Dr Andrew Carson, Medical Director and GP
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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

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Dr Andrew Carson, Medical Director and GP

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Dr andrew carson medical director and gp

Dr Andrew Carson, Medical Director and GP

The Vital Link with GPs and CCGs


Outline

Outline

  • Understanding GPs

  • GP Milestones

  • Development of CCGs

  • WMAS’ experience of working with CCGs

  • Opportunities for the Independent sector


General practice

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 practice1

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


Bellevue medical centre

Bellevue Medical Centre

1985

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

  • 2 partners became 3

  • 4,500 patients

  • 2 receptionists

  • 2 secretaries

  • No practice nurses or attached staff


Practice cultural and demographic diversity

Practice cultural and demographic diversity


General practice milestones

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 milestones1

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

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

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 service1

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

Some examples

  • Service reconfigurations

    • Trauma Network

    • PPCI

    • Stroke

  • GPs in a car

    • 85% non-conveyance

    • £1 million saved


What opportunities for the independent sector

What opportunities for the Independent sector?

  • Demand management

  • Falls?

  • High volume Service Users

  • Urgent care

  • Need for collaborative working across health economies


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