Viewing 40 posts - 441 through 480 (of 503 total)
  • What to cut to fund the NHS?
  • chewkw
    Free Member

    b r – Member
    Chewkw – you haven’t even considered Many costs that I’d expect a bureaucrat like yourself to be aware of; NI, VAT, rates, etc etc

    30% of the entire “turnover” is for cost … all cost included.

    A shared 4 private GP centre do you need 17 staff at all time? We are talking about GP centre not doing any physical surgery … those are referred to hospital.

    1 Manager/team leader
    2 receptionists
    4 Nurses – one for each GP.
    1 Backup nurse
    1 Backup receptionist

    Total = 9 employees.

    30% cost can easily cover them all with plenty to spare.

    chewkw
    Free Member

    Drac – Moderator

    For a small 4 private GP do you need to 17 staff/nurses/employees everyday? We are talking about 4 employees to support a GP everyday.

    Depends what other clinics they run. This GP is in your head so I’ve no idea.[/quote]

    What can the GPs do nowadays? I think they cannot even “cut” or perform minor surgery so mainly consultation, checking and providing prescription is that not?

    kimbers
    Full Member

    What can the GPs do nowadays? I think they cannot even “cut” or perform minor surgery so mainly consultation, checking and providing prescription is that not?

    Yeah they probably just sit around checking Facebook and play candy crush it something.

    Chewkw you should really just retrain is really easy and you’ll make a shit ton of cash

    Fresh Goods Friday 696: The Middling Edition

    Fresh Goods Friday 696: The Middlin...
    Latest Singletrack Videos
    docrobster
    Free Member

    To help with your imaginary practice I’ll confirm that of the 42 staff at my practice 11 are gps although only about 8 whole time equivalent. Obvs this is nhs and we are massively understaffed. If private sector we’d have more admin support. Or possibly not as quite a lot of admin time is spent going round in circles with the rest of the NHS and processing endless data for other parts of the System’s benefit. Maybe I’d just need one manager one nurse one receptionist. Who knows.
    I think that when GPs do a dentist a lot of services will be run by virgin/care uk/boots etc and that they’ve probably got insurance schemes ready to roll out. The market will decide. Might not be too long if TM carries on the way she is doing.

    chewkw
    Free Member

    kimbers – Member

    What can the GPs do nowadays? I think they cannot even “cut” or perform minor surgery so mainly consultation, checking and providing prescription is that not?

    Yeah they probably just sit around checking Facebook and last candy crush it something.

    Chewkw you should really just retrain is really easy and you’ll make a shit ton of cash [/quote]

    My GP told me that they were no longer allowed to perform minor surgery involving “cuts” (not sure the medical term). They told me they were mainly consultation, referral and prescription.

    I will ask him again when I see him …

    chewkw
    Free Member

    docrobster – Member
    To help with your imaginary practice I’ll confirm that of the 42 staff at my practice 11 are gps although only about 8 whole time equivalent.

    4 staff to support one GP?

    Is that the average for all GP practices?

    If I may ask how many nurses do you have?

    How many receptionist or admin staff and manager?

    Drac
    Full Member

    My GP told me that they were no longer allowed to perform minor surgery involving “cuts” (not sure the medical term). They told me they were mainly consultation, referral and prescription.

    Other GPs can.

    http://www.nhs.uk/nhsengland/aboutnhsservices/doctors/pages/nhsgps.aspx

    chewkw
    Free Member

    Drac – Moderator

    My GP told me that they were no longer allowed to perform minor surgery involving “cuts” (not sure the medical term). They told me they were mainly consultation, referral and prescription.

    Other GPs can.

    http://www.nhs.uk/nhsengland/aboutnhsservices/doctors/pages/nhsgps.aspx [/quote]

    I will read that later … (few mins later) I see …

    ” … carry out simple surgical operations …” …

    jambalaya
    Free Member

    Chew I was being pretty conservative, IMO you can’t assume Doctor is fully booked on chargable hours all day.

    The French numbers are real ones, Paris based sports knee specialist consultant surgeon for example. Certainly others do charge more, eg my BIL who is a back specialist.

