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Planning guidance – implications for primary care
The planning guidance for the NHS was published just before Christmas, but read nothing more into this timing than a desire to give local commissioners and providers as much time as possible to digest the document’s contents and meet the tight deadline to prepare local plans – the first of which need to be delivered early next month.
Delivering the Forward View: NHS planning guidance 2016/17 – 2020/21 is significant for several reasons. It spells out how a national set of local five year plans will be produced to underpin the Five Year Forward View (not itself a plan, remember). It also sets out overall NHS funding for the period in line with commitments made by the Chancellor in the autumn spending review.
The document’s emphasis on “place-based” planning marks the first steps away from funding by organisation and care sector to funding for populations.
Commissioners, providers and local authorities are expected to work together to determine local “transformation footprints”, the planning and funding units of the future. NHS England expects to be able to map these interlocking forms – with no gaps or overlaps – within a few weeks.
Each area will be asked to draw up a sustainability and transformation plan staking its claim to a share of the sustainability and transformation fund – a national pot worth £2.1 billion in 2016/17 and rising to £3.4 billion by 2020/21.
The guidance signals an end to separate funding arrangements for the confusing array of national schemes - vanguards, Prime Minister’s GP Access Fund, pioneers and so on. As the guidance puts it, “this step is intended to reduce bureaucracy and help with the local join-up of multiple national initiatives”.
These schemes will continue to be separately funded in the 2016/17 financial year.
Implications for primary medical care
STPs must cover every area of existing CCG or NHS commissioned activity, including primary medical care, irrespective of existing delegation arrangements.
Primary care figures strongly in the targets set for local leaders. By March 2017, “20% of the population will have enhanced access to primary care”, meaning access to out of hours services, including GP out of hours services, and weekend access to GP services.
Every area is required to start the 2016/17 financial year with “a local plan to address the sustainability and quality of general practice, including workforce and workload issues”. This is one of the nine “must dos” for every local system.
Local plans for GP services are reflected in the government’s commitment to increase funding for primary care by 4% to 5% each year to address the well-documented problem that primary care investment has fallen behind other parts of the NHS.
Funding allocations for CCGs have been set for the next three years, and there is a further pledge to publish the allocations for primary care making it easier to hold commissioners’ spending commitments to account.
STPs must focus on three challenges – closing the health and wellbeing gap, closing the care and quality gap and closing the finance and efficiency gap – and local plans are expected to address a number of questions under each heading. The second (the care and quality gap) focuses on the development of new care models and digital healthcare.
Local plans will be expected to go into detail under this heading on plans for sustainable general practice and wider primary care, enhanced access to GP services and use of technology. The latter includes improved use of online GP appointment systems and repeat prescriptions, but planners are also expected to say how they will expand their “online offer” to include GP consultations and other unspecified services.
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