Investment and Impact Fund – NHS England

Case Study:

Investment and Impact Fund – NHS England

Turning a Simple Spreadsheet into a £20,000 Income in One Week

Introduction

IIF, or Investment and Impact Fund, is a funding mechanism in the UK that provides financial incentives to general practices for improving their performance in various areas, such as immunizations, cancer screening, and chronic disease management. However, tracking and reporting on the progress and achievements of these targets can be a tedious and time-consuming task for practices, especially when working collaboratively in a Primary Care Network (PCN). This case study outlines how a group of practices in a PCN used a simple spreadsheet and a mini-app platform to develop an innovative solution that not only made tracking and reporting more efficient but also helped them identify missed opportunities and easy wins, resulting in a £20,000 income in one week.

The Problem

The practices in the PCN were struggling to keep up with the IIF targets due to various reasons, including the complexity of the funding mechanism, lack of clarity on what to do next after identifying gaps, and the burden of communicating and reporting the progress to PCN managers. This is the first year practices have had a high amount of incentivised indicators to achieve, with the potential for  missed opportunities and underperformance. To address these challenges, the practices decided to develop a simple yet effective solution that would not only make tracking and reporting more efficient but also help them engage and motivate each other.

The Design

The practices used a mini-app platform called eManager by X-Genics to create a custom solution that would allow them to enter data quickly and generate automated dashboards that provided instant insights into missed opportunities and easy wins. The solution was designed to focus on forward planning rather than looking back, with a month-by-month record of achievements and missed targets. The solution was financially focused, highlighting the value of missed targets and identifying easy-to-reach targets. It automatically highlighted priorities and made it easy to understand and plan. Importantly, the solution was designed to engage practices by making every practice enter data and self-examine, resulting in better targeting of patients, focused meetings on group-wide achievements, and better collaboration across the network.

Achievements

The solution had a significant impact on the practices and the PCN, resulting in a £20,000 income in one week. The financially focused dashboard enabled the practices to differentiate profitable indicators from easy kills, resulting in better decision-making and a more targeted approach to achieving the IIF targets. The practices reported better engagement and collaboration, with all four practices working together in this and other areas, resulting in a joint Patient Participation Group (PPG) for better use of common resources. The solution enabled the practices to track progression over 12 months, plan and achieve goals without any last-minute rush, and identify coding errors. The practices reported that they achieved £20,000 across the PCN in the first two weeks of using the solution, and they understood how to work with IIF for the first time as a team.

Using a fully managed system and automated Dashboards, has allowed the team to focus on performance, never having to worry about updates to the requirements or the latest version of spreadsheets. The impact on the team is evident in a single comment by Dr Peter Brown the Clinical Director of Northwest Merton PCN said “I don’t know how other PCN’s are managing without this”.

Practice Managers reported feeling a sense of achievement and feeling valued as they were able to make more effective contributions to financial performance and clinical quality measures.

“So far the system has made a real impact on visualising targets and added value as well as holding practices accountable for their end of delivery.” Said Pinar Johnson, PCN Manager of Northwest Merton PCN

Conclusion

The IIF case study demonstrates how a simple app platform that generates intelligent Dashboards can be used to develop innovative solutions to address complex teamwork challenges in the healthcare system. The practices in the PCN were able to turn a tedious and time-consuming task into a financially profitable one, using a focused dashboard that not only made tracking and reporting more efficient but also helped them identify missed opportunities and easy wins, resulting in a £20,000 income in one week. The solution enabled the practices to engage and motivate each other, resulting in better collaboration and decision-making. The success of the solution can be attributed to the practices' focus on planning forward, financially focused design, and engagement of every practice in the network.

The system can be used solely by the PCN Manager to input already consolidated data, but involving and engaging member practices has the added benefits of self-responsibility; effective delegation; grass root improvements; and individual learning, not to mention that it makes the PCN Managers life that much easier.

