Annual Report

Transcription

1 Annual Report

2 SELDOC Board and Management Dr Emma Rowley-Conwy Chair of Board Member of Operations Committee Member of Finance Committee Dr Riaz Jetha Vice-Chair of Board Chair of Operations Committee Dr Robin Rastogi Chair of Finance Committee Dr Andiappan Mani-Babu Member of Operations Committee Dr Alan Kangatharan Member of Clinical Governance Committee Dr Kishor Vasant Chair of Clinical Governance Committee Dr Rajiv Mitra Former Member of Board and Operations Committee (Resigned in October 2011) Steve Dewar Non Executive Director Martin Lewis Non Executive Director Bev Norton Interim Chief Operating Officer (Interim) Denise Grant Assistant Operations Manager Trevor Dietrich Assistant Operations Manager

3 Anita Brookman Assistant Operations Manager Robin Andrews Director of Finance (Interim) T Support Officer Cynthia Creavalle Income Accountant Irene Zagradski Expenditure Accountant Dr Jacqueline McLeod Medical Director Vice-Chair of Clinical Governance Committee Thelma Essien Quality Co-coordinator Andi Adams Patient Liaison and Quality Coordinator Metin Halil IT Manager (Interim) Manoj Fernando IT Support Officer Farhat Qasim Executive Coordinator Natsha Mitchem Day time Receptionist & Administrator

4 Chair s Report The financial year has again been a year of substantial change for SELDOC, driven in part by internal improvements, and in part by changes in commissioning and unscheduled care locally. Corporate Governance Building on the changes to the Board in 2010, in 2011 we have benefited from the appointment of two Non-Executive Directors (NEDs) to the Board, to work alongside the six elected GP Directors. We were fortunate to recruit Steve Dewar, who has a background in the voluntary sector, and Martin Lewis, who has a background in local government, but who now works for a Member of Parliament. We have continued with our Committee structure, but since our strategy is discussed at Board meetings and at specific strategy planning away days for the Board, the Operations & Strategy Committee has been renamed as Operations Committee, and focuses on resolving operational issues. Details of each Committee s achievements can be seen in their respective Chair s reports. GP Practice Members GP Practice Members have, over the year, all signed a service level agreement. We have a defined member of staff who is responsible for maintaining the GP Practice Member database, on a rolling basis, so that we can ensure effective communications are maintained. Care Quality Commission (CQC) We are proud to announce that we achieved required Care Quality Commission registration as of 1 April 2012, a step that required a lot of background work, including a comprehensive review of policies, procedures and protocols, as well as extensive training for operational staff. We are now working on sharing some of our learning with GP Practice Members. 111 and Urgent Care Centres (UCC) During the year, we have been involved in re-developing our services within Lewisham A&E, so that we now offer Out of Hours GP support to the newly built Urgent Care Centre (UCC), as well as having a dedicated SELDOC GP, providing face to face consultations for base patients from the area as well as advice calls. 4

5 We have kept up links with Kings Healthcare Partners, and are providing GP support to the Home Ward pilot, which is currently operational in the localities of Bermondsey & Rotherhithe and South Lambeth. We worked with the Hurley Group and SE London NHS Trust to be a subcontractor at Queen Elizabeth Hospital, Woolwich UCC. We are working on developing further services and integration with UCCs, having commenced a weekend service in Guys MIU from January 2012 and we expect in 2012/13 to start providing GP services at St Thomas UCC and to tender for UCC provision at Kings College Hospital. Since August 2011 our focus has been on ensuring that SELDOC is actively part of the 111 service for South East London (SEL). The SEL specification for services was issued in March 2012, and we worked to submit a bid as a subcontractor to Harmoni. Unfortunately, we learnt recently that our bid was not successful. The implementation of 111 in SEL will have a significant impact on our work as the OOH provider for LSL, and we will work closely with the successful 111 provider to ensure that we achieve an integrated and effective service for patients. The Board is committed to continuing to ensure that SELDOC serves its GP Practice Members in meeting their out of hours commitment, by providing a quality, but value for money, out of hours service. SELDOC in turn requires the active support and participation of GP Practice Members, with local GPs staffing the duty doctor rotas in order to maintain our status as a mutual organization. Thanks None of the above would have been achieved without the support of the SELDOC day time and operational staff and all our duty doctors, and the continued support of our GP Practice Members and Commissioners, for which the Board is very grateful. Dr Emma Rowley-Conwy Chair of the Board 5

