appointed from within the shareholder practices and serving for a period of 3 years each; and a Chief Officer appointed in open competition and serving for an unlimited period subject to performance. A fifth post, that of Head of Finance was not substantively filled during the past year but financial expertise is being procured an interim basis by a highly experienced former PCT Director of Finance although this post has not been operating as a member of the Board. Corporate role of the Board: The Board functions as the company’s corporate decision-‐making body. The corporate role of the Directors will continue to be consideration of key strategic and managerial issues facing Bury GP Federation whilst carrying out its statutory and other functions. It is also essential that the Board, supported by the clinical links, maintains close communication and engagement with shareholders to continue to elicit their support. Company operations: Meetings of the Board: One meeting every 6 weeks is a formal Board meeting. The remainder of meetings are held every other week and are used for Board members and invited guests to discuss development ideas and opportunities as well as day-‐to-‐day operational issues. It is proposed that this pattern of meetings will continue. In order to secure more effective communication and engagement, especially of clinicians in member practices, the Board has appointed three Clinical Link posts. These posts will devote 1 session per week to engagement and communication. Commitment from practices: In addition to the employees and contractors identified above member practices committed to give an annual amount of time to the organisation. This has been done in blocks or hourly on pieces of work again depending on the contribution and skills required by the organisation. This system has allowed for flexibility to both practices and the Company with practices able to contribute more or less depending on the task/service requirement. People within practices with specialist’s skills and knowledge will be encouraged and want to contribute to a flexible system. This system is currently under review. Market Analysis: There continue to be several major factors that primarily affect the business environment within which the Company is operating. Overall NHS resources continue to contract due to economic pressures and the national QIPP challenge requiring the service to liberate around £20bn over 5 years for reinvestment. 4 Whilst this creates a significant challenge it also delivers a major opportunity, requiring new approaches to current services to deliver better quality and greater efficiency by redistributing resources. The recent Five Year Forward View means that the Company is well placed to offer more efficient and effective primary care and community based alternatives for commissioners who are seeking to shift services from more expensive secondary care provision. Reports from well established and respected national organisations such as ‘The Kings Fund’ and ‘The Nuffield Institute’ have indicated that models of primary care delivery like that adopted by the Company offer the best way forward for primary care development and secondary care dissemination. Our success against the Prime Minister’s Challenge Fund has positioned the Company at the forefront of alternative methods of delivery for GP services and will enable significant change in GP services in Bury. In Greater Manchester the conurbation-‐wide “Healthier Together” initiative seeks to rationalise the pattern of provision of secondary care services. One key aim of the programme is to ensure that services and care are delivered as close to home as possible and the Company is ideally placed to support this. These financial pressures are also being felt in primary care where drives for efficiency continue and practices strive to find new and more cost effective ways of delivering their back office services and mobilising ways of achieving greater efficiency of procurement and associated costs. The NHS must improve its performance and, in particular, A&E performance across the system. Primary care and the delivery of extended hours have a critical part to play in achieving this and this creates another significant opportunity for the Company. Initiatives like the rollout of more integrated approaches to health and social care also offer opportunities for the Company to expand its business base. With around £3bn of NHS money being used to support this initiative there are a number of areas for development including improved services for older people both at home and in residential and nursing care. Finally the membership base of the Federation presents significant opportunities. We represent one of the largest such Companies formed by GPs. Since expansion we now represent coverage of approximately 91% of all patients registered with Bury GPs with 30 of the 33 practices in membership. This offers the Company a significant base from which to influence commissioners and suppliers and for working in partnership with other NHS and commercial service providers. The recent organisational changes in the NHS created a more cost constrained commissioner infrastructure for both secondary and primary care. Representing a large membership gives the Company the opportunity to effectively offer agency services to commissioners undertaking commissioning work on their behalf across our membership base. Whilst there are many opportunities there remain a number of key challenges. Commissioners remain cautious about making major changes in their commissioning portfolios for fear of destabilising the current system. The advent of CCGs places GPs at the heart of commissioner decision-‐making but this too presents a challenge with heightened sensitivity to criticism over conflicts of interest. 