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