How is the Five Year Forward View changing the NHS, and how can pharma help to shape new patient pathways?

When it was launched in October 2014, the Five Year Forward View (5YFV) was hailed as one of the most radical changes in the management and organisation of NHS England since its inception in 1948. Designed by NHS England and five partner organisations, it aims to put an end to the age-old divide between GPs with patients and consultants with hospitals, and develop new, integrated and cost-efficient models of care that suit local needs. In doing so, it aspires to create a sustainable NHS that continues to be funded by the taxpayer, is free at the point of use and able to meet the evolving needs of patients, now and in the future. 

Since its inception, 5YFV has been dramatically changing the way that NHS services are run, particularly at a local level, and further major changes will occur in the coming years. In the midst of this upheaval, there are golden opportunities for pharma to get involved in redesigning NHS services. 

Goals of the Forward View 

The 5YFV has three main areas of focus: 

  • Health and wellbeing: NHS England is working with Public Health England to lead or support national, preventative action on the main causes of the UK's major health problems: namely obesity, smoking and alcohol. It is also supporting NHS staff to remain healthy and set a good example.
  • Funding and efficiency gap: The 5YFV is tackling the £30 billion NHS funding gap that was predicted pre-Brexit by developing more efficient and cost-effective ways of delivering services. This includes the creation of a common measure for the good use of NHS resources.
  • Care and quality gap: The 5YFV aims to bridge the divide between primary care, community services and hospitals, and to provide a more joined-up patient experience. To this end, it is testing new ways of delivering care via its vanguard sites, which will become a blueprint for the NHS. 

A recent NHiS report, entitled The Role of Vanguards in the Development of New NHS Commissioning Structures, provides fascinating evidence of how these local NHS vanguards are redefining patient pathways.  

For example, in order to tackle the burden of alcohol on the healthcare system, one vanguard has instituted a system for rapid assessment, identification and diversion/transfer of patients presenting to hospital who want to stop drinking and require detoxification, and who would otherwise have been admitted to an acute bed. 

In this system, patients from acute hospitals across Greater Manchester have rapid access to medically managed detoxification at a specialist facility 24 hours a day. This has involved closer working with alcohol nurse specialists within acute hospitals, who provide gatekeeping and referrals, a five-seven day admission multidisciplinary team, 24-hour hospital services, and medical support for specialist individual and group psychosocial interventions, with an emphasis on supporting engagement in aftercare and recovery communities. 

Although the money invested has not yet been recouped, the programme is expected to result in savings to the local health economy of about £2 million over a 12-month period. 

What does 5YFV mean for pharma? 

The 5YFV is dramatically changing the way that NHS services are run, particularly at a local level. One of the biggest changes here is the planned introduction of Sustainability and Transformation Plans (STPs) in 2017, which will help to deliver 5YFV by providing blueprints for delivering services locally. 

Instead of taking a one-size-fits-all approach to healthcare provision, STPs will see the commissioner/provider split replaced by local planning and management within 44 areas across England called 'footprints'. 

These area-specific, whole-system plans will identify the health needs of their populations and define how they should be addressed quickly and effectively at a local level. 

Understanding the bigger picture in terms of how STPs will affect areas such as NHS structure, leadership, commissioning, KPIs, efficiency, procurement and patient pathways is crucial for pharma. The industry also needs to get to grips with the priorities and primary objectives of the 44 individual STPs. 

Armed with this knowledge, the industry should look to offer tailored solutions that fit in with the aspirations of individual STPs and will help them to fulfil the needs of their local patient populations. 

Pharma and sharing best practice 

Sharing best practice is also key to accelerating the pace of change within the NHS, and since October 2011 NHiS has been helping to do this through its Mental Health Commissioning Network conferences. 

The events, which are being sponsored this year by Lundbeck, Shire and Sunovion, bring like-minded people together to discuss and exchange ideas on how to treat people with mental health problems in a more integrated way. Wherever possible, they involve locally identified chairs plus the Strategic Clinical Networks, Academic Health Science Networks and Public Health England. 

They provide an ideal opportunity for pharma companies to get involved in shaping patient pathways and improving NHS services in line with the objectives of 5YFV. 

For example, Shire has been closely involved in the development of a toolkit for Nurse-Led Clinics for Attention Deficit Hyperactivity Disorder (ADHD) – one of the most commonly diagnosed neurodevelopmental disorders in children and young people. The toolkit has been assembled by clinical and commissioning experts from across England to enable them to set up and run nurse-led ADHD clinics, which enable nurses to deal with tasks and procedures previously performed by doctors. 

Shire helped to develop this project by initiating meetings with NHS clinicians, including ADHD consultants, nurse specialists and service managers. It then ensured there were sufficient numbers of attendees so that decisions could be made. 

Shire also funded the cost of printing the information pack for the toolkit, which comprised a number of templates. The information pack advises nurses on how to compile a business case for a clinic and has tips on recruitment, training and meeting national guidelines on the treatment of ADHD. 

One of the sites that set up nurse-led clinics reported a big drop in waiting times from as much as two years to four and five months. It also said that communication between patient and caregiver seemed greatly improved as patients were encouraged to ask questions and understand their condition and treatment better. 

Shire is now showcasing its work at the NHiS regional mental health commissioning network events. Feedback from delegates at these events shows they feel it is important to manage ADHD proactively through early intervention as this will not only enable better health outcomes, but also benefit society, the economy and the criminal justice system.   

The key for pharma, then, is to keep abreast of the changes, understand the bigger picture and find ways to utilise its expertise to add value.

Five Year Forward View for Mental Health 

Mental health problems are the largest single cause of disability in the UK. One in four adults experiences a diagnosable mental health problem every year and the illness costs the economy an estimated at £105 billion a year. 

In March 2015, the independent Mental Health Taskforce united health and care leaders, patients and experts in the field to create a Five Year Forward View for Mental Health for the NHS in England. 

This 5YFV calls for transformational change in services and attitude to mental health, and aims to ensure that mental health is given the same priority as physical health. This will be achieved through prevention, early intervention, access to crisis care on a 24/7 basis and better integration of mental and physical healthcare.

Sue Thomas is CEO of commissioning excellence and Paul Midgley is director of NHS insight at local healthcare intelligence provider NHiS