LMC Secretaries’ Conference 2013 – Workshop notes
The future format of the UK LMC Conference
Facilitator: Helena McKeown
GPC Secretariat: Holly Trotman
Feedback focussed on the following areas (areas that were considered particularly important are highlighted in bold):
Inclusivity
· A major point raised during the morning workshop was that of inclusivity. The Conference can be alienating and difficult to understand, particularly for those that haven’t attended before;
· The Conference can be intimidating because of its complex rules and the tendency for the more experienced to dominate the debates. It is more difficult to get a point across for those that are unfamiliar with the rules and procedures e.g. confusion around taking a motion as a reference. However, it was also noted that the BMA’s ARM can be worse in this respect;
· An instructional DVD of the Conference, or video on YouTube, could be very helpful for those that have not attended before;
· The introduction to the Conference given on the first day by a member of the Agenda Committee was useful and should continue;
· It is important to make the Conference more inclusive and particularly to encourage those who have not been before to attend, including younger GPs;
· There is sometimes too much focus on procedure and not enough on debating the right issues e.g. important motions not being debated because of how they are written. There should be more flexibility to amend and debate motions if necessary;
· LMCs that never submit motions should be identified and asked why;
· Grass roots GPs may have less experience of writing motions and could be disadvantaged. However, it was noted that guidance on writing motions is sent out every year, including information on the BMA’s motion drafting service;
· It could be useful to include more chosen motions on the agenda so that representatives could more easily influence the subjects debated. However, it was also noted that this could be open to manipulation by larger LMCs or those that group together;
· The voting on motions can sometimes be influenced too heavily by the GPC Negotiators and Subcommittee Chairman, who often direct Conference to accept or reject a motion. This could sometimes have a negative impact on the democracy of the Conference and its function as a Conference of LMCs.
Devolved Nations
There was a discussion in both workshops on the format of the Conference and how issues affecting each nation were scheduled across both days. The following points were made:
· It was suggested it could be more appropriate for the first day of the Conference to focus on UK issues and the second day to focus on English issues. The Conference had to begin with the speech from the GPC Chairman, so day one would have to be UK-wide;
· It was noted that there were separate LMC Conferences for Wales and Scotland and it would be appropriate for there to be an English LMC Conference;
· There were many motions on the agenda that were not relevant to the Devolved Nations, particularly now that the national contracts were diverging.
‘Fringe’ events
· A suggestion made in both workshops was that it would be useful to hold fringe events at the Conference on particular themes to allow representatives to be more actively involved in debates;
· Examples of themes would be premises, dispensing or IT, where knowledge and best practice could be shared among LMCs. Authority could be devolved to a subgroup of the Conference to debate a theme, with the subgroup acting like an expanded subcommittee. The subgroup could be asked to debate a theme on the first day of the Conference and to formulate motions to the debated by the whole Conference on the second day;
· Any fringe event must lead to the formulation of policy and not just involve discussion.
Technology
· It was suggested that parts of the Conference could be conducted via teleconference with remote voting so that it was easier for representatives to take part and to save on costs. However it was also noted that this could negatively affect networking opportunities;
· It was suggested that electronic voting was used for every vote but it was recognised that this would be considerably slower. However, it could be trialled during part of the agenda at the 2014 Conference.
Timing
· It is important for the Conference to be at the right time of year to influence the negotiations on the GP contract. It was noted that the current timing i.e. May was appropriate for this;
· There could be some value in making the Conference earlier in the year, although if it were too much earlier this could affect the relevance of motions that were passed onto the ARM;
· The Conference should be held on a weekend.
Costs
· It was suggested that the cost of the Conference be published to increase transparency and encourage cost effectiveness;
· It was suggested that accommodation could be block booked and then allocated to LMCs to save money. There was general support for this as long as LMCs had the option of choosing elsewhere.
Content
· There were mixed views on speakers at the Conference but it was generally felt that the time would better spent on debating or fringe events. If there were to be external speakers, higher profile speakers were not necessary. It was generally felt that more contentious speakers added more value;
· It was suggested that elections are removed from the Conference and are conducted separately;
· The subjects on the agenda tended to be repetitive and it could be useful to have fewer debates but more time for each;
· New subjects should be added to the agenda, particularly those with an educational rather than political focus;
· Many motions were uncontentious and did not need to be debated. The Agenda Committee should add more motions to part two of the agenda;
· The soapbox session should be extended.
Other comments
· More could be done to publicise the Conference, and changing the name could be useful. A suggestion was the ‘Annual Conference of GPs’. However, those in the afternoon workshop did not think a change of name was necessary;
· It was noted that York was a very difficult location for some and that London had better transport links. Good alternatives could be Birmingham or Manchester;
· The presence of the press made everyone ‘on message’ and could stifle debate;
· The way the seating was arranged encouraged a ‘them and us’ atmosphere, with GPC members sitting separately at the front;
· There would be little value in extending the Conference and if anything it should be shortened;
· The LMC Conference is the best way to formulate policy, but there is variation in how resolutions were taken forward after the Conference;
· More people should be allowed to speak, but for less time;
· The Conference should finish at lunchtime on the second day;
· It was suggested that the dinner be held in a less formal setting, however it was noted that venues that could cater for 500 tended to be more formal;
· Those sitting on the stage should have name plates so they can be more easily identified;
· There should be better networking opportunities for observers.
