Post on 23-Feb-2016
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Dr Andrew Carson, Medical Director and GP
The Vital Link with GPs and CCGs
Outline• Understanding GPs• GP Milestones• Development of CCGs• WMAS’ experience of working with CCGs• Opportunities for the Independent sector
General Practice• 49,000 GPs• Independent Contractor status• Running own business• Medical training – problem solvers• GPs want to remain independent• 1 million GP consultations daily
General Practice• Burgeoning workload• Changing work patterns• Most of population registered with GP• GP list is a workable denominator• Allows approach to screening and prevention• Chronic disease management• Sub-specialization
1985
• 2 partners became 3• 4,500 patients• 2 receptionists• 2 secretaries• No practice nurses or
attached staff
2014
• 7 partners but 18 doctors• 7,500 patients• 6 reception staff• 5 admin staff and PM• 6 practice nurses/HCAs• Attached HVs, DN, etc
Bellevue Medical Centre
7
Practice cultural and demographic diversity
General Practice milestones• 1990 – New Contract – NHS internal market• 1991 – 1997 - GP Fundholding
– Non-urgent and community care– Re-use of savings
• 1998 – PCGs• 1999/2000 - PCTs
General Practice milestones• Practice-based Commissioning• PCTs abolished 31 March 2013• CCGs took over commissioning role• West Midlands Ambulance Service
– 16 PCTs– 22 CCGs – varying states of maturity
Where we are now?• Even the most conservative GPs (that have
survived) are naturally quite entrepreneurial• Independent thinkers - can be good or bad in
CCGs• Familiar with public health approach• Most GPs very focused on best care for
patients
West Midlands Ambulance Service• Ambulance Trusts poorly understood
– Unlike any other part of the NHS– Urgent Care Board strategy – 42 pages– WMAS 42% non-conveyance rate
• Operational targets commissioned regionally• CCGs have attempted some local re-
negotiation
West Midlands Ambulance Service• Increasingly a primary care provider• Directory of Services
– We know where the gaps are• Increasing activity 4.5% pa• Problems with internal market structure
– Pitches each Trust against its neighbours– Purchasers can’t afford to buy– Providers can’t decide pricing
Some examples• Service reconfigurations
– Trauma Network– PPCI– Stroke
• GPs in a car– 85% non-conveyance– £1 million saved
What opportunities for the Independent sector?
• Demand management• Falls?• High volume Service Users• Urgent care• Need for collaborative working across health
economies