Planning guidance – implications for primary care

5 January 2016

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. 

Topics & resources Briefings

Latest News

Dementia diagnosis rates: December 2016

24 January 2017

The national clinical director for dementia, Professor Alistair Burns has written to CCGs with the national dementia diagnosis rate as part of the national ambition to diagnose two-thirds of dementia cases in the population. The letter urges commissioners to work with general practices, particularly those with low diagnosis rates, who are invited to seek support from NHS England’s Intensive Support team.

Read More

Health matters: combating high blood pressure

24 January 2017

Public Health England has published guidance to help providers and commissioners to reduce blood pressure through improved prevention, detection and management.

Read More

Technical guidance to support national wheelchair data collection

24 January 2017

The submission window for quarter 3 data for the national wheelchair data collection is open from now until 25 January 2017. NHS England has prepared a technical guidance document to help CCGs to submit good quality data.

Read More

Bringing new care models within reach of general practice

24 January 2017

The primary care home is rapidly gaining favour as the acceptable face of new care models. This version of primary care at scale, backed by the National Association of Primary Care, and now being piloted at 15 test sites is proving popular with GPs because it represents less radical change for general practice – or to use a phrase borrowed from Simon Stevens “goes with the grain”. Two articles from PCC, including one from Professor David Colin Thomé, who first described the original primary care home concept, set out the issues.

Read More

The future is provision, enabled and not led by commissioners - A way forward for community based care

24 January 2017

The Primary Care Home (PCH) is a concept I first described some ten years ago. It is a population budgeted community based provider organisation able to provide an alternative to current NHS hospital centricity. A home not only for general medical practitioners and their teams but for all primary care independent contractors (pharmacists, dentists, optometrists) and their staff, community health services and social care professionals. And potentially a home for many currently working in hospitals in particular those clinicians who have a responsibility for long term conditions care, for rehabilitation and reablement and for the hospital specialists who offer “office based” procedures. The population would be of GP registered patients’ lists aggregated to whatever size is locally appropriate.

Read More