    Jamba – by any stretch of the imagination you are far righ

    TJ. I think that opinion says more about your circles than mine. If I was far right I wouldn’t have stayed in the UK and paid even 40% tax. My job has always been highly mobile. Even US Democrats are to the right of Tories here.

    docrobster
    Free Member

    3 hca
    2 nurse prescribers
    3 nurses
    1/4 of a pharmacist
    1 manager 3 admin
    Lots of receptionists
    You do realise you’re talking bollocks don’t you cheeky?
    We’re not paid to do much minor surgery any more but still do some when needed
    To further answer your inane question, apart from the obvious “90% of patient contact on 7% the budget”, today I dealt with a first episode psychosis, home visit to elderly lady with polio paralysis needing home care, regular appointment with a woman who had 2 children due in teenage years and has had her allocated “therapy”, a bit of marriage guidance. Told a man where his prostate gland was. Investigate vague symptoms that might be cancer but might be nothing, spoke to the man who I was the first person to find the rectal cancer on a few weeks ago, dealt with ill child and counselled its mother whose husband had died suddenly of heart attack while she was pregnant, directed an young man who wanted help stopping smoking to the relevant service, treated a few chest infections, and the rest I’ve forgotten (35 consultations today). Filled a couple of dozen results and 35 letters including child safeguarding concerns. Reviewed some spirometry and electronically signed a 100 or so repeat prescription.
    Pretty average 11 1/2 hour day
    But please carry on imaging how much money I’ll make in the brave new workd

    chewkw
    Free Member

    jambalaya – Member
    Chew I was being pretty conservative, IMO you can’t assume Doctor is fully booked on chargable hours all day.

    I have reduced that number to 25 hr per week.
    Even with that reduction the charge is still premium high.

    chewkw
    Free Member

    docrobster – Member
    3 hca
    2 nurse prescribers
    3 nurses
    1/4 of a pharmacist
    1 manager 3 admin
    Lots of receptionists
    You do realise you’re talking bollocks don’t you cheeky?

    No, no I am trying to figure out the private practice.

    You have 16 above so are they all to support One Gp?

    Are them 16 full time staff?
    The remaining 15 are also full time receptionists?

    docrobster
    Free Member

    I give in. Read the posts. 11 gps, 8 whole time equivalent. Plus two registrars (trainees)
    Medical students
    District nurses health visitors Macmillan nurse community matron health trainers care navigators
    Are you wanting to replicate what we do now or just invent a business model?
    A patient once told me he timed his £180 consultation with a spinal surgeon at 8 minutes.
    What is the point of this conversation? (I should know better than to ask)
    Outside London there is hardly any private general practice. There is one practice in Sheffield serving half a million people. Most private work for gps currently is things like insurance medical occupational health screening etc. Not actually treating patients.

    chewkw
    Free Member

    docrobster – Member
    I give in. Read the posts. 11 gps, 8 whole time equivalent. Plus two registrars (trainees)
    Medical students
    District nurses health visitors Macmillan nurse community matron health trainers care navigators
    Are you wanting to replicate what we do now or just invent a business model?
    A patient once told me he timed his £180 consultation with a spinal surgeon at 8 minutes.
    What is the point of this conversation? (I should know better than to ask)

    I am just wondering why there are no many private GP practice available because if I am willing to pay for consultation.

    Yes, general non-urgent consultation (NOT your spinal surgeon) vs very specialist (yous spinal surgeon) consultation etc … Specialist consultant can charge you an arm or a leg if they want.

    I very much prefer to see more non-urgent private consultation available. I am sure this will free up plenty of the NHS resources.

    But what is your exact number of receptionists because you say many?

    Outside London there is hardly any private general practice. There is one practice in Sheffield serving half a million people. Most private work for gps currently is things like insurance medical occupational health screening etc. Not actually treating patients.

    That is the problem. I want to pay at reasonable price for minor ailments for private GP but I have no way of doing do so apart from being blamed for taking up NHS free resources.

    docrobster
    Free Member

    But what is your exact number of receptionists because you say many

    Not enough to answer the phones promptly enough for 13000 patients. I can’t remember. I don’t have exact numbers in my head. It doesn’t matter anyway because what you are suggesting won’t do what general practice does. It will do a tiny proportion of it. Maybe you ought to look at walk in centres for a better comparison.
    Anyway I just read this which is quite a good read
    Why extending GP hours won’t solve the A&E crisis

    jambalaya
    Free Member

    Average NHS expenditure is £136 per patient per yea

    I go to the Doctor about once every 10 years. Last time I was prescribed any medicine was 30 years ago when I had e-coli. Other vists have been private / paid for by insurance. Obviously at 53.9 that’s going to increase from here unfortunately but so far the NHS has got a great deal. Appreciate a degree of good fortune here but you get my point.

    ernie_lynch
    Free Member

    Appreciate a degree of good fortune here but you get my point.