NHS Digital - Quality Assurance Through Automation

 

Project for a unique automation solution for Practice Management
Project initiated by: South West London Digital First (SWL CCG)
Commissioned by: Group of SW London PCNs
Project led by: Northwest Merton Primary Care Network
Initial Pilots enrolled in programme:
  • 10 PCNs in SW London
  • 17 individual practices
  • 62 Total participating Practices
Status: Initial pilots have been completed and commercial roll out commences November 2022
Funding: Qualifies for PCN Development Budget

Objectives
  1. Our aim is to eliminate laborious paper-based processes and establish common and shareable high-quality processes through automation and workflow technology. This will allow all participants to acquire pre-set minimum quality standards “out-of-the-box” and perform to the same standard as an expert manager.

This will also make it possible to achieve and be certified to a recognised level such as the International ISO 9001:2015 standard with less effort, and act as a benchmark of assurance to minimise the burden for CQC Inspectors.

This project will address the following: -

  • Automatically addresses CQC Compliance
  • Structured management of Processes, and Protocols
  • Risk management
  • Team engagement, specifically Well-Led and Leadership
  • Standardised performance standards across the PCN and potentially ICSs

Peer Support Network

A common standard and common practices are essential building blocks for collaboration and efficiencies at scale. Digitisation will provide risk measured performance data, which can be used to pinpoint weaknesses to effect improvement.

Based on a centralised and real-time record of activity, we intend to introduce new ways of support and collaboration at PCN level.

This will include: -

  • Proactive member support as events arise
  • Sharing expertise and resources to lift least resourced members
  • Easier staff secondment to share good practice, knowledge, and skillsets

PCN Level Management:

  • Focused team interactions based on actual performance and issues
  • Improved collaboration and sharing of good practice
  • Learning opportunities through shared incidents and SEAs through central reporting
  • Targeted quality improvement experiences and strategies

Quality Assurance & CQC Inspections:

  • Explore and develop Peer Review Audits
  • Evidence collection to pre-empt CQC Inspections
  • Risk measured Compliance, performance, and improvement

Engagement with ICSs and Local Authorities:

The proposed system has the capability of “Channels” for other Stakeholders, which can be workflow Apps or simple data collection instruments, Examples of usage are:-

  • Interactive Safeguarding and Incident management Apps with real-time direct reporting and management to LA/ICS level as required. Providers can submit incidents and interact with Care Service Managers, with full reporting and analytics built in
  • Ad hoc secure data collection (e.g. expanding on what we learnt about local data reporting required during pandemic)
  1. The current Quality Process
    • GP Practices and other Providers work in silos, purchasing non-integrated compliance products from disparate suppliers
    • Each practice creates their own systems to their personal preferences and following their own methodology depending on experience and preferences.
    • Quality Assurance is generally assumed to be synonymous with managing and extensive library of policies.
  1. Limitations of the current process
    • Typically, all compliance and Quality Assurance is vested in the Practice Manager.
    • The system is heavily reliant on time and skills available to one individual manager. This creates a single point of failure, posing a very high risk both to the performance standard and business continuity.
    • Current methodology and design are based on laborious document management discourages Senior Management and Partners from participating in the Quality Assurance process This negatively impacts Well-Led, Governance, and Leadership objectives.
    • There is considerable duplication of effort across the board, estimated at some £15,000 per practice, but Practices often don’t have the motivation, knowledge, or resources to take advantage of economies of scale
    • The lack of a common standard, documentation, and work practices, adds a layer of difficulty in sharing and collaborating on anything from Best Practice to staff management

Business Continuity Risk:

  • There is considerable pressure and stress on Practice Managers, with some 50% indicating their intention to leave the profession. Replacing a manager can cost up to £25,000 in time and disruption.
  • A new manager, when faced with studying say 300 partially customised policies, will find it easier to scrap the entire system “personalised” by the previous manager, and start from scratch with standard policies as the baseline.
  1. Benefits for workforce

