Integrated
Ambulance
Commissioning
Mark Docherty
Director – London
Ambulance Service
Commissioning
Former Chair of
NACG
2nd April 2014
What I am going to cover
• Getting ambulance commissioning right
• Collaborative commissioning: the implications
for the Independent Service
• An update from the National Ambulance
Commissioners Group (NACG)
THE EXTRAORDINARY ADVENTURES OF AN
AMBULANCE COMMISSIONER
What is Commissioning?
•
•
•
•
1988 – 12 mentions in parliament
1997 – 248 mentions
2007 – over 1,000 mentions
2011- ,000s of mentions in both chambers
• In 20 years it is a concept that has come from
nowhere….and is now everywhere
What is commissioning really?
• Conscience – stewardship, quality assurance,
public protection
• Brain – resource allocation, service design,
planning
• Eyes and Ears – patient experience, receiving
and analysing information back to brain and
conscience
(Smith & Mays, 2005)
• Not Arms and Legs – doing and delivering
CCGs?
• 211 CCGs and average 226,000 population replace
– 151 PCTs with average population of 284,000
• 19 Commissioning Support Units
(At April 2013)
Why?
• Because commissioners are the local NHS and local
Social Care – there is no one else
• Because somebody needs to decide what’s needed
locally and how best to get it
• Because someone needs to challenge existing vested
interests and unresponsive services
• Because one day I’ll need services too….
*
*NHS Commissioning Board is now known as NHS England
Calls
Median (CALLS)
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jan-11
Oct-10
Jul-10
Apr-10
Jan-10
Oct-09
Jul-09
Apr-09
Jan-09
Oct-08
Jul-08
Apr-08
Jan-08
Oct-07
Jul-07
Apr-07
Jan-07
Oct-06
Jul-06
Apr-06
Jan-06
Oct-05
Jul-05
Apr-05
999 Call Activity - London
168000
158000
148000
138000
128000
118000
108000
98000
88000
Cat A
Median (A)
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jan-11
Oct-10
Jul-10
Apr-10
Jan-10
Oct-09
Jul-09
Apr-09
Jan-09
Oct-08
Jul-08
Apr-08
Jan-08
Oct-07
Jul-07
Apr-07
Jan-07
Oct-06
Jul-06
Apr-06
Jan-06
Oct-05
Jul-05
Apr-05
Category A (Red 1 & 2) Activity
45000
40000
35000
30000
25000
20000
Feb-13
Mar-13
Jan-13
Dec-12
Nov-12
Oct-12
Sep-12
Aug-12
Jul-12
Jun-12
May-12
Apr-12
Mar-12
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
Apr-11
Feb-11
Mar-11
Jan-11
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun-10
May-10
Apr-10
Category A Performance - LAS
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
Ambulance Demand Challenges
The Financial Context
Emergency Preparedness
Hazardous Response
MERIT / HEMS
999 Life Threatening
Urgent Primary Care
Patient Transport Services
Collaboration
Types of CCG Collaboration e.g.
A collaborative model
National and Sub-National
CCG and Local
The National Ambulance
Commissioners Group
• A forum for the lead commissioners, hosted by NHS Clinical
Commissioners (NHSCC)
• A national expert group
• No statutory or legal status
• Undertakes high quality national work-streams
• Contributes to National Publications e.g. “Tackling Demand
Together” & the “Good Practice Guide for Ambulance
Commissioning (RCGP)”
• Invited to give evidence to the 2013 Health Committee on
Urgent Care
The National Ambulance
Commissioners Group
• Produces national models – e.g. national ambulance contract,
PbR, Clinical Indicators, HART Specification
• Develops shared strategic direction ‘Achieving Integrated
Unscheduled Care’ and shares technical knowledge and skills
to improve their local leadership and contract management
• Provides informal induction and ongoing peer support for
members
• Discussions are underway to enhance the role of the NACG
and to formalise it’s status, so that it formally becomes the
organisation that influences national commissioning direction
Key Points
• CCGs are in the driving seat
• Massive challenges ahead
• NHS Ambulance Providers on their own
unlikely to be able to solve all the urgent care
challenges
• Partnerships are likely
• Relationships are key