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At the heart of general practice since 1960

‘This could set a precedent for the rest of the country’

The LMC leader at the heart of the devolution experiment in Manchester talks to Alex Matthews-King

Dr Tracy Vell - online

Manchester may seem an unlikely setting for a healthcare revolution, but it is currently the Government’s favourite place in which to try out new ideas for the NHS.

First, it was the test bed for the Prime Minister’s seven-day GP access experiment and then earlier this year the Chancellor unexpectedly offered the local authority complete control over its NHS budget.

And at the centre of this – representing GPs in the region – is the outspoken and engagingly acerbic Dr Tracey Vell.

The LMC leader speaks to Pulse after a meeting with NHS England. She’s been spending plenty of time with chief executive Simon Stevens over the past few months discussing the devolution project branded ‘DevoManc’ – apparently he has a distinctly hands-on approach to the project, but ‘keeps quiet’ in meetings.

But as Manchester-style powers look set to be rolled out to other regions, with London and Cornwall touted as next in line, Dr Vell speaks to Pulse about whether GPs should be concerned.

Were you aware of the devolution plans before they were announced?

No, it was a total shock. I think there were a few at local authority level that would have known, but that wasn’t clear to any of us. It was even more a surprise to general practice, since we weren’t initially involved in the committees representing groups of health workers and the local authority in the first part of the devolution process.

Does general practice now have a seat at the table?

It didn’t originally, but it does now. We had a conversation about how, if the agenda was a big transformation of primary care, then surely providers should have a place around the table.

At first, I spent most of the time just highlighting the differences between GPs who work for CCGs, work for federations, work in practices, registrars, salaried GPs and locums. I also had to explain that the LMC is a statutory body supporting the whole of general practice, and that we are here not just to solve problems, but actually to be strategic. That is still a difficult one for people to understand, and some days I feel I am still swimming against the tide.

What should GPs be aware of if devolution comes to their area?

Make sure your influence is felt at an early stage; you need to be fighting to be around the table before devolution comes. Show the differences between [grassroots GPs], commissioners and federations and set yourself up in such a way that you are able to withstand the huge amount of work that comes with this.

If you’re a small LMC you need to work with partners in your locality so you have  voice that’s going to match devolution geographically.

What are the main flagship policies in for DevoManc? Is there a GP voice on how these things are done?

Yes. At the moment, seven-day access has been put forward as an ‘early implementer’ policy. We’ve had influence and changed the shape from the national policy to a local policy that’s acceptable to GPs. It was hugely important to get something that’s doable and is not going to put patient safety at risk.

Dr Tracy Vell - online

Last year you said seven-day access wasn’t the best use of resources. Have you changed your position now?

Yes – seven-day access now works as a bigger part of a jigsaw, instead of an add-on. My previous concern was that it would put more pressure on overworked and under-resourced practices. We need to make sure we don’t overextend practices, and deal with out-of-hours access as a commissioned non-core service, not a responsibility for practices. I still have issues around duplicating resources. Why are we extending core hours when we already have fantastic out-of-hours services?

We’re seeing a lot of practice closures nationally – is that something you’ve seen in your area?

We’ve not had huge swathes of practices closing, but we’ve had mergers and moves to employ different groups of practitioners, such as nurse practitioners. Workforce is a huge issue and we’re haemorrhaging GPs who are in the later part of their career and don’t want to be in partnerships or buildings that are expensive.

We will hopefully be able to structure in some new-style contracts to help us keep this expertise within our communities rather than lose it.

Are PMS reviews beginning to bite?

Yes, although some places are going through the joint commissioning committees, which have a strong process involved with them, and others are largely piecemeal – with managers saying ‘we are not contracting outside core’ and the CCG doing the rest.

There are so many threats to PMS practices, which is partly why representation is important through devolution, because I can sit on groups when the subject may not be on the agenda and can say: ‘Well if we’re looking to establish this happening in this part of the community, why are we destabilising the self-same practices that deal with drugs or with alcohol or with students, only to then rebuild them in a different structure?’