5 There is a rapidly developing private provider system which is now extending to primary and community services and increasing the competitive challenge for the Company. This increased private sector will see greater sensitivity in the future to formal procurement rules and the Company has to be able to operate effectively within this environment. Overall the Company needs to ensure that it has the ability to critically assess opportunities rapidly and commit resources to their pursuit where appropriate. This will inevitably lead to some investment in projects that do not come to fruition and this is unavoidable. Equally the Company needs to ensure that it is clear about those opportunities that it needs to pursue on a more planned basis. Business Strategy Marketing and Communication: As a new type of organisation we will continue to devote significant time and effort to engaging with potential customers for our services. These may be commissioners or other providers and indeed our own members. We need to ensure that they are aware of the potential of the organisation to deliver improvements in efficiency, effectiveness and quality for them. We need to exploit the unique nature of our organisation being both within the commercial sector and thus able to operate outwith some of the traditional constraints of NHS organisations whilst also being composed of trusted local NHS practitioners. Constraints: The biggest single constraint has been that of capacity within the organisation. All of those involved have had only a part time commitment and therefore limited time to devote to Company business. With our success in securing the PMCF bid we have now increased our Chief Officer input to full time and engaged clinical links who will also increase our capacity. Finally we hope that our developing working relationship with PA Consulting will give us some additional flexibility to investigate some internal business areas. However as a small organisation we will need to remain ruthlessly focussed on assessing the most viable commercial opportunities that chime with the values and beliefs of the organisation. The Board will continue to have to have a clear business strategy to frame its actions whilst retaining sufficient flexibility to respond to new and evolving opportunities. Of necessity and given the fluidity of the current market, the Company Business Strategy continues to be presented at a high level recognising that as a new and currently small organisation we have to be cautious not to over-‐reach our capacity to deliver quality products and services. Income, surpluses and dividends: The first priority for the Company is to develop income streams that can be used to generate operating surpluses that will, in turn, generate funding to maintain the organisation, reducing the need to return to shareholders for further financial support. The estimated core running costs of the Company are effectively the overheads of the Company and exclude all but the high level costs of running specific projects. 6 Overhead costs are calculated for each individual contract so as to ensure that we remain competitive in our pricing whilst ensuring that contracts agreed cover their own total costs, and deliver a contribution to the organisations overall running costs. The ultimate goal of the Company remains to deliver surpluses sufficient to repay shareholder loans and deliver a dividend to shareholders. Whilst the Board’s initial thinking was to await full operating surpluses before delivering returns of loans to shareholders we have reconsidered that approach and last year used our positive cash flow position to begin the task of repaying loans. Ultimately we still hope to deliver a ‘real’ return to shareholders within 3-‐5 years through growth in volume of business. Internal sub-‐contracting: Where the Company sub contracts to its own shareholders for the delivery of specific services it will be necessary to ensure that there is scope within each sub contract for the local provider to also achieve an element of surplus. The Company has developed a set of principles for contracting within the organisation to set the general framework within which arrangements will operate. Business Framework The Board, supported by shareholders, has developed a number of key business development areas in which opportunities for contracts will be pursued. Whilst a number of such opportunities will be pursued on a proactive basis the Company needs to retain the ability to quickly respond to new opportunities with short deadlines. Given the fluid situation within the NHS it is not possible to predict when these opportunities will arise but it is reasonable to assume that they will largely be framed around areas where the NHS is perceived to be currently failing. These might include A&E, secondary care efficiency and integrated care and all these are areas in which we are already seeking to develop commercial propositions. Our success over the past year with Healthier Radcliffe, winter pressure services and the PMCF bid have generated confidence within and outside the Company that we are well-‐equipped to respond to these types of opportunity. We do however need to demonstrate our ability to secure and deliver on-‐going service contracts and this has been a priority over the past year. Business Opportunities: Direct Clinical Services: As the Company exists to provide high quality services and is essentially clinically focused a range of opportunities present themselves. These include: o Provision of services transferring from secondary care to provide better access for patients and a more efficient model for commissioners e.g anticoagulation o Better integrated health and social care services with primary care at the heart of delivery e.g. “Healthier Radcliffe” and subsequent rollout across Bury 7 o