    No what is your point? That you haven’t got your money’s worth out of the NHS because you saw doctors privately?

    docrobster
    Free Member

    just wait till you are 80
    You understand averages yes?
    Average 6 consults a year
    Some go less
    Some go more
    Simples
    your experience of the system does not represent the whole system

    chewkw
    Free Member

    docrobster – Member

    But what is your exact number of receptionists because you say many

    Not enough to answer the phones promptly enough for 13000 patients. I can’t remember. I don’t have exact numbers in my head. It doesn’t matter anyway because what you are suggesting won’t do what general practice does. It will do a tiny proportion of it. Maybe you ought to look at walk in centres for a better comparison.
    Anyway I just read this which is quite a good read
    Why extending GP hours won’t solve the A&E crisis[/quote]

    The govt should encourage more private non-urgent GPs that only do 25 hours a week (I am talking about non-urgent) and even charging at £40 an hour will give the GP £52K per year. Now you may say that is too little but I am saying for some GPs that is enough without stress. I am sure if few of them combine to operate a centre they are still able to make a decent income without the current stress.

    chewkw
    Free Member

    docrobster – Member
    just wait till you are 80
    You understand averages yes?
    Average 6 consults a year
    Some go less
    Some go more
    Simples
    your experience of the system does not represent the whole system

    I am saying that some may prefer to stay with NHS but if GPs want to go private govt should make it easy for them.

    Which means win win for all. The govt will be able to fund the current GP system, the current GPs get all they want and those who want to run their own practice is able to; and to make a living. Taking the burden off the govt and perhaps even current NHS system. As a patient I am will to pay the rate affordable to me so no need to take up NHS doctor time.

    Therefore, for the young, affordable and able perhaps paying a bit to see private non-urgent GP is much better, leaving the NHS for other more urgent matter with people who are less fortunate.

    kimbers
    Full Member

    The costs only add up as you age, triple bypass £10k
    Cancer treatment £20k a year plus….

    Which is why we need young immigrants to balance out all the oldies dragging the country down

    DrJ
    Full Member

    No, no, no – the NHS has not worked out profitable for a healthy, rich person, so it must be broke. Obvious.

    br
    Free Member

    The govt should encourage more private non-urgent GPs that only do 25 hours a week (I am talking about non-urgent) and even charging at £40 an hour will give the GP £52K per year.[/I]

    On the EU thread I believed you don’t have a clue, now you’ve proved it.

    Work on 48 weeks per year, so £48k gross INCOME would equate to about £24k gross salary…

    How much do you think you cost your employer, if on a final salary double your salary and then factor in buildings, IT, HR etc.

    chewkw
    Free Member

    b r – Member

    The govt should encourage more private non-urgent GPs that only do 25 hours a week (I am talking about non-urgent) and even charging at £40 an hour will give the GP £52K per year.

    On the EU thread I believed you don’t have a clue, now you’ve proved it.

    Work on 48 weeks per year, so £48k gross INCOME would equate to about £24k gross salary…

    How much do you think you cost your employer, if on a final salary double your salary and then factor in buildings, IT, HR etc. [/quote]

    £40 per 20 mins. Not per hour. My late night does not help …

    £120 per hour x 25 hr per week x 48 weeks.

    That should be £144,000 per year gross.

    docrobster
    Free Member

    Don’t forget cqc fees and medical indemnity insurance.
    Current full time NHS salaried gp or partner pays about £10k medical indemnity insurance. If it’s more than one session per week out of hours then they class that as unscheduled care- higher risk- double the premium (I was told this by my insurer last week).
    Private sector unscheduled care no continuity higher expectations maybe? Prob £25k to work full time. So how much would this fictitious go need to earn to make it worthwhile?
    Are you any closer to understanding why special things like health care cost a lot of money?
    All I’ve seen so far just tells me that people don’t know the value of what they’ve already got.

    duffmiver
    Free Member

    Jeremy Hunt’s throat

    grumpysculler
    Free Member

    The govt should encourage more private non-urgent GPs that only do 25 hours a week (I am talking about non-urgent) and even charging at £40 an hour will give the GP £52K per year.

