I’ve written a lot recently about the potential for hospitals to subcontract work to general practice via either the practices themselves, the primary care networks or potentially a GP federation.
On the face of it, even the thought of piling more work onto GPs seems preposterous. How on Earth could GPs – already drowning in work – possibly take on more tasks?
But when you step back and consider for a minute how it might work in practice, it starts to makes a lot of sense – and carries phenomenal potential for the Pharma, MedTech and Devices industry to get involved. Still not convinced? Let me explain.
Some work is easily shifted across from secondary care to general practice
Firstly, it’s worth considering the type of work that would be suitable for general practice to take on from secondary care. Processes I’ve seen successfully shifted out include:
- Diagnostic tests, including 12 lead ECGs, Holter ECGs, and 24 hour ABPM
- Microsuction for ear, nose and throat patients
- Insulin initiation and titration and GLP-1 initiation for diabetics
- DVT (Deep Vein Thrombosis) pathways
- Women’s Health
There are many more, the key is the type of work we move. The rationale for moving procedures like this is straightforward. When there’s a delay at the hospital in getting them done, the unwell patient doesn’t sit at home. They return to their GP and ask for the referral to be sped up. That’s a waste of an appointment when the GP has already taken the decision to refer them. When that doesn’t happen, they often return to the GP on many occasions, while they continue to feel unwell.
Funding and workforce capacity is essential
The key to bringing this work into general practice is, first, to fund it properly. Sometimes we will need to bring the hospital team as well because if we can bring this work into general practice and do it more quickly, all those unnecessary appointments and hospital referrals will be avoided.
Rapid access to a diagnostic test, for example, means you get a confirmed diagnosis. Subsequently, rapid access to the correct treatment means better patient outcomes as well as fewer appointments, referrals and admissions.
For the avoidance of doubt, General Practice needs the money to pay staff to deliver the work. Sometimes these types of clinics are interesting for staff – a whole clinic on cardiology, gynaecology, women’s health, dermatology, or diabetes might actually be attractive to staff as a change from the day-to-day grind of acute general practice, even more so if you make this the Enhanced Access work, where I find it is hard to rota staff to deliver more acute on the day General Practice, but there is a greater interest in working in services that interest them.
The key to success is to cost business cases correctly. When supporting my clients, I do that in minute detail, with every single step in the pathway costed appropriately. So from staff hourly rates, equipment, consumables, patient information, step up and step down care, drugs and patient discharge, every aspect of the pathway is accurately costed.
The second important step is to never get into a negotiation on price – negotiate on workload instead. Why? Because when you cost a project accurately and comprehensively, it becomes easy to justify how you’ve arrived at the price you do – giving you confidence to have a frank discussion with the commissioner.
If they still feel it’s too expensive, offer to take steps out of the pathway. Reduce the price by reducing the workload – you can’t reduce the price just because they say it’s too expensive. If the work is costed correctly and appropriately, then the price is the price and dropping below that becomes a dangerous game to play, as you will end up with loss making services and are likely to end up handing the contract back.
Products, drugs and devices are easily embedded
You’ll often find general practices are willing to take on this kind of work because it means they see the patient once and give them access to the service they need instead of seeing them seven, eight or nine times, while they wait in the hospital queue. It’s a really good practical solution to reducing unnecessary workload.
Of course, it does need careful handling and planning, but I’ve many examples from my work within the NHS up and down the country where this has been perfectly achievable.
And for the Pharma, MedTech and Devices companies, there are some brilliant opportunities to support this to happen. It’s a great way to embed products, drugs and treatments, as well as kit and equipment, into the pathways.
We want a high-quality, standardised approach without any unwarranted variation in those pathways. So we would specify (and again, I’ve got examples of doing this that I would be happy to share with you) the kit, the drugs, the pathways, the referral process, the step-up and step-down care, the patient education, the discharge process, literally everything in the pathway. We tie the provider payment to exact delivery, and then we audit and evaluate, and act on any shortfall.
My clients all over the country have managed to embed their products into clear pathways, and they monitor and evaluate every month to make sure they achieve great delivery.
Build a team that can work anywhere
There’s one other thing that is absolutely key in all this. If you work with a high-quality standardised approach with no unwarranted variation and you focus on putting the right patient in the right place at the right time with the right healthcare professional who has the resource to deliver the right care, that makes all of that team completely interchangeable.
That means if you were doing this across a primary care network of eight practices or a GP federation, which ranges from 15 practices up to 50 (I’ve even got one with 133 practices!), all the staff are interchangeable. You’ll always be able to deliver the service because you can build a little team of people who all know exactly what they’re doing in any environment.
Again, that’s where the Pharma, MedTech and Devices companies can really step in and support, it’s a great opportunity for them.
The hospitals are like general practice – drowning in workload – and so they are potentially looking at different, innovative ways of delivering. That could include giving some of their consultant time to help support the practices, reducing everybody’s workload.
My best example of this in play is in East Sussex, where we’re working with one of the hospital trusts across four specialities. We identified that 80 per cent of the referrals were connected to sub-optimal treatment. And with a bit of education, improved diagnostics in primary care really supporting the practices to improve the patient outcome, we’re avoiding all that workload in practice, and it’s not hitting secondary care either.
There are examples all over the place of a really great way to tackle the issue that is affecting the NHS across many services – too much workload and not enough people to meet the demand. We have to innovate and work in different ways.
This is one of those innovations – change the pathway, bring the work and the money out to primary care and increase that rapid access to diagnosis and/or treatment, which then reduces the workload.
Scott McKenzie helps pharmaceutical, medical technology, and device firms increase revenue through market access strategy development that gets products and services in front of the right NHS decision-makers. If you want to get your products fully embedded into treatment pathways, we offer market access support, key account manager support and NHS sales strategy training. We’ve doubled revenue for our clients and can share these processes with you too.