The key benefits of this system are: -

  • A single system for all Quality Assurance data, processes, and protocols. Everything in one place
  • Focus on Well-Led, Leadership and Governance, arguably the most difficult to prove at an inspection
  • Central repository of all Best Practices, processes, and protocols
  • Fool-proof processes, everyone gets it right first-time-every-time
  • Time, costs, and efficiencies. Always up to date, zero time wasted on updating policies, processes, protocols
  • Foundation for “Big Data” and granular data for performance benchmarking
  • Secure cloud data storage, not easily visible or accessible to malevolent parties

Benefit for PCNs

PCNs will achieve instant economies of scale with zero effort. Their library of common Best Practices is maintained centrally with automatic updates.

Setup takes minutes, and the system is simple and intuitive, taking a couple of minutes to learn.

  1. Benefits for Patients

Automation will free up Practice Managers, the most valuable member of the team, for more productive tasks.

Standardisation of Best Practice and streamlining of processes will provide consistency of service quality. Patients can be assured that their Provider is adhering to a high-quality standard on a continuous basis and not just at a single point in time of the CQC Inspection.

(100 words max scored)

PHASE 1: PROJECT START

 

No

Borough

ODS

PCN

Practices in PCN

1

Merton

U52546

Northwest Merton Primary Care Network

4

2

Merton

U52546

PCN Head office

1

3

Merton

 

Residential Care – Heathland Court – I

1

 

Total software installations

6

         

PHASE 2: 2ND WAVE

     

No

Borough

ODS

PCN

Practices in PCN

1

Kingston

U19424

Chessington and Surbiton PCN

5

2

Kingston

U72231

Surbiton Health Centre PCN

3

3

Kingston

 

PCN Head office(s)

2

 

Total software installations

10

         

PHASE 3: Testing and Feedback

Phase 3 is feedback & fixes from Phases 1 & 2

 

 

 

PHASE  4: New Volunteer Pilots

 

PCN Wide Pilots

     

No

Borough

ODS

PCN

Practices in PCN

1

Croydon

U33024

One Thornton Heath PCN

6

2

Croydon

U52199

Selsdon Addington and Shirley PCN

4

3

Croydon

U38734

Selsdon Purley and Coulsdon Health PCN

4

4

Merton

U77811

North Merton PCN

5

5

Merton

U00070

West Merton PCN

2

6

Wandsworth

U97650

PRIME Wandsworth PCN

4

7

Wandsworth

U73458

Wandsworth PCN

6

8

   

PCN Head office

7

 

Total software installations

38

         

Individual Volunteer Pilots

 

No

Borough

ODS

Practice Name

Locations

1

Croydon

H83005

Upper Norwood Group Practice

1

2

Croydon

H83013

Old Coulsdon Medical Practice

1

3

Croydon

H83020

Eversley Medical Practice

1

4

Croydon

H83042

Leander Family Practice

1

5

Kingston

H84015

Brunswick Surgery

1

6

Kingston

H84020

Fairhill Medical Practice

3

7

Merton

H85076

Stonecot Surgery

1

8

Merton

H85078

Mitcham Family Practice

1

9

Merton

H85101

Grand Drive Surgery

1

10

Sutton

H85023

Bishopsford Road Medical Centre

1

11

Sutton

H85063

Cheam GP Centre

1

12

Sutton

H85095

Robin Hood Lane Health Centre

1

13

Sutton

H85618

James O’Riordan Medical Centre

1

14

Sutton

H85653

Wallington Family Practice

1

15

Wandsworth

H85001

Wandsworth Medical Centre

1

16

Wandsworth

H85007

I Group Practice

1

17

Wandsworth

H85065

Alton Practice

1

 

Total software installations

19

 

The first batch of Trial Versions will be sent out from early November.
Initial Expressions of Interest indicate high demand. Priority will be given to PCNs and subject to slots available on the waiting list.