    Almost all GPs are private, we don’t pay to see them.

    Given that our population seem to struggle between deciding what needs and A&E visit and what can be dealt with by the GP, I’m not sure adding on a third tier will help.

    teamhurtmore
    Free Member

    We do pay to see them – just not at the point of delivery.

    chewkw
    Free Member

    docrobster – Member

    Don’t forget cqc fees and medical indemnity insurance.
    Current full time NHS salaried gp or partner pays about £10k medical indemnity insurance. If it’s more than one session per week out of hours then they class that as unscheduled care- higher risk- double the premium (I was told this by my insurer last week).
    Private sector unscheduled care no continuity higher expectations maybe? Prob £25k to work full time. So how much would this fictitious go need to earn to make it worthwhile?
    Are you any closer to understanding why special things like health care cost a lot of money?
    All I’ve seen so far just tells me that people don’t know the value of what they’ve already got.

    You can increase your public indemnity insurance cost to £20k or £30k per year if you wish because they are all tax deductible. Other fees might also be tax deductible but I haven’t checked.

    Assuming non-urgent private GP work for £144,000 gross. The take home pay is about £86,587.

    £25k is wrong calculation for private GP at 25hr/week as it is actually £144K.

    samunkim
    Free Member

    “Jeremy Hunt’s throat”

    That got a laff round the office

    Drac
    Full Member

    Look he’s typed in bold, that means it’s important.

    chewkw
    Free Member

    Drac – Moderator
    Look he’s typed in bold, that means it’s important.

    Isn’t indemnity insurance tax deductible?

    Also Pay at point of delivery. If they are private they should not get funding from govt etc so what’s the problem?

    Drac
    Full Member

    Well yes.

    docrobster
    Free Member

    Yes of course it’s tax deductible. It’s just another expense to take into account, you know, that reduces profit. Just helping you with your business plan chewkw
    Ps it’s a special insurance only doctors need, for doing especially risky work, that they can’t practice without, and it’s on top of public indemnity insurance that all businesses need. Just so you understand.
    It’s going up about 10% a year and is one of the reasons GPs are not so happy/thinking about quitting. Ambulance chasers etc

    samunkim
    Free Member

    Gaining Grip and Control of NHS Expenditure
    http://www.whh.nhs.uk/_store/documents/27januaryboardpapers.pdf
    Page 44 onwards