6 Operations Committee The Operations Committee meets monthly to monitor and develop all aspects of the operational side of SELDOC. Our key successes in were continuing to meet our National Quality Requirements (NQRs), achieving registration with the Care Quality Commission, completing the re-organization of the operations staff and developing our IT infrastructure. As well as providing the OOHs service, we have worked to develop other contracts within local UCCs and build our relationship with the local NHS Trusts. Activity In , we achieved our NQRs with just a minor blip on New Year s Day. Homeworking shifts have now been extended to include both full shifts and standby shifts to support surges in demand. We were commended by our Commissioners for setting up an emergency service to support surgeries affected by the summer riots. The table and graph below shows the activity for 2009/10, 2010/11 and 2011/12 for calls coming directly into SELDOC including those referred from NHS Direct. Case Type 2009/ / /12 Advice Base Home visit Out of hours activity for , month on month In September 2011 we were appointed to provide primary care services at University Hospital Lewisham UCC during late evenings and weekends, and commenced sessions at the MIU at Guys Hospital in January We have continued to provide duty doctor sessions at Gracefield Gardens, Streatham. We have also trialled establishing pop-up bases at local GP surgeries. 6

7 We have worked with the Deanery to offer a protected rota for trainers and their registrars, allowing them to book their training shifts automatically through Rotamaster. Duty doctors have been issued with a Service Level Agreement as a commitment to secure the arrangements between the two parties and enhance governance. The Board are extremely grateful for all the hard work and dedication shown by the operational staff and duty doctors in continuing to meet the targets. However, filling the duty doctor rota continues to be a challenge with only just over a third of local practices contributing to the duty doctor rota in As a GP co-operative we can only recruit from the pool of doctors working in LSL practices. We need more GPs to come forward to volunteer to work as duty doctors. This is the key to us continuing as a cooperative and remains a challenge for the Operations team for 2012/13. Operational staff The operational staff at SELDOC had a variety of contracts and terms and conditions, with the majority retained on the bank with limited job security. The Board agreed their terms and conditions should be improved and from October 2011 operational staff were provided with new permanent or bank staff contracts. These staff now receive paid annual leave, sick pay and have the opportunity to have a pension. We have provided training for all operational staff including customer care, information governance, safeguarding, as well as mandatory fire, health and safety and manual handling. IT We have continued to develop our IT capability. This year we have improved the telephony and call recording systems by introducing soft-phones that work over the internet for home workers and moving to cloud telephony, and for the first time we have achieved IGSoC compliance. Our key outstanding priority is to secure a more robust system for hosting our IT infrastructure. Future The focus in will be the impact of the SEL commissioned 111 service, which requires the 111 provider to deliver GP advice and for the existing OOH providers to offer face to face and home visiting. The implementation of 111 will result in significant changes in work patterns, which will require another restructure of the organization and its staff. 7

8 Clinical Governance Committee Effective clinical governance is at the heart of SELDOC s purpose, which is to deliver unscheduled primary medical care to the population of Lambeth, Southwark and Lewisham that exceeds our patients expectations, the standards set by our Commissioners and the expectations of our members. This year has seen the development of service provision at new sites, Lewisham Urgent Care Centre and Guys Minor Injuries Unit, providing opportunities to work with secondary care and other primary care providers on joint clinical governance pathways. Since January 2012 SELDOC has also supported the Kings Healthcare Partnership Home Ward Pilot, enabling admissions avoidance through the provision of 2 part-time Home Ward Doctors who provide medical supervision for a range of interventions in the community. Development of the Clinical Governance Team at SELDOC Dr Jacqueline McLeod (Medical Director) continues to lead on clinical governance, 3 days a week. She is supported by the clinical governance team of two full-time cocoordinators, a pharmaceutical advisor and three local GP s, associate members who undertake call audits. The Clinical Governance Committee has two GP Board Directors, ensuring a direct link and accountability to the Board and engages a non-executive director as necessary to provide independent support and guidance on patient and public matters. Registration with the Care Quality Commission During the financial year SELDOC invested in a comprehensive review of its services against the Essential Standards of Quality and Safety in order to strengthen our processes and procedures and meet the requirements for registration with the National Care Quality Commission (CQC). The CQC work-stream was led by the Clinical Governance Committee, who undertook a gap analysis, identified training needs and set out an action plan for compliance. Updated evidence-based policies were implemented, and a coordinated programme of training undertaken to embed strengthened procedures across the organization. Registration was achieved as of 1 April 2012; however, the work is ongoing as annual CQC registration is contingent on assurance of maintained standards. 8

