GPs opt for special interests to exploit PBC opportunity

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GPs opt for special interests to exploit PBC
opportunity

• But trusts misuse GPSIs says report
• PULSE 13 APRIL 2006

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This short talk is aimed squarely at the GP
thinking of setting up

• These are uncertain times - this talk is for
  guidance only
• Local conditions will apply and the DoH reserves
  the right to change its mind

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Why is it going to happen?

• White Paper says Dermatology is a speciality that
  should be delivered in Primary Care
• PCTs are cash strapped and this represents a
  possible saving
• The service is relatively easy to set up
• Patients welcome local services
• GPs want to develop this - interesting and
  ?lucrative
• PBC will encourage development along this path

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Nothing is ever easy in the modern NHS but it can
be done!
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Where Do I start?

• Do you have the energy?
• Do you have the time?
• Can you make the time?
• What will your partners think?

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Is there a need for a Dermatology GPSI service?

• Discuss with PCT, Local Trusts, Consultants, GP
  colleagues
• Get some idea of referral patterns numbers
• Look at tariffs and get a grasp of finances

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Need established - where now?

• Do you get qualified first ?
• Do you structure the service and negotiate first?
• Do you do both at the same time?
• IT IS OFTEN A LEAP OF FAITH!!

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Setting up the Service3 key needs

• Quality
• Structure
• Funding

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Getting Qualified

• Nothing yet is set in stone!
• Guidance
• BAD
• DoH guidelines on Dermatology GPSIs 2003
• Core activities of a GPSI service 2002
• PCDS
• Guidelines for GPSI service 2005
• GPSI in Dermatology working group

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Being Credible

• Current guidance suggests
• Diploma in Dermatology -Cardiff,Glasgow,London
• 100 supervised clinics or one year as a clinical
  assistant ?reasonable
• What about skin surgery?
• Clinical indemnity-check with your defence
  organisation

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The future? -PCDS proposals

• Diploma
• Post Dip year
• reasonable number of supervised clinics
• mini assessments in year by supervisor
• Qualified
• Regular audit
• work closely with consultant
• regular joint case discussion/critical events
• ongoing PEP

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Skin Surgery

• Separate or part of the service?
• Same practitioners or different?
• Different accreditation pathway
• ? Courses
• Mini assessments by specialists?

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Structure of a GPSI service

• Service targeted to Local Needs
• Gate Keeping - Open access or Triage
• Skill mix -Consultant,GPSI,Nurses
• Premises
• Record systems
• Equipment
• Admin support

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Local needs-scope of the clinics

• Full diagnostic/management service?
• Only a chronic dermatoses management
• Skin surgery
• How many sessions?

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Triage

• Nearly all referrals are appropriate! It is
  unlikely to save money but it can influence the
  flow of referrals this can be helpful in
  establishing the service
• Clear guidelines about who does it,in what time
  scale,what needs to go directly to secondary
  care, what can be managed in primary care and by
  whom?
• of referrals seen in Primary care varies from
  40 to 80

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Staffing

• Consultants -do they come to surgeries?
• GPSIs -do they work in hospitals or surgeries?
  What is their role? Autonomy?
• Specialist Nurses - what is their role?
• Administration

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Administration

• Dont skimp
• Good secretarial support
• Dedicated Reception staff?
• Record keeping-CG and Medicolegal
• IT support
• Audit clerks-clinical, and financial
• Local or distant?
• Who provides?

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Integrating with sec care

• Access to patch testing,PUVA,Laser etc
• Urgent cases - fast track to consultant
• Specialist dermatology nurse access
• Roaccutane prescribing-designated chemists,
  prescription pads
• Skin cancers -clear management pathways

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Finance-The business case

• PBC is the future
• Payment by results - National Tariffs are the
  method by which prices are set and therefore
  income can be calculated
• You are negotiating with your colleagues via PCTs
• These are uncertain times but the potential is
  enormous

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Example

• Tariffs for Dermatology cases currently 118 per
  new case 55 per follow up
• Say in your clinic you see 8 new cases and 10
  follow ups 1494
• Room Hire /Consumables 94
• Administration 250
• Education/training 25
• Profit 1125 per clinic

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Profit 1125 per clinic!

• But you must demonstrate a saving for the service
  to be commissioned
• Therefore pay GPSI 725 per clinic
• Leaves a surplus of 400 per clinic
• Say 3 clinics a week for a PCT
• 150 clinics a year 100000 saving per annum

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Tips on setting up

• Be determined
• Make sure you have everyone on board
• Work very closely with your consultant colleagues
• Dont undersell yourself
• Make sure your business case is properly worked
  out
• Get it in writing

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GOOD LUCK !