1. A plan setting out how the financial and high level benefits of the merger of PMETB with the GMC will be achieved.

Transcription

1 7 April 2010 Postgraduate Board 4 To consider Benefits Realisation Plan Issue 1. A plan setting out how the financial and high level benefits of the merger of PMETB with the GMC will be achieved. Recommendations 2. a. From 1 April 2010 the Postgraduate Board should receive regular reports on the benefits realisation phase and that periodic reports are presented to Council on behalf of the Postgraduate Board (paragraphs 16-18). b. The constraints identified within the plan are accepted as informing the benefits realisation programme (paragraphs 19 and 20). c. The benchmarks noted are accepted as an appropriate baseline for the benefits realisation plan (paragraphs and Annex A). d. The plans to achieve the high level and financial benefits are accepted (paragraphs and Annexes B and C). e. A further version of the plan is submitted once the recommendations of the Patel review have been considered (paragraphs 37 and 38). Further information 3. If you require further information about this paper, please contact us by gmc@gmc-uk.org or tel

2 Background 4. Following the acceptance of the Full Business Case (FBC) by the Department of Health (England) to provide financial support for the merger of PMETB with the GMC, the GMC undertook to develop a benefits realisation plan to meet the commitments set out in the FBC and the broader policy aims of the merger. 5. The benefits realisation plan is split between high level benefits and financial benefits. In setting out the high level benefits the plan focuses on the early post-integration period and will be further informed by consideration of the Patel review by Council and on the outcome of any business improvement activity. 6. Constraints on the plan are identified including: the need to ensure the strategic aims of the GMC are met through the merger; the capabilities of the GMC to undertake a further major change programme at this time; and the need to meet the policy aims set for the merger. 7. The plan is informed by internal and external data collection including interviews with stakeholders. Benchmarks are established for each project. 8. We continue to follow the high-level implementation plan agreed by the Joint Steering Group (JSG) at the initiation phase of the programme. The high-level implementation plan comprises four distinct phases: a. Phase 1 Scoping and groundwork (now complete). b. Phase 2 Planning and implementation (May 2009 April 2010). c. Phase 3 Delivering post-merger benefits (from April 2010). d. Phase 4 Post-implementation Review and Evaluation (mid-late 2011). 9. As we are now confident of achieving a successful merger on 1 April 2010 we have begun to plan in earnest for the post-merger phase, during which merger related benefits will be delivered. 10. The benefits realisation plan detailed below covers the five years from 2010 and provides details of how the benefits will be delivered across phases 3 and 4 of the high level implementation plan. Full business case 11. Following approval of our outline business case in August 2009 and following the additional work undertaken, we prepared and submitted a Full Business Case in September 2009; this was approved by DH(E) on 23 October 2009 and includes the provision of 7.1 million of DH(E) funding to support the merger over the five years of the merger programme. This covers the costs of achieving co-location by 1 April 2010, integration of PMETB and GMC activities over the following two years ( ) and gap funding over the following three year period ( ). 2

3 12. In making the FBC the following high-level benefits were identified: a. Rationalisation and simplification of regulation: a single competent authority for medical regulation from entry to medical school to the end of a medical career. b. A single point of contact for key interests. c. The opportunity to share best practice and achieve improvements. d. An integrated approach to education and training. e. Access to greater resources through a wider cost base. f. The complete integration with other regulatory functions enabling a focus on the whole doctor at key stages of the career pathway. 13. As well as high-level benefits, the FBC also identified specific operational savings ( 4.4 million) that will be delivered in the five year period post-merger. 14. These include: a. A 66% reduction in the budgeted costs of PMETB Board and panels. b. The non-renewal of temporary and fixed-term employment contracts within former PMETB functions. c. The release of PMETB s training and recruitment budget (PMETB are already benefiting from wide participation in the GMC s training and development programme). d. Natural turnover in headcount in roles that will not be required to be replaced beyond the point of merger. e. Operational integration efficiencies (a range of back office processes and systems). 15. Both the high level benefits and the financial savings form the basis of the benefits realisation plan. Discussion Governance arrangements 16. The benefit realisation plan is presented for endorsement. The plan was considered and agreed by the Joint Coordination Group the joint GMC/PMETB committee overseeing the merger at its meeting on 15 March

