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

partners became 3 4,500 patients 2 receptionists 2 secretaries No practice nurses or attached staff 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

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Practice cultural and demographic diversity

General Practice milestones 1990 – New Contract – NHS internal market 1991 – GP Fundholding – Non-urgent and community care – Re-use of savings 1998 – PCGs 1999/ 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