What did you think of the ‘new deal’ for general practice?

I don’t know what was ‘new’ or a ‘deal’ in what we were told. The only way you make people come to general practice is that you make it worth coming to and there was no structure for how we make that happen. Plus it has a timescale we all know is way off what we were being told. So that’s not really new or a deal. I didn’t really think much of it because there wasn’t much content to think about. But I’m hoping that Manchester is brave enough to make a difference and maybe set a precedent for the rest of the country.

CV

Age

47

Family

Married for 22 years and has two children aged 16 and 17

Career

1991

Graduated in medicine from the University of Leicester

1995

Qualified as a GP

1996

Set up one of the first out-of-hours limited companies

2006

Began working as a GP

2014

Became honorary secretary of Manchester LMC

2015 - present

Chief executive of Manchester LMC. Appointed to the devolution board for Manchester

Career high

‘Hasn’t happened yet.’

Interests

Supporting her daughter Chloe, who rides for the Great Britain dressage team

 

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Readers' comments (12)

  • Well done Tracey 'outspoken and engagingly acerbic Dr Tracey Vell.'
    Holding out for GPs who could be crushed between George Osbourne and Manchester Councils

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    ...We need to make sure we don’t overextend practices, and deal with out-of-hours access as a commissioned non-core service, not a responsibility for practices. I still have issues around duplicating resources. Why are we extending core hours when we already have fantastic out-of-hours services?....

    This is the ultimate bottom line and the core of our argument on 7D access all day long . If OOH becomes the 'victim' and being replaced because of this , you can see the tide will be higher coming our way .

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    'No, it was a total shock. I think there were a few at local authority level that would have known, but that wasn’t clear to any of us. It was even more a surprise to general practice, since we weren’t initially involved in the committees representing groups of health workers and the local authority in the first part of the devolution process.'

    Totally understand how shocked you were. But ,
    You would have been in the group of people last to be informed anyway.
    For the 'true protagonists' of 7 D access , it was a political bargain in secret meetings in number 10 , Downing Street :' A political mission to sell 7DA hard in exchange of devolution of power'. That explains the story so far......

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  • In Northern Ireland The NHS has been combined with local authority for many years. Their outcomes are just as bad if not worse than ours and primary care is in an appalling state with GPs grossly over worked. They have some of the highest consultation rates in the UK, if not the highest

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  • "I still have issues around duplicating resources. Why are we extending core hours when we already have fantastic out-of-hours services?"

    Absolutely agree - why are we indeed?

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  • We already have NHS care 24/7 from A&E for emergencies down to 111 fro minors issues / advice.
    We can still have a home visit at night, we have paramedics that do a fantastic job without needing buildings in every town, staff etc. they are sent our from one location. GP practices have to pay staff to man surgeries, pay for heating, light etc, just to deal with minor matters that could be managed by parents ... if they were educated re proper child care.
    The real problem is the ignorance of the public, mothers who take snotty nose kids to A&E, cuts on knees that could be cleaned and dressed at home, every time a kid coughs it is a trip to A&E not forgetting Jeremy hunt who is happy to admit he takes his kids to A&E because it is a quicker service ... and I bet he doesn't want four hours!

    All new mothers should be made to do a basic fist aid course.

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  • Ivan Benett

    "Last year you said seven-day access wasn’t the best use of resources. Have you changed your position now?"

    "Yes – seven-day access now works as a bigger part of a jigsaw, instead of an add-on. "

    Unsuitable or offensive? Report this comment

  • If we all generated enough hot air the whole thing might actually just float.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    To take on a political mission , one needs 'certain qualities'.


    'Not every choice we make are blessed with moral clarity .....
    We are the no-man of the no-man's land'
    Homeland season 4 season finale

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  • I am lost between all these pieces. To me, the Universe is mathematical.
    There is no money to do what we have to. You can cut the botched pie any number of ways, but the total is still a pie. It will never ever be a fillet steak mignon.

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