4 17. Although the benefits of the merger will cut across the functions of the GMC and encompass the continuum of medical education, it is proposed that for clarity the Postgraduate Board should receive regular reports on the ongoing merger programme, and in particular, the benefit realisation phase. We also propose that periodic reports are presented to Council on behalf of the Postgraduate Board, to ensure that members of Council receive an update on progress and have an opportunity to contribute to the ongoing programme. 18. Alongside this the Resources Committee will as a matter of course receive regular updates on the progress of matters within its particular remit, namely finance, information systems, facilities and human resources. Constraints Recommendation: From 1 April 2010 the Postgraduate Board should receive regular reports on the benefits realisation phase and that periodic reports are presented to Council on behalf of the Postgraduate Board. 19. There are four constraints on the benefits realisation plan over the five year period of the plan: a. The plan must meet the commitments contained within the Full Business Case which includes high level and financial benefits. The GMC is accountable for public monies spent to support the FBC and must demonstrate achievement of the commitments within the FBC. b. The merger and subsequent benefits realisation must support the strategic aims of the GMC for the period demonstrating that medical regulation improves the quality of healthcare and enhances patient safety. Specifically this requires that: i. The capability of the regulator to enter only those doctors who are appropriately qualified on the register is maintained. ii. The quality assurance process for medical education is appropriate and able to deliver robust but proportionate regulation. iii. Benefits identified in the planning stages of the merger are realised in a way that provides value for money. c. The plan must provide confidence to external stakeholders that the policy aims of the merger as articulated by Sir John Tooke and subsequently endorsed by the Department of Health (England) will be achieved. In part this is contingent on the consideration by Council of the Patel review and on the outcome of any business improvement work undertaken post merger. 4

5 d. The planning assumptions must reflect the capabilities of the GMC over the period of the plan. The GMC is undergoing a series of significant changes both to its regulatory functions as a result of the Government White Paper, Trust, Assurance and Safety - the Regulation of Health Professionals in the 21st Century, and to its operations through projects such as Seibel which all have a significant draw on its resources. In addition there is limited ability to undertake extensive changes to the education function in the early period of the plan as the legislative framework reflects the lift and shift approach adopted. This approach is also reflected in the GMC s commitment to no redundancies as a direct result of the merger and maintaining PMETB s functions in London for a period of time. Furthermore, experience both within the GMC and elsewhere suggests that change programmes are affected by an optimism bias with a tendency to overstate benefits and understate costs. Adjusting for this tendency is built into the FBC and reflected here. 20. In practical terms this means that a cautious approach to the benefits planning has been adopted which seeks to avoid risk to the GMC s ability to fulfil its statutory functions and maintain the confidence of stakeholders. This is reflected in the phased approach below. Recommendation: The constraints identified within the plan are accepted as informing the benefits realisation programme. Phased approach 21. The consolidation of functions and relocation of PMETB staff will not, in itself, achieve the full benefits that we anticipate from the merger. Indeed, according to the planning assumptions in the FBC, the full benefits of the merger will not be realised for up to five years following the merger and plans for the delivery of these benefits will be developed and agreed as we move forward over the coming years. It therefore seems appropriate to adopt a phased approach to managing benefits. 22. In order to support this approach, the following key phases have been identified: a. Phase 1 Pre merger benchmarking (January 2010 April 2010) (now complete). b. Phase 2 Merging of functions (April 2010 October 2010). c. Phase 3 Business improvement and evaluation of the merger (October 2010 April 2012). d. Phase 4 Stronger regulatory framework (April ). 5

6 23. This approach assumes that the early phases will principally focus on establishing appropriate benchmarking to support the benefit realisation plan (Phase 1) and on achieving the assimilation of PMETB into the GMC without disruption to the regulatory functions (Phase 2). In the longer term (Phases 3 and 4), we anticipate being in a position to use the greater resources and experience of the GMC in order to deliver more efficient processes and put in place some of the wider benefits identified by Lord Patel s review and through a better understanding by the GMC of the work previously undertaken by PMETB. Phase 1 - Pre merger benchmarking (January 2010 April 2010) 24. During the period prior to the merger a benchmarking exercise was undertaken to provide a baseline for the benefits realisation plan. The elements of this exercise were: a. Data collection from within PMETB including financial information and information relating to PMETB s performance against key performance indicators. b. Workshops with GMC and PMETB staff supported by telephone interviews where appropriate. c. Interviews with stakeholders holding positions of leadership within the delivery and development of specialty including general practice training. A note of these conversations is contained at Annex A. High level benefits benchmarking 25. High level benefits relate to non financial improvements principally to the regulatory framework for medical education. Benchmarking for these benefits prior to the full consideration of the Patel review is informed by interviews with external stakeholders and the internal workshops. External views 26. The interviews with stakeholders highlighted four themes: a. There is a strong consensus that the process of merger is going well. b. Success means no disruption to service or loss of engagement. c. The emphasis placed on short term engagement echoes more significant concerns about longer term engagement. d. A number of suggestions were made for early improvements but there is no single view on early benefits. 6

