NHS can expect more of the same in 2019 – only the words will change

28 December 2018

If a five year plan appears to have worked reasonably well during turbulent times it’s understandable that politicians should seek to repeat the exercise, perhaps even doubling down and working with NHS bosses on a ten year version.

We still await the white smoke from NHS England that a new long-term plan has been signed off. It may already have been: in these Brexit-benighted times, it must be difficult to find a date in ministerial diaries and the news grid for a rare good news story.

However, we have had some smoke signals from the Elephant and Castle since Theresa May announced a five year funding settlement for the NHS. She also, of course, demanded a ten year plan “to help the NHS tackle waste and inefficiency”.

We can expect that plan will emphasise our old friends integration, population health and primary care delivered at scale. That has been the recent direction of travel – and in the case of integration at least – a holy grail for half a generation.

“At scale” is likely to remain the phrase of the moment for everyone from ministers through mandarins to managers. Integrated care systems (ICSs) will play an ever greater strategic role – focusing on population level health planning at a high strategic level. This might yet mean a certain amount of structural reform, with responsibilities moving between organisations.

Clinical commissioning groups (CCGs), the new kids on the block when the Five Year Forward View (FYFV) was published, will decrease further in number as the trend towards CCG mergers or shared leadership accelerates. To make more radical change the legislative boundaries may need to ease to allow more commissioning responsibilities to pass to provider organisations in the longer term. 

ICSs were not named in the FYFV – but the accountable care organisations (ACOs) they effectively replicate were. Rebranding was meant to rid ICSs of any negative associations with the US healthcare system but the bigger challenge will be how providers, trusts and social care can work with primary care to develop a more coherent system that demonstrably improves the experience of patients.

Emerging integrated care providers will be similar to the primary and acute care systems (PACS) described in the FYFV, but regardless of the terminological sleight of hand, the central challenge continues to be the need for providers to work together. This means focusing less on concerns about individual organisations’ finances and more on the financial wellbeing of the local system as a whole. The alliance contracts now in place in some areas represent the first practical steps to this vision of collective financial responsibility.

There has also been some rebranding at local level where much will be expected of primary care networks (PCNs). Serving populations of 30,000-50,000, PCNs will be expected to deliver the primary care at scale that has been seen as a key plank of more efficient NHS provision for the last two or three years.

This will be underpinned by the continuing search for meaningful integration. It will include an emphasis on encouraging and co-developing services with roots in the community that will support effective signposting and social prescribing. Such services can improve the overall health and wellbeing of local populations and in particular older or socially isolated people who may turn to their GP for support that could often be provided more effectively elsewhere.

It will be interesting to see how much of the innovation promised by the FYFV  remains at the core of the latest plan. The wording may change but we can expect, at least, that the emphasis on integration, primary care at scale and population health will remain.

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