    Ensure that there are tight procedures around payment approvals
    Ensure that no payments are made to non-essential purchasers
    Consider approaching commissioners to advance funding to temporarily improve cash flow (we have seen commissioners advancing payments over 10 rather 12 months to assist with immediate cash flow problems)
    Establish weekly cash committee with operational, financial and procurement representatives present
    Consider stretching creditors beyond current creditors days
    Review and assess existing debtors ledger and focus on “easy wins” to target for immediate collection
    Develop strategy for each debtor – assess risk, ability to net-off if provider to provider debtors / creditors where the trust is in a positive net-off position. Ensure that utilise assistance linked to recovery of income from overseas patients (Cost Recovery Support Team and Overseas Healthcare Team).
    Consider process change within the collections team to optimise cash management etc.
    Review and recover all private patient non-payments
    If possible, discuss further support with commissioners – bring forward date when income received (from 15th to 1st) (in addition to action 1.4)
    Immediately assess estates position, if there are any external landlords consider renegotiation of terms to pay in arrears rather than in advance
    Assess what assets can be sold
    Reduce the number of payment runs to ensure that there is a greater control over outflows
    Implement cash focussed KPIs and a reporting dashboard
    Ensure that invoices are issued as soon as possible rather in batches
    Establish pro-active debt collection – cold call all key debtors before due date to ensure that payments are received
    Develop payment plans for key and large creditors where possible to ensure smoother profile and cash conservation
    Income
    Create commercial board to oversee income opportunities (this should include estates value maximisation opportunities – please link this to a review of estates strategy – 3.21)
    Undertake a full coding review (establish working group aimed at improvement of the depth of coding – assuming that there is not a block contract)
    Ensure that any changes in coding are clearly communicated to and recorded with the commissioners to ensure that income is received.
    Review income contracts with commissioners to highlight any opportunities to maximise income and to reduce penalties.
    Review progress on CQUINs, RTT, activity etc. and assess the likelihood / size of penalties for non-delivery or underperformance
    Optimise car parking income (if possible)
    Ensure fully recovery of any income from 3rd parties (use of facilities, estates, joint appointments, consultants working outside trust, junior doctor training etc.)
    Run refresher meetings with consultants and junior doctors to ensure contracts are understood and to ensure that key staff understand what levers to pull to ensure increased revenue
    Consider estate rationalisation where possible (rent/sell where possible)
    Review any tenant and licence agreements to see if there is any possibility to further maximise income from estates
    Cost and expenditure
    Finance related controls
    Review the approach used by the trust to improving quality and reducing costs across the organisation. Consider alternatives such as lean etc.
    Complete a full budget review – identify budget reduction opportunities and target overspend areas, create plans to bring them back in line with the initial budget
    Identify the full value of the creditor ledger including unapproved invoices
    Review PO system; strengthen or improve if required. Going forward any non-PO purchases should be reported by exception
    Reset budget holders if required
    Bring all existing orders on the system by creating POs (mainly agency staff, long term call off contracts etc.)
    Reset SFIs and delegation authorities if required
    Impose stringent controls over expenditure – overspends may need to be linked to disciplinary action
    Establish controls over central and corporate expenditure
    Review all telephony and large IT contracts – renegotiate where possible
    Undertake a user review for IT and telephony – cancel all unused mobiles, telephone lines, dongles etc.
    Review, reduce and control all “discretionary” spend such as travel expenses, subscriptions, training, clothing, hospitality, bed hire, office equipment etc.
    Identify priory suppliers and confirm that cash is available for priority suppliers
    Review all VSM pay costs – consider action (where applicable) on retire & return staff and ensure that the trust complies with guidance on “off payroll” workers and daily rates
    No invoices to be paid unless matched with PO
    Review scope for savings from making use, or increased use, of NHS SBS (where applicable)
    Review scope for savings from making use, or increased use, of NHS Professionals (where applicable)
    Review if can utilise NHS BSA to determine potential saving opportunities on 3rd party non-pay spend via NHS Supply Chain (where applicable).
    Where applicable, test saving opportunities via use of NHS Core list.
    Ensure that Medical Capital Equipment Asset register, medical equipment maintenance schedule and capital medical equipment procurement plans are in place.
    Review saving opportunities via use of Crown Commercial Services where applicable.
    VAT position has been reviewed and all recovery opportunities maximised
    Procurement related controls
    Review procurement, understand what contracts are due to expire/when to assess ability to renegotiate contracts or put contracts for tender
    (Re)set targets for procurement for contract renegotiations
    Procurement – remove rolling, value based purchase orders
    Contracting related controls
    Understand supplier discounts and penalties for early / late payments – set out plans to recover / avoid
    Ensure that all key contracts (including agency staff) are procured via appropriate frameworks. Any off framework arrangements should not be permitted, except in exceptional circumstances.
    Review or create list of all key contracts and external suppliers – including start dates, breaks etc.
    Look into cost reduction via consolidation of supplier base and invoices
    Ensure that the rules around professional fees over £50k are adhered to
    Estates related controls
    Specifically review and benchmark overall running costs for facilities and estates. Put in place cost reduction plans if above average (see utility and other contract review points)
    Undertake a review of estates strategy and confirm if action points, cost reductions etc. have been undertaken. If not implement “low hanging fruit” decisions immediately
    Ensure that estates have been rationalised – vacate all unused buildings, switch to rent on daily basis, room rather than floor rent etc. where possible
    Ensure that all lights and heat is turned off in unused buildings (ensure that comply with insurance requirements)
    Review all utility contracts to ensure that represents best value
    Waste disposal is managed and monitored
    Other controls
    Undertake clinical and non-clinical cost benchmarking
    Undertake drug formulary review and medicines management review
    Ensure that all overtime and enhanced payments are subject to prior approval and are monitored and minimised where possible
    PMO and CIPs
    Review the existing PMO structure: is it fit for purpose and is there board support and staff buy-in?
    If the answer to 4.1 is no, start working on improvement and strengthening of the PMO office
    Review existing CIPs for quality, deliverability and progress
