Taurus Healthcare Graeme Cleland
About Taurus An independent company limited by share Owned by the partners of all 24 practices in Herefordshire Incorporated as a stand alone provider business, contracting vehicle and Primary Care Federation CQC, NHSIG and N3 registered Has held NHS standard contract Able to hold APMS or even a GMS contract Part of the wider NHS family
About Our Pilot - To improve access 8-8, 7 days per week the critical enabler will be shared patient information across GP clinical systems - But this only partially addresses access issues for some groups of patients (and may not be the single intervention that has a system wide impact) - Improving access in a broader sense means working with partners to provide a targeted whole system response to individual and different needs across the system - Specific interventions need to be linked to specific measurable outcomes (evidenced or tested to ensure they work) - New developments need to happen in the context of existing programmes of work and be supported by all parties
The Journey
Organisational Forms 1. What are the Options for Working Collaboratively: 1. Community Interest Company. (CIC) 2. Not For Profit (NFP) 3. Formalised Cluster / Locality 4. Limited Liability Company (LLC) 5. Super Practice 6. Lead Practice
Where to Start Three Key Pillars of Establishment CQC Registration N3 Registration IG Accreditation
Where were we when we bid in January 2014 1. Established Entity with CQC Approval 2. Recently achieved IG Level 2 Compliance 3. Recently N3 compliant but not yet installed 4. Totally misunderstood by core software providers what General Practice meant in a truly federative model Just another practice... 5. 6 of 24 Practices fully IG L2 Compliant the rest varying degrees of preparedness. 6. Still some cautious and concerned members of the primary, secondary care and commissioner community
Mobilization Challenges What were our challenges Federation IG Compliance Experience Data Sharing Agreement Legal challenges Project Governance N3 Accreditation Contracting Process CQC Compliance Patient Engagement Confused Shareholders Practice IG Compliance Patient Consent
Where are we Now 1. Full CQC Accreditation 1. Registration of emerging sites is ongoing 2. IG Level 2 Compliant for 2014/15 and 2015/16 3. N3 Accredited and Installed, and BTN3 Development Partner 4. Legally verified data sharing agreement completed and in place with 22 / 24 Practices 5. 7 Day PMCF APMS Contract signed in June of 2014 6. Delivering 7 Day primary Care since July 2014 1. 21 of 24 Practices Actively Sharing Data and Booking Patients to 7 Days. 2. 22 of 24 Practices fully IG L2 Compliant. 3. Last two Practices Forecast to achieve IG Compliance in December 2014 7. Adolescent Outreach to colleges GP Surgery in a Secure Cabinet in operation 8. Provider Governance Forum in Operation
How Did We get here Quickly 1. Started Early and proceeded at Risk. 2. Formalised our CQC Position a key to IG and N3 Compliance. 3. Focused on IG Compliance a key for N3 accreditation 1. Developed a practice toolkit for IG Compliance 4. Worked with Software Houses to understand what was available out of the box and what needed development before commencement, and have maintained close collaborative working with them since 5. Completed robust Programme and Project Planning before commencement of initiatives 6. Consulted with Shareholding Practices, and their management teams before / during and after submission. 7. Worked with patient representatives, the practices, the commissioners, other providers and the media to maintain engagement 8. Didn t fear getting things wrong allowed for better engagement
Critical Success Factors 1. Established principles of maximising the output of primary care by sharing expertise, delivering excellent clinical care, by standardising inputs, outputs and clinical pathways. 2. Developed a mature sense of Federation, - that has taken some time to achieve 3. Full time Executive leadership remember this is complex 4. Establish a Programme Office with strong project management skills 5. Maintain a high level of clinical input and GP Leadership 6. Ability to be flexible, adaptive and consider new ways of working- no dogma 7. Establish internal corporate, clinical and programme governance structures which is key to establishing a countywide provider governance forum 8. Foster good relationships with other providers and software vendors
Keys to Mobilisation Start Now Establish Foundations CQC IG and N3 Programme Governance Establish your Entity Engage with others Ask Questions of Others Make time to do this properly Meet Software Partners - Now