Extended hours in primary care to improve access and reduce demands in A&E o
Enhanced primary care for key target groups such as the elderly e.g. Care Home LES o
Public health-‐commissioned services including immunisation and vaccination services Non-‐clinical services To utilise economies of scale and become a hub in areas where it is appropriate to reduce practice expenditure. • Develop the vision of creating a Business Management arm of the organisation to assist practices in organisational development and human resource policy • Support collaborative commissioning to achieve better supplier pricing •
Provide mutual support services to cover short and long term staff absences Current Services provided: A Healthier Radcliffe – an NHS England Integrated Services Demonstrator Site -‐ “What’s it all about”? Ensuring that the population get the best possible healthcare is important to the GPs of Bury. Through their innovative approach by working together within a federation they are ensuring that the residents of Radcliffe are in the vanguard of modernising health and social care services. Radcliffe will benefit through a revolutionary way of providing healthcare. Through its 6 GP practices and the visionary joint working between them, the local authority, Pennine Care Community and Pennine Acute Trusts amongst others, alongside patients and voluntary groups, patients get quicker and more effective care. Surgeries are open for longer enabling those who work to get to see a doctor or nurse without having to take time off work. By improving access to care for conditions such as diabetes, heart and lung diseases there will be less need for people to have to go to hospital. By opening longer hours, parents are finding it easier to get care for their children without the hassle of going to A&E. Patients are able to see a doctor or nurse from 8 in the morning till 8 at night in the week and 8 through to 6 at weekends and Bank Holidays. This is not an emergency or locum service. Patients see staff that regularly work in the local surgeries. Their own doctor may not be available all of the time but they all work the extended hours at the Radcliffe Primary Care Centre no matter which GP they are registered with as long as it is from one of the 6 Radcliffe practices. They are able to book an appointment with their own surgery. Patients will only be seen with an appointment. 8 The project involves the staff being able to use the notes of all the people registered with the Radcliffe practices so that the doctors and nurses are able to ensure that they know what medication and previous conditions the patients have suffered. They can have confidence that their records are kept confidential and only used when necessary by those who have a right to see them. Patients are supported to be able to take care of themselves and where this is not possible those with more complicated problems get care plans bringing the health professionals together. The project is divided into two parts; the first to extend the opening hours of the GP service and the second is to work more closely with other health and social care providers. Initially, the project has been focusing on helping frail elderly people, trying to prevent them getting admitted unexpectedly and keeping them as autonomous and independent as possible preferably being able to stay in their own homes. The care of children forms the second arm of the project. There includes a paediatric observation and assessment service reducing the need for children with self -‐limiting illnesses having to go to hospital. Families with complicated problems with children will also be a focus. Often, families who have many problems get patchy care. We are trying to provide joined up care reducing the stress and pressure on families and improving their health and wellbeing. The project is continuously monitored to ensure that it delivers what it sets out to do. There will be a final external evaluation which will compare it to the other 5 Greater Manchester demonstrator sites. “Bury Easy-‐GP” -‐ Prime Minister’s Challenge Fund: The Federation is now delivering new and improved GP services to the people of Bury including: • Extended surgery hours for all patients registered with a practice in Bury. GP services will be available to all patients from 8am to 8pm on weekdays and 8am-‐6pm at weekends based in 5 sites across the borough. Services in Radcliffe are delivered as part of Healthier Radcliffe, those in the town centre are sub-‐contracted to Rock Healthcare and those in the south and north are delivered directly by the federation. All services are being delivered for a six month period from January 1st for evaluation by Bury CCG and NHS England. • Dramatic increases in online access for all our member practice patients. Currently patients can book appointments on-‐line or order repeat prescriptions but only if they are registered to do so. Up to now the process of registration hasn’t been easy but this will improve dramatically over the next few months. • A standard alternative to face-‐to-‐face consultations for all patients in member practices. All patients will be offered the opportunity when they ring for an appointment, of having a planned telephone consultation if they would prefer. This won’t suit all patients but many will find it a useful alternative to having to attend the surgery. 