Primary Care, New Care Models and STPs Roundup
Hempsons is pleased to bring you the latest in its series of news updates on new care models, STPs and integration.
At the time of writing the various party manifestos have not been released and so the potential effects of the election on the NHS generally, and STPs / New Care Models specifically, cannot yet be considered.
From midnight on 21 April 2017 public bodies have entered the purdah period. This is the informal name given to the election period up to the formation of a new government where special rules on decision making and other behaviours apply to the civil service and public bodies. The rules are published by the cabinet office and are available here and should be noted by NHS bodies.
The rules are not strictly binding on NHS bodies, but they are expected to follow the guidance.
Christian Dingwall, Partner comments: “A snap election has the potential to be disruptive to the plans of NHS bodies. The Cabinet Office Guidance covers what can and cannot be done in the election period. The guidance covers a diverse range of issues, from Freedom of Information to the general prohibition on new public consultations. Aspects of the guidance, such as commentary on access to NHS premises by candidates in the election period, directly impact on NHS bodies and should be noted”.
Next Steps on the NHS Five Year Forward View sets out the main national service improvement priorities of the NHS over the next two years. That timeframe was aligned with the previous election cycle and it is not yet clear what the impact of the election will have on NHS planning. However, until we hear otherwise, Next Steps is a very useful guide to the progression of the strategic direction set out in the Forward View.
The Next Steps highlights an ambition to “use the next several years to make the biggest national move to integrated care of any major western country”. The vehicle for this will be Sustainability and Transformation Partnerships and for some geographies the creation of integrated (or ‘accountable’) health systems. Importantly, the guidance sets out three guiding principles about STPs:
- STPs are not statutory bodies and supplement rather than replace accountabilities of individual organisations
- The way STPs work will vary across each STP area
- All STPs need a basic governance and implementation ‘support chassis’ to enable effective working between partners, requiring all NHS organisations to be part of a Sustainability and Transformation Partnership which will form an STP board drawn from constituent organisations and to put in place programme management support.
- So, governance remains more important than ever. Please see our guide which may help in relation to this, including our template MOU to support STP partners in developing their plans.
Next Steps also includes interesting information about Accountable Care Systems and Accountable Care Organisations – more on those in our next roundup.
“General practice provides over 300 million patient consultations each year, compared to 23 million A&E visits…..if general practice fails, the NHS fails”
So Next Steps acknowledges the importance that primary care has to play in the reshaping and integration of health and social care across the country.
The key improvements for the next two years identified in the review include:
- Boosting GP numbers: an extra 5000 doctors working in general practice by 2020 (with numbers entering GP training up 10% since 2015 and a commitment to reach 3250 trainees per year)
- Extended and more convenient patient access to GP services: Making available bookable evening and weekend appointments, to extend to 100% of the country by March 2019. Practice profiles will be published on ease of making an appointment and, from October 2017, practices who shut for half days each week will not be eligible for a share of the extended access scheme.
- Expand multidisciplinary primary care: This will see: ◦ Increase the number of clinical pharmacists working in GP surgeries to over 900 by March 2018 and over 1300 by March 2019.
◦ 800 mental health therapists will be placed in primary care by March 2017 rising to over 1500 by March 2018.
◦ Increase in the training of physician associates to incentivise up to 1000 of these staff to work in General Practice.
- Modernise primary care premises: Over 800 further infrastructure projects are identified for investment by 2019.
To deliver these improvements, funding is being increased (in line with the original FYFV), practices are being encourage to work together in ‘hubs’ or networks (of at least 30,000-50,000 patients) and a successor to QOF will be developed, which would allow the reinvestment of £700 million.
This is certainly reflected in the work that is flowing through to us, as we have seen a marked increase in the number (and scale) of practice mergers (including Super Partnerships or “super-surgeries” as they are called in the review) and collaborations between primary care, the acute sector, community nursing, mental health, and clinical pharmacy teams.
However, it is the local Sustainability and Transformation Partnerships that will have the most impact on the shape and scale of primary care over the next few years and, in most cases, primary care has not yet collaborated in sufficient scale to have a material impact on the direction and development of the STPs.
For more information contact Ross Clark.
Partner Andrew Davidson comments: “The chapter on workforce covers well trodden ground with a focus on employee health and wellbeing, inclusion, flexibility in working arrangements and staff engagement. The importance of developing and supporting new clinical roles such as the Advanced Clinical Practice (ACP) nurse role, physician and nursing associate roles and so on to add to the frontline is recognised. It’s clear that more registered nurses will be needed by 2020 and that this will be achieved by, amongst other things, encouraging return to practice, a fast track “nurse first” programme and improving retention.
The other key theme is flexibility – more flexibility in contracts for NHS workers (term-time contracts, seasonal hours, annualised hours) and e-rostering and job planning as a way of more efficiently using resources. The now well established idea of a staff passport to allow easier movement between different parts of the health sector raises its head again.
Overall there is little to disagree with in the workforce section and some useful details have been set out.”
The review acknowledges that technology underpins all of the major NHS work programmes. The key strategies for technological improvement identified are:
- The implementation of solutions that help individuals to manage their own health. Online access to services will be increased significantly.
- A fast tracking process to encourage digitisation of hospitals. Hospitals previously identified as ‘Global Digital Exemplars’ will be partnered with ‘fast followers’ who will rapidly mirror the GDE implementations. Mental Health Digital Exemplars have also been identified.
- The adoption of technologies to support the NHS priorities including those that facilitate enhanced online access to patient data, on-going development of NHS 111 Online and further roll out of the NHS e Referral Service.
- Taking steps to enhance the UK’s position as a global leader in life sciences. A range of strategies are acknowledged including the roll out of new treatments, expanding the UK’s genomics capability, improving the clinical trials environment and growing academic and industry partnerships with the NHS.
Gill Hall, partner and IT lead, comments: “Since the Forward View was published, there has been increasing recognition within the NHS of the importance of adopting new technology. Some significant steps have already been taken, for example Greater Manchester’s Datawell project, and Next Steps provides some clarity about areas of priority in the coming years.”
Hempsons’ Integration Resource Centre contains a series of articles and in-depth reports on new care models, integration, STPs and governance.
Have a browse through the available topics and contact us if you have any questions.
We hope you found something of interest in our roundup. For more information on how any of the issues may affect your organisation, please contact us.