Setting up a new provider company based on local practices
Facilitator: Mark Galloway, Business Manager, North Hill Medical Group & Chief Executive, GP Primary Choice Ltd
GPC Secretariat: Alex Ottley
The presentation and Q&A were led by Mark Galloway (MG) – group practice Business Manager in Colchester, with a banking background, and heads up a local provider organisation set up earlier in 2013
Discussion
1. What was the capital outlay from each practice?
15p per patient on the list – about £45,000 or £1,000 per practice – which is really tight, but we did not think we could ask for any more. The legal costs were the most expensive outlay in the process - £22,000 went on legal fees and CQC
2. Do you have to have someone who is pretty driven to make this happen?
Yes, you need to be driven and committed.
3. How did you extract funding from the Area Team?
The LMC managed to negotiate some funding from the Area Team for this.
4. Did the consultants advising you push you in the direction of being a for-profit organisation?
The simple answer is it is quicker to set up a for-profit organisation. Commissioners are currently hung up on social enterprises without really understanding how they operate.
5. We were thinking of setting up a mutual and dividing the county into two limited companies. Do you see any problem with that?
No, that sounds like a good idea. It is good to use your Practice Managers (PMs) because they are likely to be more business orientated than many GPs.
6. Can NHS Pensions Scheme entry be affected?
As it stands, there are only two models available that allow people to remain and continue to join the NHS Pension Scheme. Private companies limited by shares and social enterprises or community interest companies (CIC). This is known as directed body status.
If you’re setting up a private company, you can decide who you want to invite and not invite. In creating interest and excitement from the outset, that will generate willingness for practices to buy into your business plan.
Setting up social enterprises or CICs is a more complicated process and will require detailed legal and financial advice.
7. Did you approach the LMC or did the LMC approach you?
The LMC approached me to find out what I was up to and it spiralled from there.
8. Who owns the shares in the organisation?
The GP partners own the majority of the shares and every PM has one share. There was a huge debate about who would own the shares, but we decide against including salaried GPs. The PM’s had to pay a penny for their share, but also gave 10 hours of unpaid work which was useful in terms of getting accreditation for CQC etc.
9. How much time did it take once you started setting things up? Do you need to clear your diary for two months to allow things to happen?
Very difficult to say about time – I personally spend 7-10 hours a week working on company stuff in my own time. One PM has fallen by the wayside because of the challenging role in his practice.
As soon as we were created, suddenly everybody tendering wanted every GP involved in the contract.
10. How is your relationship with the LMC now? Did commissioners talk directly to you now instead of LMCs?
No, they talk to us directly like they would with Virgin or Care UK.
11. Do you use a tariff for the work you bid for to ensure the work you have to deliver is subsequently funded?
We spent quite a bit of time preparing our financial model because you create a hold load of base costs. We had an interesting battle with the CQC about how much they wanted us to pay. We’re going to be able to pay 17p more per patient on phlebotomy than practices were previously receiving for the local enhanced service (LES). You must have some people who understand finance, even if this means buying it in from an accountant.
12. LES are always an oddity, so is it going to be worth practices taking them up? Do you talk to practices before you take up a contract?
It’s very early days still and we haven’t won a contract yet. We’re only here to enhance practices or do what they cannot do for themselves. We won’t bid for anything where we have to go to a practice without a clear plan of why this is good for them.
This is not about the company it is about the practices. We have had to reject opportunities to bid because the finances from commissioners have not stood up. We have advised commissioners of appropriate funding levels where they have priced things too low.
13. These organisations need to set aside reserves to cover wind up costs – these organisations have finite life expectancies and may end up being useless when the next NHS reorganisation occurs. VAT is also an issue because everything that is not delivery of care is VATable.
If you are going to run a back office function you are only going to do this to reduce costs. It is great until practices realise this means losing staff.
I have had some interesting debates with CQC and at one point they wanted us to register every practice, which would have cost over £45000 per annum. We have now managed to get CQC to agree that we are one provider subcontracting to the practices.
14. What happens if you do not win good contracts? What are your plans?
You must be honest with the shareholders from the off. The risk is if we do not win contracts or we win bad contracts, they lose their £1,000. There is also a corporate risk to the directors too.
15. The footprint of your company is co-located with the CCG. Is your public health footprint the same as your CCG? How are you going to work together to get those contracts?
We are desperately trying to get other provider organisations to talk about this as public health covers seven CCG areas. We also do not want to rule ourselves out of winning these contracts and then subcontracting with practices in other areas.