7 27. Based on these insights four key performance indictors from across PMETB s quality and certification functions have been selected to provide confidence that service will not be disrupted. The benchmark is the average percentage achieved figure for the first three quarters of 2009/10. Achievement against these benchmarks will be reported to Council as part of the regular performance updates. The benchmarks are: a. 98% or more CCTs issued within 20 days (but no earlier than 10 days prior to CCT date) of receiving an application and a recommendation from the relevant Medical Royal College or Faculty. b. Where required at least 95% of new CESR/CEGPR applications passed to the medical Royal College or Faculty for evaluation within five weeks of the completed application being received by GMC. c. To process more than 86% of requests for changes to approved programmes within 30 days. d. At least 80% of applications for out of programme training (including out of programme experience for research) processed within 30 days. Internal workshops and interviews 28. Staff members from both PMETB and GMC from relevant teams were invited to a workshop with the aim of identifying how the GMC might achieve the high level benefits. Whilst all the benefits identified within the FBC were considered the focus was on: a. A single point of contact for key interests. b. An integrated approach to education and training. 29. After the workshop staff were invited to submit plans that identified benchmarks. Financial benefits benchmarking 30. The financial benefits of the merger are identified against five headings in the FBC with assumptions about how they would be achieved. These assumptions have been reviewed against the data available at the point of drafting and are reflected in the plan. 31. The benchmarks for financial savings are derived from PMETB s budget 2009/2010. Recommendation: The benchmarks noted are accepted as an appropriate baseline for the benefits realisation plan. 7

8 Phase 2 Merging of functions (April 2010 October 2010) High level benefits 32. The high level benefits realisation plan is at Annex B. All the projects listed will start immediately post merger but a number will not be completed until the end of the year. 33. These projects are: a. The creation of a single point of contact for raising concerns about undergraduate and postgraduate medical education. b. Consultation on a rationalisation of standards across the continuum of education. c. Bringing the Quality Assurance of the Foundation Programme and the Quality Framework under one body working towards a single best practice approach to QA. d. The linking of evidence on different stages of medical education and training with evidence from Fitness to Practice and Registration processes. 34. The plan also includes a programme to monitor performance based on PMETB s key performance indicators selected to give reassurance that the merger will mean no loss of service. Financial benefits 35. The financial benefits realisation plan is at Annex C. The programme headings are based on the plans set out in the Full Business Case. In some cases the savings expected will be realised more quickly than was assumed when the FBC was drafted. For example the merger of the websites will bring full savings immediately in infrastructure support. However, this will be offset by later than anticipated savings on IT support for PMETB s certification database which will not start to be realised until 2011/ The programme headings are: a. PMETB Board and Panels disbanded. Target: 353,100 each year with full saving of 1,767,000. b. Natural reduction through turnover of headcount. Target: 525,000 over the period of the plan. c. Non renewal of temporary/fixed term contracts. Target: 450,000 over the period of the plan. d. Release of PMETB s training and recruitment budget Target: 300,000 over the period of the plan. 8

9 e. Support function and procurement integration efficiencies (non-hr related).target: 300,000 over the period of the plan. f. Operational integration efficiencies (non-hr related).target: 660,000 over the period of the plan. g. Difference between accommodation costs. Target 168,750 over the period of the plan. Recommendation: The plans to achieve the high level and financial benefits are accepted Phases 3 and An updated version of the plan will be submitted once the recommendations of the Patel review have been considered by Council and the initial post merger integration stage has been completed. Early projects could include (with references to the Patel report where appropriate): a. Developing effective systems for the transfer of information across the different stages of medical education (paragraphs 50-54). b. Consideration of recommendation 13 of the MMC Inquiry 1 which proposes that the GMC create robust databases that hold information on the registered/certificated status of all doctors practising in the UK. c. Rationalising the regulatory regime for the Foundation Programme and defining the outcomes required from the second year of the Foundation Programme (paragraphs 71 72). d. Developing a framework for the accreditation of trainers and putting in place a regulatory structure for the education and training for doctors in career posts (paragraphs 82 85). e. Examining the GMC s role in regulating CPD activity with the new focus provided by revalidation (paragraphs ). f. The potential of developing the role of the training surveys drawing on the benefit of linking with the GMC s database (paragraph 47). 38. A fuller return will then be available for the Department of Health (England). Recommendation: A further version of the plan is submitted once the recommendations of the Patel review have been considered. 1 Final Report of the Independent Inquiry into Modernising Medical Careers January

10 Resource implications 39. The Benefits Realisation Plan identifies funding to support the implementation of the plan. There are no additional resource requirements as a result of this paper. Equality 40. An Equality Impact Assessment was conducted as part of the process of agreeing the draft Section 60 Order. Periodic reports will be made to the Equality and Diversity Reference Group to ensure that in archiving the benefits of the merger are consistent with the GMC approach to Equality and Diversity. Communications 41. External and internal communications in relation to the benefits realisation will be managed by though a post merger communication plan led by the Director of Communications. 3