    Reset CIP targets for each division / directorate – ensure that these new targets have been prepared by each directorate to ensure buy-in
    Review CIP quality approach – maturity level grading (idea, documentation, financial verification, quality approval, DoF CIP executive lead sign off to go live as a scheme)
    Undertake series of workshops with the workforce (ensure good crosssection of staff such as clinitian, estates, finance, procurement etc) to generate ideas and buy-in
    Ensure that staff receives training to use tools and templates
    Establish CIP budget holders in each division / specialty to ensure that each area is accountable
    Forecasts. reporting and turnaround plans
    Prepare financial baseline
    Assess underlying run rate vs outturn positions
    Increase finance team bandwidth / review capabilities / align to divisions etc.
    Reduce the number of budget holders and reset objectives
    Develop turnaround plan (recovery plan)
    Develop clinical service sustainability review and strategic plan
    Develop structure of daily, weekly and monthly operational performance review
    Develop automated key performance reports and KPI dashboards
    Business cases / Capital expenditure
    Review live business cases and assess what can be deferred or stopped
    Review planned capital expenditure what can be deferred or stopped
    Ensure that all business cases and capex is procured via appropriate framework
    Governance
    Create turnaround board or steering committee
    Ensure that the committee meets on a regular basis and feeds back to the board and to overall staff communications
    Review effectiveness of current management structures – are they effective
    Consider utilisation of non-executive directors for certain roles (if the skill set fits) to increase Trust’s capacity
    Create a plan to gain and maintain “grip” – including controls and processes. Ensure that the plan has key milestones and assigned responsibilities.
    Management and executive board
    Review necessity for various management meetings and committees etc. to free up management time
    Ensure that there is a greater challenge during board and other key meetings
    Establish list of ongoing and planned projects and determine what can be cancelled or delayed to free up people’s time
    Establish list of budget holders and determine level of buy-in so far (link with the SFIs reset)
    Turnaround board to approve all new projects across the trust (reduce distractions, focus on critical path)
    Culture and communications with internal and external stakeholders
    Review existing workforce communications plan and improve and change to reflect the key changes in culture and approach
    Establish regular contact and communications with the staff to ensure staff understanding and engagement (maybe establish employee forum)
    Establish regular workshops to gather cost saving ideas and drop in session to communicate changes
    Ensure that the management and the board embraced the “culture of cuts” and of continuous improvements throughout the trust.
    Establish regular contact with the trustees and ensure that they understand the key developments and changes
    Establish regular contact with external stakeholders such as commissioners, other acute trusts, NHSE, Monitor etc.
    Performance management
    Reset executive team objectives – ensure that these are geared towards grip and stabilisation
    Reset staff objectives and establish process to appraise within three months of year end. Ensure trust objectives are cascaded appropriately into personal objectives
    Where possible, identify non-performing individuals across the trust and ensure that they enrol on performance improvement programmes to improve skills (co-ordinate with HR)
    Create internal special measures / recovery plans for loss making specialties/directorates
    Ensure that service line management is fully implemented throughout the organisation – this will require clear management structures and strong performance management buy-in.
    Workforce planning
    Establish vacancy control board
    Assess recruitment process and establish processes to maintain quality but accelerate on boarding
    Implement weekly head count tracker (temporary and substantive)
    Assess number of interims, termination dates and daily rates
    Consider apprentices to be hired for administration, band 1 and band 2 posts under the Agenda for Change
    New recruitment to be considered on short hours e.g. 30 not 37.5
    Ward staffing levels v guidance (including uplift)
    Impose greater controls over bank and agency – self imposed cap on agency spend
    Impose greater controls over locum spend
    Review unfunded posts – check if some funds could be recovered
    Consider a direct engagement model for medical and medical support staff hired through locum and agency
    Consider rostering options and opportunities
    Review costs associated with RTT – do the penalty savings outweight the additional spend (if applicable)
    Review on-call run rate
    Review contract rates ensure that all aligned by band / post etc.
    Review any regular overspends on locum and agency staff – impose caps where possible
    Review and compare job plans for consultants, specialist nurses – improve if and where possible
    Ensure that e-rostering is in use for nurses and benefits realised
    Ensure that clear systems are in use for junior doctors, consultants etc.
    Monitor absence and sickness on individual, service line and trust level
    Ensure that rigorous illness policy and procedure is in place to minimise absence at work.
    Ensure that sickness is regularly reviewed at the board level.
    Inventory
    Establish current inventory levels and stock ordering system
    Review stock and reset stock targets by category / area (if required)
    Consider collection of excess drugs from wards and return to the pharmacy (if possible and applicable)
    If possible, establish automated stock cabinets to improve stock control
    Ensure that drug costs are benchmarked against peers
    Off contract spend controls and reports are in place and monitored
    Wastage and overspend are monitored and reported
    Where possible, procurement function is fully integrated into the process and incentivised to reduce costs
    Operational grip (including estates)
    Ensure that uncoded spells have been minimised or eliminated – ensure that clinicians are included in the process and proper and regular training is in place.
    Review and if required enhance capacity planning for each key areas such as outpatients, wards, day cases, A&E, community areas etc.
    Ensure that capacity planning is fully implemented across the trust, down to sub-specialty level
    Ensure that utilisation data is collected and compared to plan and peers – the data to be made available throughout the trust (board, clinicians, service lines etc.). Ensure that the data creates basis for utilisation improvement initiatives.
    Ensure that key management information is shared with the clinicians to ensure that they understand performance and targets.
    Review outpatient procedure to ensure that as efficient as possible and any downtime is minimised
    Review theatre utilisation against peers and targets, share within the trust (where appropriate) and build into personal performance targets
    Monitor bed utilisation, compare to peers and targets
    Length of stay performance is actively reviewed and managed
    Ensure that clear discharge policies are in place, with clearly defined responsible individuals to ensure that patients are discharged at the earliest opportunity where appropriate
    Ensure that staff levels are matched to patient demand patterns to avoid waits and avoidable admissions