9 • A website allowing patients a dramatically improved ability to compare services and performance across member practices to enhance their choices about general practice. The information in this pack is largely drawn form the company’s 2014-‐15 Business Plan. Further information is available from the company website at – www.burygpfederation.com 10 Bury GP Practices Limited Position: Salary: Chief Officer – full time £65,000 – 70,000 per annum – more may be available for an exceptional candidate (the company has applied to join the NHS Pension Scheme and is awaiting confirmation) Hours: The role is full time and the post-‐holder will be expected to work flexibly The post-‐holder will be a Director of the company and a Board member and may be required to act as Company Secretary for a period. Bury GP Practices Ltd was registered at Companies House in November 2012. Originally comprising 26 practices from Bury in north east Manchester the company accepted a further 4 practices as shareholders in April 2013. Further practices may wish to pursue membership in 2015. The company is currently reviewing its organisational structure which may lead to changes at Board level. The Board presently comprises an Independent Chairman, a Clinical Vice Chairman, an Organisational Medical Director and a financial adviser. The company will be seeking to appoint a Finance Director when the Chief Officer is appointed. Job Purpose: To lead both the development of the company and the delivery of its operational business working closely with directors, shareholders, commissioners and key delivery partners to ensure that the company delivers benefit to its shareholders and to the people of Bury. As a director and Board member you will share corporate responsibility for all company affairs. Key responsibilities: The post-‐holder will be expected to – • Provide day-‐to-‐day leadership of the company, working closely with other Board members, shareholders and partners 11 •
Prepare the annual company business plan and any other documentation required by shareholders or the Board •
Work with shareholders and partners to develop new and innovative ways to improve the quality of general practice and primary and community services •
Oversee the management of the company’s financial systems and processes and ensure that the company’s performance is within parameters agreed by the Board, reporting any potential deviations promptly •
Lead the company development team comprising the Medical Director and Clinical Links •
Ensure effective two-‐way communication with shareholders and partners •
Ensure that the company retains a regional and national profile as a leading entity in collaborative GP organisations •
Advise the Board on all matters relating to organisation and employee development. •
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Promote and maintain workforce systems and practices which meet the requirements of external quality standards e.g. CQC/Monitor and internal governance requirements. •
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Ensure that the company complies with company law and fulfils all the requirements of registration with Companies House Ensure that the company secures acceptance into the NHS Pension scheme and maintains that membership Appoint and manage such staff as may be required to deliver the business of the company This is not an exhaustive list of responsibilities but aims to outline the key parameters of the post and key expectations of the post-‐holder. It will be subject to review by mutual consent. Due to changing workload priorities and competing demands, the post holder is expected to appropriately re-‐evaluate tasks and requirements for themselves and the team to ensure that all targets and deadlines are met. January 2015 12 Bury GP Practices Limited Person Specification -‐ Chief Officer The successful candidate will be required to demonstrate – Personal qualities: • Sensitivity and emotional intelligence •
Politically astute and self-‐aware •
Confident and resilient •
Energetic and innovative Experience and Skills: • Evidence experience of: o working in, or closely with, general practice o commissioning and provision of services o mechanisms for improving and redesigning clinical pathways across primary and secondary care o involving and empowering a range of clinical professionals to make healthcare services more cost-‐effective and better quality •
A commitment to o improving work at the interface, principally between practices and community staff, within and beyond the NHS hospital services o developing community-‐based services as a better alternative to hospital based services •
Excellent influencing skills and good relationships with colleagues including strong negotiation skills •
Excellent communication and presentation skills with both small and larger groups in formal and informal settings 13 •
Skills and experience to plan and chair large meetings with multi professional groups •
Ability to work as a part of a team in leadership, advisory and supportive capacities Ability to engage effectively, commanding respect from a wide range of stakeholders including clinicians, patients and the public and in particular, ensuring effective two-‐way communication with member practices Ability to communicate complex and challenging issues clearly and effectively in public meetings •
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Ability to develop and maintain an understanding of the legal environment in which the organisation operates. •
Ability to give an unbiased view on possible internal conflicts of interest Experience of managing budgets and maintaining financial balance in the face of increasing demand •
January 2015 14