9 Our Strategy In 2011the CGC set out a six-fold clinical governance strategy (Fig.1) and plan, actively promoting the provision of high quality services for patients and supporting both clinical and operational staff in delivering this. Fig1: Clinical Governance Strategy ( ) The Clinical Governance Committee has been working hard to achieve this plan in collaboration with staff, clinicians, patients and their carers, through a culture of openness, learning and continuous improvement. The Clinical Governance Committee meets monthly reviewing progress against the Clinical Governance Strategy and Annual Operating Plan, performance against National Quality Requirements (with a focus on NQRs 5 and 6) and overall quality and safety monitoring using a range of measures including: Clinical audits Prescribing audits against our key policies e.g. Controlled Drugs, High Risk medicines Questionnaire survey results (minimum of 1% patients), feedback, compliments Performance status of duty doctors, including review of balanced scorecards Incidents /Serious Untoward Incidents Complaints Risk Register 9

10 A Learning Organization SELDOC s focus on promoting a culture of personal and organizational learning is central to its drive to consistently deliver high quality care. Incidents, complaints and feedback from all sources are viewed as opportunities for reflection, experiential learning and improvement. The learning is synthesized and shared along with celebration of good practice through clinical newsletters, updates and pop-up reminders on Adastra. Clinical Audit In line with the changing nature of unscheduled care provision, SELDOC not only audits clinicians calls but has also adapted the Urgent and Emergency Clinical Care Toolkit (2011) 1 to audit face-to-face consultations. A suite of prescribing audits is conducted monthly to optimize prescribing practice out-of-hours. In addition, the clinical governance team has worked extensively with the Operations Team to strengthen call handler training and implement an urgent / immediate transfer protocol. Clinician Feedback In the past year we have been able to enhance the feedback provided to our duty doctors, adding call audit scores and number of complaints/compliments to the quarterly balanced scorecard. We know from experience, that the scorecard is valued as a reflective learning tool and evidence to support annual GP appraisal. See Figure 2. Fig 2: Balanced scorecard 1 Urgent and Emergency Care Clinical Audit (2011): RCGP, Royal College of Paediatrics and Child Health, The College of Emergency Medicine. 10

11 Medicines Management During SELDOC has further strengthened its prescribing processes and procedures with concise relevant policies and up-to-date online prescribing references integrated into the Adastra clinical system. Quality assurance is maintained through a suite of monthly prescribing audits and clinician feedback. Patient Involvement Our publicity, posters, leaflets and website have been developed to increase accessibility, improve transparency and provide consistent, clear messages about our services and wider health information. We have developed more efficient ways of obtaining timely feedback from patients and their carers and have used a combination of questionnaires, compliments, complaints and feedback to inform improvements to the customer experience and enhance support for staff and clinicians. We have been encouraged by the volume of positive feedback received. IT Development The clinical governance team has overseen the necessary step-change in SELDOC s information governance to enable alignment with developments in national standards and legislation. In addition, we have navigated our way through the complex project of customizing Adastra to enable automated audit and support evidence-based care. Plans for the future SELDOC has embraced the quality agenda and through the active engagement of staff and clinicians much has been achieved. In the year ahead we will continue to develop our patient and public engagement by setting up a dedicated user group and seek to establish systems that assure equity of care provision. In order to facilitate the smooth transition to 111, the new single point of access for unscheduled care, we will focus on: developing effective working relationships with other providers of health and social care developing referral pathways to enable efficient transfer of patients to other providers developing coherent clinical governance mechanisms across all our new sites 11

12 Finance Committee SELDOC has made an operating surplus of 32k for , continuing the good financial management developed in In achieving financial balance, the charges to GP Practice Members and Commissioners for patients of opted-out practices, have been kept to the level set in This continues to be highly competitive price in comparison to other Out of Hours providers. We also successfully secured an investment grant in year from the Commissioners to support the continued developments that we started in SELDOC has continued to invest in technology in year to support home-working GP shifts with laptops and soft-phones, securing hosted telephony services and developing the Adastra software system. Departmental budgeting and training were introduced. Budget holders have regular meetings with the Finance team to ensure robust monitoring of expenditure. In we continued to provide the dental advice and Lewisham Special Allocation Service for LSL commissioners and support members with half day cover and answering services. We gained further income from providing new services at Lewisham UCC and Guys MIU. We are continuing to seek additional opportunities to generate income with our existing resources. SELDOC s expenditure for the year is broken down as set out in diagram 1 below. Diagram 1: SELDOC Expenditure

13 South East London Doctors Cooperative Limited (SELDOC) Summary Accounts Year Ended: 31 March 2012 Company Number: (England and Wales) Report of the Board on the Summary Accounts for the Year Ended 31 March 2012 The summary accounts contain information extracted from the full audited financial statements of SELDOC. The full financial statements were approved by the Board on 7th August 2012 and will be submitted to the Registrar of Companies in due course. The full financial statements have received an unqualified audit report. The summary accounts may not contain sufficient information to allow a full understanding of the financial affairs of the company. For further information the full accounts can be obtained from SELDOC Ltd, Dulwich Community Hospital, East Dulwich Grove, East Dulwich, SE22 8PT. Independent Auditor s Statement to the Board of Directors of SELDOC Ltd We have examined the summarised financial statements set out on pages 11 to 14. Respective responsibilities of Directors and Auditors The Directors are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view. Our responsibility is to report to you our opinion on the consistency of the summarised financial statements with the full financial statements and Annual Report. We also read the other information contained in the summarised annual report and consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with the summarised financial statements. Basis of opinion We conducted our work in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board's Ethical Standards for Auditors. Opinion In our opinion the summarised financial statements are consistent with the full financial statements and the Annual Report of SELDOC Ltd for the year ended 31 March Ronald Price FCA (Senior Statutory Auditor) for and on behalf of Beak Kemmenoe Chartered Accountants & Registered Auditors 1-3 Manor Road Chatham Kent, ME4 6AE 13

14 Profit and Loss Account for the year ended 31st March TURNOVER 3,981,667 3,638,260 Cost of sales 2,469,439 2,235,279 GROSS PROFIT 1,512,228 1,402,981 Administrative expenses 2,008,024 1,900,763 Other operating income 495, ,925 OPERATING PROFIT 28,612 23,143 Interest receivable and similar income 4,911 4,959 PROFIT ON ORDINARY ACTIVITIES BEFORE TAXATION 33,523 28,102 Tax on profit on ordinary activities 982 1,041 PROFIT FOR THE FINANCIAL YEAR 32,541 27,061 14

15 Balance Sheet as at 31st March FIXED ASSESTS Tangible assets 214, ,738 CURRENT ASSETS Debtors 1,227, ,866 Cash at bank and in hand 2,374,558 3,011,004 CREDITORS 3,602,462 3,961,870 Amounts falling due within one year 620, ,104 NET CURRENT ASSETS 2,981,675 3,183,766 TOTAL ASSETS LESS CURRENT LIABILITIES 3,196,370 3,395,504 CREDITORS Amounts falling due after more than one year 104, ,589 NET ASSETS 3,091,457 3,058,915 RESERVES Profit and loss account 3,091,457 3,058,915 3,091,457 3,058,915 15

16 Cash Flow Statement For the year ended 31 st March Net cash inflow from operating activities (595,299) 68,088 Returns on investments and servicing of finance 4,944 7,364 Taxation (1,750) (5,230) Capital expenditure (44,308) (122,574) Decrease in cash in the period (636,446) (52,352) Reconciliation of net cash flow to movement in net funds Decrease in cash in the period (636,446) (52,352) Change in net funds resulting from cash flows (636,446) (52,352) Movement in net funds in the period (636,446) (52,352) Net funds at 1 st April 3,011,004 3,063,356 Net funds at 31 st March 2,374,558 3,011,004 16

17 Accounting Policies Accounting convention The financial statements have been prepared under the historical cost convention. Turnover Turnover is the total amount receivable by the cooperative for services provided excluding VAT. Tangible fixed assets Depreciation is provided at the following annual rates in order to write off each asset over its estimated useful life. Electronic equipment Office equipment Motor vehicles Furniture and fittings - 20% % on cost - 15% on reducing balance - 25% on reducing balance - 10% on cost Pension costs and other post-retirement benefits The company operates a defined contribution pension scheme. Contributions payable to the company's pension scheme are charged to the profit and loss account in the period to which they relate. Deferred Government Grants Deferred government grants in respect of capital and revenue expenditure are treated as deferred income and are credited to the profit and loss account over the estimated useful life of the assets to which they relate, or when the expenditure is incurred. 17

18 Patient Feedback SELDOC has been actively attempting to increase and improve upon the level of patient feedback we receive in 2011/12. Feedback is now dealt with by our Patient Liaison and Quality Co-coordinator (PLAQ). We obtain feedback via the following means: a redesigned questionnaire, relevant to our NQR targets, is posted to a percentage of our patients in Lambeth, Southwark and Lewisham who have received either advice on the telephone or a home visit from a doctor. Other questionnaires are available in the Dulwich base reception for visitors attending a doctor s consultation. We plan to introduce similar questionnaires in UCCs.. Leaflets and forms explaining how to contact SELDOC with compliments, concerns, comments or complaints are displayed in our waiting room, and can be easily downloaded from our website ( Posters in our Dulwich base waiting room encourage people to leave more detailed feedback via a specially designed form that can be anonymously submitted via a blue postbox. We have been experimenting with new ways of processing the feedback we receive. Detailed feedback is acted upon by our PLAQ, who documents how much positive feedback the service receives against the amount of negative feedback. Anything flagging a potential matter for concern is acted upon. All feedback is logged. Positive feedback identifying a particular doctor will be recorded on Adastra and subsequently in the doctor s balance scorecard. The PLAQ will contact members of non-medical staff with this feedback via . We monitor the amount of patient questionnaires sent out against the numbers received back. The PLAQ reviews the received questionnaires on a monthly basis for patterns and trends in the information given. Anything of note is fed back to the Clinical Governance Committee, with the percentage of questionnaires deeming our service to be Excellent, Good, Satisfactory or Poor. Since the new system of questionnaires came in, 89% of our responding patients have rated the service as Excellent or Good, 7% as Satisfactory and only 4% overall as Poor. This information is displayed at Dulwich base for duty doctors and staff to see. As part of a patient participation initiative, our PLAQ has been visiting patient participation groups at GP member surgeries. This has helped us to spread awareness of the service SELDOC provides, make contacts with our SELDOC GPs and surgery members, speak to patients outside of a clinical situation and receive their comments, suggestions and ideas about the service. I have always found SELDOC very useful and efficient. They have always been there when I really needed advice and help. I have found them a great comfort. All the staff so far have been kind and helpful and I would like to thank SELDOC for their service. Keep up the wonderful work you do. - Anon, Dulwich base 18

19 Profile of our Organisation SELDOC is a GP Co-operative, run as a not for profit mutual organisation, set up by local GPs in 1996, for the provision of out of hours services to the million patients of Lambeth, Southwark and Lewisham (LSL). The distinctive feature of SELDOC is that it is owned, managed and resourced by local GP Practice Members. SELDOC uses local GPs, familiar with the locality and health services in the area, to provide its services. We manage and respond to nearly 60,000 patient calls a year. All contacts are initially triaged by a GP. If a face to face consultation is required, patients are invited to attend one of our four bases - at Dulwich Hospital, the Primary Care Suite in Lewisham Hospital, Guys Minor Injuries Unit or Gracefield Gardens in Lambeth. We also provide a home visiting service through our dedicated mobile doctors using a fleet of environmentally friendly low emission automatic cars.

20 20