Steve How, Paul Midgley and Oli Hudson, of Wilmington Healthcare, explore some of the seismic changes that have been occurring in the NHS since the Long Term Plan was published
It may be only six months since the NHS published its blueprint for the future in the form of the Long Term Plan, but many local health economies are already making significant progress on transforming services.
These developments show how key tenets of the plan – such as boosting out of hospital care, reducing pressure on emergency services, delivering population health and personalised care and digitising aspects of primary care – will be achieved.
They are being enabled by changes in workforce and finance structure, technology and service integration – changes that pharma should be fully conversant with when brand planning.
Trusts and CCGs unite
In line with the NHS’ vision to deliver fully integrated health, community and social care services by April 2021, we have been seeing significant structural changes in some local health economies this year. For example, Croydon Health Services Trust and Croydon Clinical Commissioning Group (CCG) in London recently announced that they plan to appoint a single leader for the trust and the CCG.
This would be supported by a common committee, with members from both organisations selected to consider strategy, transformation and finance decisions. The two bodies already share a nursing director and a chief pharmacist, and the trust runs community services in the borough.
In a joint statement, the organisations said: “Working together, the trust and Croydon CCG will be able to remove duplication and speed up decision-making. This will help to improve recruitment and retention of staff, focus on improving quality, while innovating and redesigning care to be more efficient.”
Trusts take over GP practices
In recent years, some trusts have become responsible for running GP practices and this method of integrating services has continued since the publication of the Long Term Plan. For example, an acute trust in the north west of England is in talks over running several GP practices in its area. St Helens and Knowsley Teaching Hospitals Trust hopes to be running five more surgeries within two years, having already taken over one practice. The model involves GPs voluntarily giving up their NHS England contracts and becoming substantive employees of the trust, along with other practice staff.
The trust has been receiving advice and support on the project from Royal Wolverhampton Hospitals Trust, which now runs multiple GP practices in its region. This service integration has enabled Wolverhampton to make big changes in some areas, including new referral guidelines and rapid access to consultant expertise for gastroenterology.
Primary Care Networks
The Long Term Plan explains how expanded community multidisciplinary teams will work alongside new Primary Care Networks (PCNs), which will see neighbouring GP practices work together to serve populations of around 30,000 to 50,000 people. A total of £1.8 billion of funding has been earmarked to support these place-based care systems, which are designed to help the NHS improve patient outcomes and reduce health inequalities for entire populations.
Clinical directors have already been appointed for PCNs and the networks were officially launched on July 1. PCNs are the basic units of place-based care and although they are based on GP practices, they involve community trusts, community pharmacists, social care and voluntary services. In Wigan, these kinds of organisations have already become so integrated that local staff are defined by where they work not by which organisation.
As well as delivering core GP services, PCNs will deliver seven new services that are all linked to Long Term Plan priorities. One of these services, which will start by April 2020, is enhanced health in care homes. This is a continuation of work that began under the Five Year Forward View and was successfully trialled in Enhanced Health in Care Homes (EHCH) Vanguards.
In line with this, the NHS recently announced that it had recruited an “army of experts” – which will comprise pharmacists and pharmacy technicians – to help prevent care home residents being given too many medicines as part of a package of measures to improve older people’s health and care in the Long Term Plan.
This move has big implications for the pharma industry given that care home residents are prescribed an average of seven medicines a day, with many taking ten or more, at a cost to the NHS of an estimated £250 million every year. Pharma will need to consider how it will engage with the new multidisciplinary teams that are going to be tackling the issue.
The Long Term Plan promised to continue backing hospitals that wish to separate urgent and planned care into different sites – known respectively as ‘hot’ and ‘cold’ sites – in a bid to improve surgical services. Getting It Right First Time (GIRFT) is piloting this method of working for trauma and orthopaedics in a number of hospital trusts across the country.
For example, Professor Tim Briggs, GIRFT chair, formally opened new side rooms at St Michael’s Hospital in Hayle at the start of the year. The Royal Cornwall Hospitals NHS Trust has transferred its planned inpatient orthopaedic surgery to Hayle and the changes have released capacity at the Royal Cornwall Hospital for emergency patients.
Also, it was recently announced that United Lincolnshire Hospitals NHS Trust (ULHT) had moved to split-site working for trauma and orthopaedic (T&O) surgery, following a successful pilot.
Urgent Treatment Centres are also being rolled out as per the Long Term Plan to provide a locally accessible and convenient alternative to A&E for patients who do not need to attend hospital.
The Long Term Plan promises a wide-ranging and funded programme to upgrade technology and digitally enabled care across the NHS. Among the changes is the right for all patients to access online or video consultations within the next few years. This includes the ability to switch to a digital-first practice, like Babylon’s GP at Hand, which offers patients in London and surrounding areas free video consultations if they register with its practice based in Fulham.
It was recently announced that GP at Hand is poised to expand into Birmingham. This will mean that, for the first time, a London-based practice will be registering patients remotely in another city. GP at Hand will have a physical clinic in Birmingham but most of the care will be delivered digitally.
There has also been a very interesting development in secondary care where, rather than seeking to partner with GPs to reduce pressure on its hospitals which are inundated by urgent attendees, University Hospitals Birmingham Foundation Trust is looking at a technological alternative with Babylon. The trust’s board recently agreed to explore using Babylon’s services, including video appointments and digital triage, to help divert pressure from its severely strained hospitals.
If the controversial deal goes ahead, it would be Babylon’s first partnership with an NHS hospital.
The Long Term Plan promises ‘to speed up the pipeline for developing innovations in the NHS, so that proven and affordable innovations get to patients faster’. In line with this, the government recently announced changes to the Accelerated Access Collaborative (AAC), to ensure that the most promising medicines, diagnostic tools and medical technology get through the clinical development and regulatory approval process faster.
As part of the changes, the government said: “The AAC will now become the new umbrella organisation for UK health innovation. It will act as the ‘front door’ for innovators looking to get their products funded by the NHS and will provide support to overcome barriers that can prevent the best medical innovations from reaching patients.”
In February, health secretary Matt Hancock announced plans to create a new joint organisation for digital, data and technology, known as NHSX. The organisation, which is expected to be operational from July, will support digital transformation in the NHS, to help patients and staff to benefit from the latest digital systems and technology.
The Long Term Plan has provided further definition on the direction of travel outlined in the Five Year Forward View, ensuring implementation in local health economies in the first half of 2019. We expect change to intensify over the next 12 months, following the official launch of PCNs in July.
Documents such as the CCG Improvement and Assessment Framework and the Commissioning for Quality and Innovation (CQUIN) CCG Indicator Specifications for 2019-2020, will provide useful barometers on progress and areas of focus.
Pharma should also track the development of individual ICSs, ICPs and PCNs in order to understand where the key players sit, what investments are being made and where they are happening. These changes will have huge implications for the pharma industry and its relationship with the fast-changing NHS as it moves to the new integrated style of working envisaged in the Plan.