Steve How and Paul Midgley, of Wilmington Healthcare, explore the diverse needs of local NHS health economies as they respond to the Long Term Plan’s demands for joined-up, holistic care
The Long Term Plan, which was published at the start of the year, reconfirmed the NHS’ commitment to integrated care and set the pace for all local health systems in England to adopt this style of service delivery and budgeting.
The plan, which states that all areas of England will be covered by an Integrated Care System (ICS), by April 2021, validated the work of health economies in England that have already become ICSs.
However, for many other health economies, particularly those in financial recovery, the Long Term Plan signals the start of a journey towards a very different style of working.
In this article, we explore the diversity among NHS England’s health economies with regards to progress on integrated care, why pharma should segment them, and how it should then tailor its engagement strategy in light of this information.
Even within the first wave of 14 ICSs there are varying levels of sophistication, with a handful of high fliers leading the way. These advanced systems are exploring contracts with a greater element of risk share between providers and commissioners, allowing for more integrated working. Indeed, they are setting the standards that all other health systems are expected to emulate within the next few years.
One such ICS is Dorset, whose chief system integration officer, Dr Phil Richardson, was guest speaker at a recent Wilmington Healthcare webinar on the NHS Long Term Plan. During the webinar, he explained how Dorset ICS runs “a family budgeting system”, where money has already moved from one organisation to another to achieve balance across the system.
He intimated that there was a lack of understanding among some pharma companies about what his ICS needed from them. He said: “Pharma comes in wanting to be strategic but sends a salesperson to talk about the product. They need to be thinking about the whole person in the community and how they can help them.”
He added: “Pharma must move away from promotion. Co-production and development are key. We want organisations working together to solve problems like frailty and how care can be brought closer to home. Industry needs to work out how it can get involved in service design.”
As evidenced by Phil’s comments, the most advanced ICSs are demanding new ways of engagement from pharma and there is a real opportunity for industry to get involved in shaping the strategic direction of these organisations. Top level discussions involving a pharma company’s chief executive or managing director should be held in addition to deploying sales staff to engage at clinician level on products and how they fit into care pathways. Pharma could also consider sharing best practice learnings from these ICSs with other health economies.
Poised for change
The majority of ICSs are not yet delivering fully integrated care, but they are preparing to do so, hence change is imminent. In common with all Sustainability and Transformation Partnerships (STPs), ICSs have certain areas that they must focus on under the Long Term Plan, such as diabetes, cancer and respiratory disease. Pharma needs to identify what is happening in these areas and other key workstreams and the people who are leading them.
Pharma also needs to pinpoint where transformation is occurring within individual ICSs and whether this aligns with its products and services. Information on local health systems’ priorities can be found in the plans that they must submit to NHS England (NHSE) in response to the Long Term Plan. These should be found in draft board meeting minutes published in March.
When engaging with integrated systems, it is useful to understand how the services your product is involved in are contracted. Where aligned incentive or risk share contracts are initiated with an integrated provider, the impact of a product could be more than clinical. For example, does it reduce the workforce needed either due to effectiveness and reduced failure and readmission rates, or even just by a reduction in administration, as is the case with some of the subcutaneous biosimilars for example? Also consider whether your product is innovative and, if so, does it change aspects of the whole pathway by, for instance, reducing hospital costs by enabling self-administration of a drug? Here it is useful to think of system pathways rather than just treatment pathways. Also, what are the workforce and structural implications and what change management is necessary? Are all stakeholders aware of the total system pathway cost implications often versus the higher drug cost?
Commissioners rely on clinicians to verify that pharma’s solutions will work. So, in addition to engaging with commissioners and system leads, pharma must also engage with clinical champions and convince them of the value of a treatment. This will involve clearly linking the product to the strategic plan and showing how it can help to improve patient pathways, or even redefine them.
Local data analysis for pathway evaluation would be helpful in this regard. A pathway evaluation toolkit, for example, could include Hospital Episode Statistics (HES) data evaluation of other health economies and data from Getting It Right First Time (GIRFT) and NHS RightCare. Such knowledge and engagement can really help to empower clinical customers in decision-making.
Starting the integrated care journey
Health economies that are embarking on integrated care strategies are required to detail how this will happen, so again it is essential to keep abreast of the local plans that have to be published in accordance with the Long Term Plan. Pharma also needs to identify the clinical leaders who are tasked with managing transformation and who will be leading workstreams.
Offering to broker cross-organisational meetings would be particularly valuable for local health systems at this stage. This could involve people from different departments or clinicians working within one department. Ultimately, however, it will need to involve wider health and social care organisations.
By assisting with this type of engagement and supporting the understanding of local plans, pharma can help these local health economies begin to look at the wider integrated care picture. So, discussions around a product for rheumatoid arthritis and musculoskeletal disorders could ultimately include physiotherapists, occupational therapists, GPs, employers and local authorities.
Pharma could also share best practice learnings from health economies that have already been through the process and show how they have implemented change and how and where this has added value.
As these STPs undergo change, pharma needs to be aware that making direct cost savings is currently a priority for them as their budgets sit in silos. However, reducing system costs across the whole pathway is the driver for future change.
Primary care transformation
Pharma should also be mindful that regardless of their progress to date, all local health economies must meet specific deadlines around integrated care as set out in the ‘Preparing for 2019/20 Operational Planning and Contracting’ guidance on Primary Care Networks (PCNs), issued by NHS England in December 2018.
The guidance, which has since been updated following the publication of the Long Term Plan, requires all ICSs and STPs to have a Primary Care Strategy in place by April 1, 2019. This must include system-wide plans for the sustainability and transformation of primary care and general practice, and the development of PCNs – groups of practices that collaborate locally, in partnership with community services, social care and other providers of health and care services.
The PCNs, as a new provider organisation, will operate within Integrated Care Providers (ICPs) which will hold the new style contract for population care, eg end of life or musculoskeletal. Also, as of this year, all CCGs will be required to actively engage in supporting integrated working with all local providers, in line with the CCG Improvement and Assessment Framework.
Overall, we will see primary care encompassing much more than general practice, with increased investment in community services and PCNs. Pharma must understand how ICPs and PCNs operate and identify the leaders within them.
Pharma should also consider initiating and supporting cross-organisational discussions on primary care transformation particularly in areas where integrated care systems are being initiated. There may also be opportunities for industry to assist in service redesign.
There are golden opportunities for pharma to support local health economies in delivering integrated care – from getting involved in the strategic redesign of services to helping to facilitate cross-organisational meetings and sharing best practice.
The key to capitalising on these opportunities lies in understanding where ICSs and STPs are in their integrated care journey, identifying their priorities and transformation goals and understanding the challenges they face in delivering them.
By acquiring this level of in-depth knowledge and understanding, pharma can determine how to engage with NHS England’s diverse local health economies in tailored and highly strategic ways that will deliver real and lasting value.
Steve How and Paul Midgley are part of Wilmington Healthcare’s Consulting Team. For information on Wilmington Healthcare, visit www.wilmingtonhealthcare.com
To hear more from Dr Phil Richardson, of Dorset ICS, regarding integrated care and the Long Term Plan, free access to Wilmington’s webinar is available via: