P s ri e m ic v ar r y e In y S teg nit rated Commu

Primary Integrated Community Services

Limited Registered Office: Unit H4, Ash Tree Court, Business Park, Nottingham NG8 6PY P s ri e m ic v ar r Tel: 03000 830000 y e In y S [email protected] teg nit rated mmu www.picsnhs.org.uk Co

Annual Report 2016/17 Excellence in patient and primary care Registered in & Wales Company Registration Number 8763136

Primary Integrated Community Services Foreword Primary care Integrated Community Services are proud to present a copy of the second Annual Report

The report highlights our achievements and progress over the last year, including a summary of our accounts and current financial position. ‘We Care’ “We Care” about our patients, carers and families, our partners and all the people we work with underpinned by our core values and our “can do” approach. We regularly review our values and ensure these are integral at all levels of the organisation. Our Values Our values are integral at every level of the organisation and were created by “us” the people that work here. n Family and patient need is central to our decision making

n We have a “can do” approach that is responsive, creative and innovative

n We are non-judgemental, open and transparent with a no blame culture

n We are inclusive and collaborative inside and outside the organisation

n We are professional and passionate about our care for patients and one another

n We put safety first in everything we do

n We protect and support General Practice and our clinicians

n Our care is evidence based, safe and effective

2 3 Message from Message from Alison Rounce Managing Director Dr Kelvin Lim Medical Director

I am very proud of the progress PICS has working with some groups of practices to Our organisation has grown considerably over This good work was led by Dr Kerri Sallis. Our CCG made over the last year. We have a won a help coordinate the implementation of GP the last year and PICS provide an increasing is very effective at all levels of the organisation number of contracts including a contract to Access teams. Changes in commissioning number of services in a wide geographical area through the ability to cascade information and deliver Community Pain Services across South and delivering national and local financial and and in partnership with many different providers. feedback to and from every service. Our CCG . efficiency targets will set challenges going Retaining a positive caring culture, patient safety provides assurance through the robust processes forward but PICS aim to ensure primary care and a high standard of clinical care is paramount. and policies in place and that any concerns are We will be working in partnership with a and GP practices are central to care delivery The Medical Director is accountable for managed effectively. It is heartening to see how number of other providers to deliver the service. now and in the future. continuously improving the quality of services and conscientious our clinical staff are in the welfare It showcases our tried and tested pain model safe guarding high standards of care by creating and care of their patients and how they strive to in delivering excellent patient care and our We were asked to caretaker two practices, an environment in which clinical care can flourish. improve the patients quality of life. It demonstrates ability to transcend and integrate with other one in Balderton and one in Kirkby in how our values are truly integrated in to specialities. Ashfield (KCPCC) and have made significant New schemes of accountability and delegation working life. improvements with a good report from CQC for have been implemented and improved and we Our core aim since the inception of PICS Balderton and awaiting inspection for KCPCC. have recruited further clinical leadership; Clinical All components of clinical governance are subject has been to help with the sustainability and Governance Nurse (Hazel Firmin) and GP lead for to scrutiny and challenge through the Board innovation in primary care. GP practices are As our organisation has grown we have Clinical Governance (Dr Kerri Sallis) for Balderton of Directors. These include; risk management, experiencing many national changes that are introduced additional capacity to manage new Primary Care Centre and Kirkby Community clinical audit, education and training and impacting on their future viability coupled with initiatives; an Operational Manager, Business Primary CareCentre. professional development, evidence based care, many GPs leaving the profession. PICS have Manager, Data Analyst and we have created patient and carer experience and staffing. All been working hard with our GP members to identified nurse and GP leads in Clinical The Clinical Governance committee (CGC) has reporting and risk registers are presented to the collaborate and find ways of delivering services Governance. Our schemes of delegation and monthly meetings and has been successful in board for assurance with any action plans that are more efficiently and at scale by utilising PICS as Clinical Governance have improved to match the ensuring that PICS as an organisation is able required giving an opportunity for both challenge a vehicle and platform to support primary care growth and we are looking to phase in further to care for patients safely. We have reviewed all and support from non-executive Directors. sustainability. capacity to the corporate structure and board complaints, safeguarding reports, audits and over time. significant events that have occurred in the last Over the last year we have been working with year. Having one process has allowed us to analyse mid Nottinghamshire practices and have helped I would like to acknowledge how conscientious, trends, ensure learning across all parts of the them to deliver new services, for example, professional and caring our staff are both organisation and feedback to all staff. the Acute Home Visiting Service at Newark, administration and clinical. This is evidenced Clinical Pharmacist pilots and we are currently by the excellent patient satisfaction we receive. The CGC is multi-disciplinary with representatives Dr Kelvin Lim Quite simply our organisation is our people, and from Nursing, General Practice, Pharmacists and our reputation and success depends on them. Management. It is chaired by the Medical Director and should it be necessary representatives from I would also like to thank all the partners we different disciplines are invited. work with in secondary and primary care and the third sector who help us to work together We have already used audits for good effect and to give our patients the good care they deserve. improved learning outcomes and will continue to share audits and protocols in the forthcoming year across both KCPCC and Balderton, PICS and where appropriate, the wider primary care community. Alison Rounce We have successfully completed audits on use of Atorvastatin in CKD 3, regular measurement of U&E in patients on Methotrexate and ensuring the DMARDS registers are robust in both practices.

4 5 Our Aims

To deliver and provide clinically led pathways for patients that are evidence based, Our clinical and efficient, cost community pathways effective and of high quality care. include: To deliver pathways for patients that are truly n Respiratory and Nurse Educator Role seamless through secondary and primary care built on n Cardiology and Atrial fibrillation our partnerships with a wide networks of n Palliative care for long term conditions stakeholders n Diabetes To provide a platform and vehicle for our n Urology primary care partners that will provide: n Gynaecology n A governance structure and partnership that enables practices to deliver services n Carpal Tunnel at scale n Care Coordination Our Structure n A conduit and integrator with other providers n Acute Home Visiting n A platform to help practices deliver n 24 hour ECG The organisation is a company limited by The Business Manager and the Finance and collaborative work in primary care shares and (nominally) ‘for profit’. We say Corporate Manager are in attendance at n Clinical Pharmacy nominally because the company expects each meeting. to make a profit eventually but in the early n Pain Services years will seek to re-invest any profit in In our November 2017 AGM we will appoint expanding the organisation, allowing it to a non-executive Director Chair and an PICS currently provide a caretaker role for compete more effectively for contracts and additional non-executive GP subject Balderton and Kirkby Primary Care Centres become a stable business entity. The idea to shareholder approval. The board is based in is to invite GPs to become a member by supported through risk assurance, schemes and and Ashfield CCG area. purchasing a share in the new company. of delegation and management Our board consists of a small group of controls including a governance committee Directors; Dr Kelvin Lim (Chair), Dr Andrew providing robust corporate assurance. Parkin and Dr Junaid Dar and the Managing Director Mrs Alison Rounce.

6 72 Our Pathways

Respiratory Pathway Our respiratory nurse team has a wealth support networks is essential. We have of knowledge and specialist training in access to the psychology team and we Respiratory Nurse Cardiology and Atrial respiratory disease. have a unique relationship with several Educator Role Fibrillation Pathway Breathe Easy groups in Nottingham. They We have secured a contract with Nottingham Our service is provided by a dedicated team All patients referred to the team have long support the groups in all sorts of ways; North and east CCG to provide a Respiratory of specialist heart nurses who deliver care in term conditions including; COPD, Idiopathic answering questions of members, checking Nurse educator role starting September a community setting in Nottingham West and Pulmonary Fibrosis, Bronchiectasis and inhalers, making sure patients understand 2017 The aims of the service are: Nottingham North and East CCG areas. We difficult asthma. instructions, being speakers, organising work in conjunction with other providers and speakers and trips, and being a valuable We know that respiratory problems of a To provide additional support and education rehabilitation groups to help improve care resource for patients and carers. long term nature pose a major physical in respiratory disease for the GP practice for patients with chronic heart failure; Left teams with the aim of: challenge for our patients who are trying to The relationship with Breathe Easy allows Ventricular Systolic Dysfunction (LVSD) and cope with breathlessness in their activities of patients to have peer support in a supported n Providing improved quality of care for Atrial Fibrillation (AF). Our service is highly daily life. Acute episodes of breathlessness environment and enables them to build their patients and their carers regarded by referrers and patients and has can potentially result in life threatening confidence, try new activities and encourage shown a reduction in hospital admission and situations for both patients and their carers them to socialise with others. This leads to n Providing improved carer experience successful up titration of beta blockers. and increase symptoms of anxiety and fewer exacerbations, hospital admissions n Reducing unnecessary admissions to We receive many comments and letters of depression. and gives them a greater sense of wellbeing. hospital thanks from our patients and carers. Part of our work is to help patients and Clip below from one of our carers: families recognise their symptoms and to n Improving patient and carer satisfaction develop a plan that the carer and patient can “As the main carer for both my mother and n Delivering further savings for the health follow and put into action if the need arises. father you were an invaluable support to economy Managing anxiety, depression and social me in helping me to navigate the obstacles isolation play a big part in the mastery of Our designated nurse, Alison Sutherland has which are faced by individuals such as me. respiratory illness and the involvement of 24 year experience of working in respiratory I was always met by you with compassion care, a teaching qualification and has and caring and will never be able properly lectured to a wide audience. explain how much that meant to me.

She has established a wide group of I believe that the post which you hold is networks in the respiratory field; in primary vital in ensuring that patients with heart and secondary care and the third sector She failure are well cared for by a specialist currently practices in a respiratory specialist practitioner. You are truly making a role for PICS and has been with them for difference.” over 9 years.

8 9 Urology Pathway

The Lower Urinary Tract Service (LUTS) is The clinical leadership for the pathway is provided for men with prostatic symptoms Dr Mike Henley, a consultant urologist who and a normal Prostate Specific Antigen (PSA) works with a highly trained team of nurses. and creatinine clearance. The patients are seen locally and Ultrasound Scan (USS) and We have a high patient satisfaction rate and urinary flow rates are performed. use of this service has resulted in a lower Palliative Care Pathway overall rate to urology. Our Palliative Care pathway provides care In addition, patient satisfaction has been The service provides care closer to home and and support for patients and their carer’s in found to be very high with the service, with better assessment in the community which the last 12 months of their life. Our teams 95% rating the service they received as good is consistent with NICE guidelines. provide care for people in Nottingham City, or excellent. Within the survey patients also Mansfield and Ashfield and Nottingham provided comments such as: West CCGs. The aim of the service is to provide support to help patient’s live as “Cannot speak highly enough of the care actively as possible until death. Using a and support received from the nurse” case management approach care can and Diabetes Pathway be individualised to the patient’s needs. This may include symptom management, “always approachable and caring and go out The community diabetes service supports both to the DSN’s Pat Clarke and Karen advance care planning, advanced decisions of their way to answer questions and allay practices and patients in the delivery of Richardson., and the practices. The service to refuse treatment, carer support, any fears.” enhanced diabetes services from within their is co-ordinated through a local GP, Dr Paul bereavement support, liaison with the wider own practices. It has been running for 10 Jacklin who serves as the GP mentor and integrated community team and the out of The service which is aimed at patients years and has supported the development of practice link for resolving problems. hours service. with non-malignant disease is able to offer practice nurses and GP’s, particularly in their support to patients with many differing ability to manage patients on insulin. It has The scheme has satisfaction data which By utilising a case management approach long terms conditions such as respiratory, achieved this through regular educational outperforms NUH since inception, and working collaboratively with other cardiac, renal, liver and neurological sessions, audit and formative learning. and has hugely reduced hospital clinic providers of health, social and palliative problems. This means that patients within attendances and new referrals. care, the team have been very successful these areas have support at the end of life It has encouraged practices to analyse in providing proactive and responsive care, regardless of diagnosis. national statistics, and challenged and enabling over 90% of their patients to die in supported them with the development of their preferred place of care. This compares their diabetes teams. very favourably to the national average. Our 2 diabetic specialist nurses provide Public Health England (2013) reported that regular practice based clinics throughout 67% of patients expressed a preference to NWCCG and are supported by a consultant die at home but despite this the majority from the QMC, Mr Simon Page who provides were still dying in hospital. clinical governance and educational support

10 112 Gynaecology

Our community gynaecology service The service is provided by two local GPs, successfully completed the Nottingham Dr Easson and Dr Sawyer, Health Care West CCG pilot in March 2017 with excellent Assistants, Jo Stackhouse, with clinical Carpal Tunnel outcomes in terms of efficiency and patient leadership consultant support from a highly outcomes. The CCG agreed to extend the respected consultant gynaecologist service for a further year. We work closely (Mr Martin Powell) and offers an alternative The Carpel Tunnel Service is subcontracted The service is managed by expert with our partners; Circle Treatment Centre to referral to hospital for a range of to the Nottingham Road Clinic and it surgeons and supported by a fully trained to ensure pathways for patients is seamless gynaecology conditions. The service is provides a very effective and value for money multidisciplinary team. and any patients with urgent needs are currently provided in Nottingham West. service. We carry out this service at the clinic to free up spaces for surgeons to do All patients are given customer surveys and referred immediately. The service provides these are analysed and reported bi-annually Patient feedback has been extremely positive more complex operations in the theatres advice, follow up and treatment for the and discussed with our surgeons and staff especially being able to receive care closer at Sherwood Forest Hospital Trust allowing following conditions; to see if we can make improvements. Our to home. Some examples of patient feedback surgeons and to provide services closer to home in a more informal and relaxed setting. referrers are happy with our service with no n Cervical polyps below; outstanding issues. Patients are seen within 2 weeks of us n Fibroids of a manageable size “I was nervous but the nurses soon made receiving the referral. We offer weekday and me feel at ease.” n Menopause problems weekend appointments. “Everything was well explained from the n Severe premenstrual syndrome and start.” menstrual disorders “Discussed options, formulated a good plan n Pelvic pain of action, excellent service”

n Polycystic ovarian syndrome “Listened attentively and shared n Prolapse and pessary changes understanding.”

n Sterilisation requests.

12 13 “Amy Scott, PICS’ only Allied Health New Developments Professional for PICS, attended the Royal College of Occupational Therapy (RCOT) The team are now trying to proactively conference in Birmingham in June 2017 to identify patients suitable for intervention promote the Care Co-ordination service. from the Care Coordination team before they reach crisis point from eHealthscope on a Amy designed a poster and completed a daily basis. presentation to delegates, explaining how the service works in our area, what Occupational It is a Nottingham-wide information system Therapy contributes to the treatment for delivering patient care originally piloted Care Coordination patients receive, how Clinical by Nottingham West practices which allows GP practices and local care teams to Care Co-ordination has changed over the regularly review key cohorts of patients who The Care Co-ordination Service is a A number of dedicated posts have been past two years and how the service is hoping have COPD, Heart failure, Stroke, dementia locality based model in Nottingham West created within the Local Care Team to develop in the future. The work received & end-of- life registers. that coordinates care and support for including Clinical Care Coordinators, positive feedback and the conference was We also monitor and where necessary older people. The aim of the service is to Administrators, Therapists and Social also an opportunity to make connections contact patients with a dementia diagnosis support patients and carers aged 65 and Workers. It also incorporates close working with other Occupational Therapists involved who have just been discharged from hospital over and those with complex needs to with the Psychological Therapies for Long in working in primary care. with an urgent admission in the last two live independently for longer and reduce Term Conditions Team, the Community and The current RCOT campaign of “Improving weeks. avoidable admissions to hospital care. Voluntary Sector and Broxtowe Borough Lives Saving Money” highlights the Council and signposts to local services and importance of involving Occupational To enable joined up patient-centred care resources. at the right time, improving the patient Therapists in commissioning primary care experience of health and social care. We are very proud to have recruited an services and how valuable their role is in Occupational Therapist to the team. This role supporting people to remain in their own The team receive referrals, co-ordinate has enhanced our ability to respond and act homes and reducing the need for statutory the appropriate response based on an quickly in improving our ability to help people services. holistic assessment within the agreed stay at home. pathways to the most appropriate services, including urgent calls. They monitor the case and liaise with all the relevant health professionals and voluntary sector services.

The team work closely with general practices and existing services to support the proactive identification of patients at high risk of admission / loss of independence.

14 152 Care Coordination Feedback

GP Feedback “Overwhelmingly the view is that the service makes a real difference to the lives of patients and saves significant time of doctors. The service has prevented admissions to hospital by rapidly sorting out care for patients and their dependents in a manner which has been very helpful to all concerned.” “The service is very good at being sensitive to relative and carers and involving them in what is happening. Accessing notes and recording into our systems is always helpful. Calls are answered straight away and referrals are taken over the phone without complex form filling in and this is really appreciated. Referrals are always accepted without question and the response is immediate. It has been very helpful have direct contact with a social worker who is willing and able to help patients with the complicated funding issues with social care and someone who can be called on for advice.” Dr Katie Rhodes - Chilwell Meadows Surgery

Patient Feedback “You have a fantastic service with great staff, very professional, understanding, listens to what my needs are.”

16 17 NHS England Clinical Pharmacist Pilots

Developing Clinical Since April 2016 PICS has been involved in NHS England’s Clinical Pharmacist pilots in Nottingham West and Ashfield areas. Pharmacy in Nottinghamshire The scheme piloted over a 4 years, enabled practices to access funding to support the PICS has been successful in winning a bid The programme was independently employment of Clinical Pharmacists in for funding from NHS England to support the evaluated by the University of Nottingham, General Practices. employment of Clinical Pharmacists to work School of Pharmacy, who confirmed it was The pilots were launched to help support in general practice across Mansfield and a very successful programme from patients, the increasing demands in General Practice, Ashfield and Newark and Sherwood CCGs. GPS and Pharmacist perspectives. by subsidising employment of clinical Gerald Ellis joined the PICS team in April The programme was also shortlisted as a pharmacists. and will be leading the recruitment and finalist in 2017 Chemist and Druggist awards A broad range of tasks can be undertaken implementation of the programme. for GP Pharmacy partnership of the year. with the right training and mentoring, which “The last 18 months have been Gerald developed a successful local pilot The Local GP Pharmacy transformation is all included as part of the training for the challenging but rewarding as I have with NHS England, which tested how programme was a shortlisted finalist at pilot. become established in my practices. It is satisfying to help patients to gain better Independent Prescribing Pharmacists could 2017 Chemist and Druggist Awards for GP This includes medication reviews, understanding of their medicines and get support delivery of primary care. Pharmacy partnership of the year. supporting discharges from hospitals, better use out of them. medication queries and long terms condition

management. This is the new direction for pharmacy and There are 6 participating practices in I can foresee the day when all GP practices Nottingham West and 6 participating have a resident clinical pharmacist.” practices in Ashfield. The Clinical pharmacists work in teams typically of 6 with Sarah Abbot, a senior clinical pharmacist supporting up to Senior Clinical Pharmacist, 5 clinical pharmacists. Ashfield Pilot

Pictured are Robert Severn (Nottinghamshire Local Pharmaceutical Committee Chair) Gerald Ellis, and An audit of how independent prescribers supported Samantha Travis (NHS England) general practice was presented at the University of Nottingham Health Services Research and Pharmacy Practice conference in April, 2017

18 192 Pain Services

PICS have been providing community Pain Our integrated model of care ensures that Services for over ten years covering the patients who are experiencing chronic pain Nottingham West CCG and Newark and or chronic fatigue are appropriately managed Sherwood ECG. We have now added to our in a community environment. Patients portfolio by successfully winning the Greater requiring secondary care can be referred Nottingham procurement for Pain Services. through our pathway into an appropriate We are excited to share our evidenced model hospital setting when they need specialist with a wider geographical area. intervention.

We commenced our new service In July We provide: 2017. We work in an integrated way with n a number of partners and stakeholders. Multidisciplinary triage service We provide a multi-disciplinary team that n The most appropriate pathway for the can triage all referrals and manage the patient according to clinical need patient’s physical, psychological and social needs associated with pain. We are able to n Self-care management tools to help provide psychological treatment, including with the long term management of their cognitive behavioural therapy to help with the condition symptoms of depression/anxiety disorders. n A care plan agreed collaboratively with We are an integrated multidisciplinary the patient underpinned by the principle team which is led by our eminent pain of Shared Decision Making. management consultant, Mr Greg Hobbs and a team of physiotherapists, nurses, support workers and psychological therapy who are all supported by our excellent coordination hub.

“We are an award-winning, multidisciplinary team of specialist clinicians.”

20 21 The Acute Home 24 Hour ECG Visiting Service Monitoring service

In April 2017, Newark PICS became the The 24 hour ECG monitoring service aims to provider of a new Acute Visiting Service (AVS) improve the service and referrals for patients in Newark. with Atrial

We are a small team of Advanced Nurse Fibrillation (AF) by: Practitioners (ANP’s) and an Emergency n Providing services closer to the patient’s Care Practitioner (ECP) and we provide acute home Our partnership in visits to patients in their own homes or care homes in the Newark, Sutton on Trent and n Reduce anxiety for patients Southwell areas. n The ability to interpret the ECG quickly Mid Nottinghamshire When patients contact their GP requesting a and efficiently same day home visit for an acute need, the GP’s can choose to refer on to the AVS. The n Reduce current waiting times for a PICS have worked hard over the last Our membership across Mid-Notts has aim of the service is to reduce inappropriate hospital appointment (currently 5 to 6 18months to support our members and GP increased significantly. Newark PICS hospital admissions and enable patients to weeks) practices in creating a platform and vehicle federation meet regularly and have recently be cared for at home when it is clinically safe n Quick diagnosis and instant result for to help in the formation of collaborative developed an Acute Home Visiting Service to do so. working and to help in the formation of clinically led by Dr Julie Barker and Dr Mark specialist referral if needed federations along with the Local Medical Folman. The Newark PICS Federation have Since its inception in June, local GPs in Equipment will be fitted and removed within Committee (LMC). also recently established a 24 hour ECG Newark have given very positive feedback the three host GP practice by practice staff. monitoring service hosted by three practices; about the service and initial patient feedback Data is then sent to a central provider which We are working to support practices to has been very encouraging. provide services at scale including practices Balderton Primary Care Centre, Collingham will return contextualised reporting for GP that wish to take up the GP Access Scheme; and Lombard Practices. assessment. The service will commence in Mansfield North will be the first to take up September 2017. the scheme.

Newark

Sherwood

Mansfield & Ashfield

The team consists of ANPs Donna Beveridge, Hazel Firmin and Sharne Rooke and ECP Darren Hodgkinson Nottingham West

22 232 Balderton Primary Care Centre

PICS have looked after Balderton Surgery We have just completed a CQC inspection since May 2016. Since then the surgery has which resulted in a rating of Good for the Kirkby Community gone from strength to strength. We have surgery. introduced a daily on call system and access to advanced appointments is within 48-72 The clinical and admin workforce has hours. stabilised considerably and everyone is Primary Care Centre extremely happy in their current roles. The The management team is always supportive practice is also supported by PICs to make During the time we have had the Caretaker The work we have done has given stability and the Practice Manager meets with the sure that all policies and procedures are kept Contract at KCPCC (Since Oct 2016) we to the practice and the list size is on the MD monthly in a face to face meeting along up to date and regularly checked. have worked very hard to put structure and increase, the results in all areas are moving with regular booked telephone calls every process into the already quite competent in the right direction. The overarching clinical governance team week. We have a permanent lead GP who is team. The clinical team were already well meets monthly where all PICs, Balderton supported by regular long term locums. established and working well with long We have our CQC visit coming soon and are and Kirkby complaints and SEAs are term locums. We have recently recruited confident that the rating will take us out PICs has supported all the staff with discussed and actions recorded. a Full Time Advanced Nurse Practitioner, of special measures. This is now a much their training requirements and staff are and we are still aiming to recruit at least happier place to work than it was one year encouraged to go on training courses other The results to our monthly friends and family one Salaried GP in the near future. The ago. than the mandatory training courses that are test suggests approval ratings in the high admin team was very large and not working expected of them yearly. 80s/early 90s every month. efficiently. One of the Practice Nurses, Rachel We have implemented robust recruitment Harris has just completed her non clinical and training mechanisms into the practice. prescribing course which gives the practice We have introduced a full suite of up to date greater flexibility with appointments. polices and protocols for staff to refer to.

The staffs have been supported to commence training, a nurse is now doing her prescribing course, and a designated receptionist has trained as a phlebotomist and is competent at back fill and extra cover.

24 25 Supporting and training our workforce

My name is Kerri Sallis and I’m a GP that I have played an active role in creating the Our Workforce came to work with PICS over a year ago. Newark federation. I am now supporting the I started working at Balderton Primary Medical Director in Clinical Governance and care Centre and have seen our team both leadership at KCPCC and have just been As our services have grown over the last year and clinically and administratively come together awarded a role with the Governing body of we have increased our staff numbers by over to build a real sense of enjoyment and team the local CCG. 40%. “the NHS now moves at such a fast pace, work in the practice. it is very important that our clinicians I have an active role and provide passionate consider their own individual learning I have been supported by PICS to achieve support to the charity???…hence the Bat Staff Survey needs. As an organisation, PICS philosophy a Medical Leadership and Education woman outfit certificate. We have recruited to new management is to support our staff wherever possible, posts to support our growth; Stephen that is one of the things that make it such a Well done and congratulations to the following Andersen (Business Manager). Stephen great organisation to work for.” is a qualified accountant and has over 20 staff who have achieved the following qualifications years of experience of working in the NHS Staff Feedback working in commissioning and primary and Our staff feedback compared very favourably secondary care. We have recruited a Data to the national statistics although we do Analyst, Andrew Hale to support Stephen. acknowledge we have smaller numbers of Wendy Berridge is our new Operational staff. Manager and is a nurse by background with a specialist interest in primary care with over We scored highly on job satisfaction and we 20 years of experience in nursing. had excellent responses on the enthusiasm and enjoyment towards the job role and Wendy said looking forward to going to work. “Having been a “clinical nurse” since In general all responses were on the good to 1986, the thought of not seeing patients excellent scale. Elaine Watts Eve Elliot on a daily basis was a difficult thing to MSc in Palliative Care Non-Medical Prescribing Some staff felt they would like more comprehend. Lots of soul searching later involvement in service development and and having made the decision, I now innovation and we will be ensuring staff have feel eight weeks into the job, that it was more involvement in this by developing their absolutely right for me, of course I still own “plans on a page.” miss the patients!”

Corina Swann RCGP Accredited Diabetes Rachel Harris management course Non-Medical Prescribing Mentorship module

26 272 Review of Financial Statements to 31st March

During the year the company moved over to QuickBooks to improve its financial reporting and controls Fixed assets Turnover Additions to fixed assets total £6,682 and relate to computer equipment.

The turnover to 31 March 2017 totals £4,255,131, compared to £1,953,067 last year. This is an Current assets increase of £2,302,064 (117%) compared to 2016. Current assets include debtors for fees not yet received at 31 March 2017 totalling £201,723 (2016 - £226,720) and prepaid insurance totalling £23,949 (2016 - £12,620). The increase relates to a new pharmacists service together with expansion of other services. The balance on the company’s bank account stood at £1,416,748 (2016 – £974,575). In addition the company is now managing two GP surgeries Gross Profit Creditors Trade creditors total £189,383 (2016 - £42,044) include all outstanding payments due at The company has achieved a 13% gross profit for the period compared to 10% in the year to 31 March 2017 including staff pensions and supplier costs. The increase largely relates to the 31 March 2016. The increase relates largely to the relative management mark up over and accounting for invoices now via the purchase ledger rather than unpresented cheques as was above the direct costs of operating the services. the case last year.

Administration costs £150K was borrowed from Nottingham West Health Ltd when the company first incorporated, this will be extinguished when the Nottingham West Health Ltd company cessation accounts Administration costs relate largely to overheads in respect of head office including staff are finalised. watogether with other none direct administration charges. Corporation tax based on these draft accounts totals £36,608 (2016 - repayment £12,253) and is due for payment by 1 January 2018. The accounts also include deferred income held by the company for funding paid for in advance totalling £757,425 (2016 - £879,662).

The accruals total £196,162 (2016 -£4,800), the additional accrued expenses this year relate to Balderton room hire. Kirby rent charges, locum services and management charges not included in the trade creditors ledger. Profit and Loss

The company has made a profit after tax of £114,782 (2016 - loss £58,274). This is significant turnaround in comparison to the previous year, due to the increase in turnover whilst expenses generally have not increased comparatively this year.

The profit and loss reserve at 31 March 2017 total £216,130.

28 29 Future Plans

We believe that primary care has a central We are expanding our workforce and role to play in the STPs (bringing health governance to support growth and increase and social care under one model) and that in number of contracts. We recognise the close alliance with commissioning and importance of caring for our workforce, hold other providers is essential in terms of real our culture and values transformation. dear and are looking at ways to improve Bringing care closer to home, making working lives. We will be developing ways to efficiencies and developing new pathways increase our patient involvement including of care in the community are reliant on establishing a number of local forums and integration with GP practices. improving our feedback mechanisms. PICS can support this process by helping We are also in partnership with a GP owned federations and practices to deliver services Chambers Company called Pallant and at scale and act an integrator with and are working towards developing a local between other providers. Chambers concept. If successful this will provide a virtual practice for quality locums The GP forward view is a key element of and help support gaps in recruitment. P s ri e m ic transformation and we believe that all v ar r disciplines in primary care have a role Quality of our services to patients is y e In y S to play. We are working to increase our paramount and our Medical Director will teg nit rated ommu membership to a wider geographical area. continue to pursue best practice, evidence C based care and strong and capable clinical We currently have a large GP membership leadership at all levels and in all services. in Nottingham West, Mansfield and Ashfield and Newark and Sherwood CCGs and are We look forward to helping and supporting looking to expand our membership in the primary care to play a more central role in Nottingham North and East CCG. wider integration across Nottingham and Nottinghamshire. We have been helping to support the development of local GP practice collaborations and federations and are supported by the Nottingham Local Medical Committee.

30 312