Transcript Document

Dr Andrew Carson, Medical Director and GP
The Vital Link with GPs and CCGs
Outline
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Understanding GPs
GP Milestones
Development of CCGs
WMAS’ experience of working with CCGs
Opportunities for the Independent sector
General Practice
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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
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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
Bellevue Medical Centre
1985
2014
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2 partners became 3
4,500 patients
2 receptionists
2 secretaries
No practice nurses or
attached staff
7 partners but 18 doctors
7,500 patients
6 reception staff
5 admin staff and PM
6 practice nurses/HCAs
Attached HVs, DN, etc
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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
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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 renegotiation
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?
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Demand management
Falls?
High volume Service Users
Urgent care
Need for collaborative working across health
economies