    Northwind
    Full Member

    What’s the actual point of Chewkw’s current derail? Is he inventing private healthcare? We have that already.

    chewkw
    Free Member

    docrobster – Member
    Yes of course it’s tax deductible. It’s just another expense to take into account, you know, that reduces profit. Just helping you with your business plan chewkw

    You get them back in the form of lower overall tax liability. I haven’t checked how much you get back but there you go …

    samunkim – Member

    With that the entire system is in trouble.

    Northwind – Member

    What’s the actual point of Chewkw’s current derail? Is he inventing private healthcare? We have that already.

    I am advocating private GP practice where they receive NO funding from govt apart from paying patients. Why not? If they are no good nobody goes.

    I am not sure what yours mean by private health care … I am advocating GP practice where they do prescription only.

    This also takes the burden off NHS. Don’t you want others to take the burden off NHS fuding?

    You don’t have to use them if you have no wish to so what’s the problem?

    If patients are willing to pay the entire cost private GP (non-urgent) why prevent them?

    Drac
    Full Member

    Shhhh! He’s thinking.

    [video]https://youtu.be/XAALcw1y6bw[/video]

    Northwind
    Full Member

    chewkw – Member

    I am advocating private GP practice where they receive NO funding from govt apart from paying patients.

    We already have that too. No?

    Northwind – Member

    If patients are willing to pay the entire cost private GP (non-urgent) why prevent them?

    Do we?

    chewkw
    Free Member

    Northwind – Member

    chewkw – Member
    I am advocating private GP practice where they receive NO funding from govt apart from paying patients.

    We already have that too. No? [/quote]

    Where in GeordieLand you tell me. i.e. Where in North East?

    I am Certainly not paying the rate of £78/20 mins but I am will to pay £40/20mins for non-urgent consultation.

    I just want to consult get prescription or advice.

    Do we?

    Why not if you can afford to? I am willing to pay if it makes me well, not to wait for long, happy etc …

    My doctor’s appointment is one month wait for non-urgent matter, I am willing to pay but where can I go?

Viewing 40 posts - 441 through 480 (of 503 total)

The topic ‘What to cut to fund the NHS?’ is closed to new replies.