Oli Hudson explores the changes that have occurred in the NHS this year as the Long Term Plan has been rolled out at speed in response to the COVID crisis
At the start of this year, the NHS was working on the next stage of its Long Term Plan and defining how key aspects, such as integrated systems and moving more care out of hospitals, would work in practice.
However, day-to-day working in the NHS dramatically changed when COVID-19 presented the system with what its leaders have described as ‘arguably the greatest challenge it has faced since its creation’.
The pandemic saw NHS hospitals in England told to suspend all non-urgent elective surgery for at least three months from April 15; many staff were redeployed to look after COVID patients and care pathways reconfigured to try to manage the crisis.
In this article, we explore how the pandemic has forced the pace of the Long Term Plan and prompted the NHS Reset. We will also assess the impact of these changes on customer engagement for pharma.
One of the most significant financial changes during the pandemic was the suspension of payment by results (PbR), and the announcement that all NHS trusts and foundation trusts would move to block contract payments for an initial period from April 1 to July 31, 2020.
This was followed, in September, by a new ‘system-level’ funding arrangement that supports integrated working by enabling large sums of money to be released to healthcare systems for distribution, rather than to individual providers.
Under the scheme, NHS England has issued financial allocations to local systems to cover the second half of 2020/21, and these will be subject to adjustments depending on how each system is able to restore elective activity.
System-level funding, combined with other joined-up finance approaches already in operation, such as blended payments, will expedite the holistic approach advocated by the Long Term Plan. This will help to drive major reconfiguration across care pathways from triage to follow-ups as the NHS seeks to deliver on key Long Term Plan priorities and reset services.
A consultation process is now underway about the long-term future regarding NHS funding, but it is expected that the changes we have seen during the pandemic will continue and that the move to population-based healthcare will be permanent.
Most GP work was still conducted face-to-face at the start of the year, but the pandemic has forced dramatic change in this area too. Indeed, one influential GP, Dr Clare Gerada, commented in March that social distancing had led primary care to adopt digital triaging as its primary way of working in just three weeks.
Digital patient engagement was a fundamental aspect of the Long Term Plan, which stated that all patients in England should have access to online consultations by 2022/23 and the ‘right’ to switch to ‘digital first’ GP practices.
The plan also advocated a similar expansion of online consultations in secondary care to avoid a third of all hospital outpatient appointments within five years. This style of working has begun to be adopted and we expect many more patients will ultimately be managed remotely at home or via multidisciplinary teams in the community.
Some services will still need to be delivered in hospitals, although service locations are changing as part of the acute care reconfiguration that has been happening this year in terms of general/specialist and cold/hot sites (at ‘cold’ sites capacity is protected to cut the risk of operations being postponed last minute if more urgent cases come in, while complex, urgent care on a separate ‘hot’ site allows trusts to provide improved trauma assessment and better access to specialist care). Again, this was part of the Long Term Plan and it has been accelerated by the pandemic, which has also seen the creation of some coronavirus-free hospitals.
COVID-19 has created an urgent need to keep patients out of hospital where possible. This issue, which was another key Long Term Plan aspiration, has led to the creation of new pathways to enable treatment to be provided in the community or at home. The changes began back in March when new guidance from NHS England outlined how non-COVID patients across multiple disease areas should be managed during the pandemic.
Patient safety, with regard to how a particular drug fits into the new COVID-friendly pathways, continues to be a critical factor for immunocompromised patients and this has been having a big impact on the pharma industry.
The changes needed to support care in the community in terms of NHS structure had already started to take shape in 2019 with the introduction of Primary Care Networks (PCNs). These organisations, which see groups of GP practices collaborating locally with community services, social care and other health and care service providers, are each responsible for a population of around 30,000 to 50,000.
Care homes are a key area that will come under the aegis of GPs, who in their PCN contract have responsibility for managing these patients in situ and reducing referrals. This is just one area in which they will play a critical role in delivering key aspects of the Long Term Plan, managing the pandemic and implementing the Reset.
The NHS Reset
In July, the NHS entered the COVID-19 recovery phase, where it set about tackling the elective care waiting list and restoring capacity while continuing to work towards key Long Term Plan ambitions. However, the onset of a second wave of COVID-19 in the autumn has hampered progress.
Indeed, a recent HSJ analysis of NHS England data in October showed that eight hospital trusts have surpassed the level of COVID-19 patients in general acute beds which they recorded in the spring peak.
The NHS Reset, which aims to build on the positive changes that COVID-19 brought to the NHS and to ensure that all pathways and services are reformed with a focus on innovation and system-wide change, is going to be critical in helping the NHS to tackle the challenges that lie ahead.
Many of the primary objectives of the Reset align with the NHS Long Term Plan, particularly around keeping patients out of hospital, where possible, and treating them at home or in the community.
Managing early discharge and risk monitoring will be essential to prevent hospital admissions. More patients will be triaged remotely and the Reset will find ways to make this as efficient and safe as possible while reducing hand offs and appointments to maximise capacity.
Technology will be key to driving these changes including Artificial Intelligence (AI) and products that support community and home-based care by, for example, enabling patients to be monitored remotely. It will also be important to empower patients to take greater control over their health if more care is to be managed in the community or at home.
With face-to-face meetings largely abandoned during the pandemic, digital channels have become the primary method of customer engagement for pharma and this is expected to continue post-pandemic. Pharma needs to think creatively about how it can utilise various digital channels and tailor content to different stakeholder groups, while allowing for face-to-face engagement, if required.
The pandemic has given industry a chance to show its ability to work in true partnership with the NHS in a time of crisis and this kind of problem-solving approach is going to be vital going forwards.
All pathways are being reviewed and pharma needs to work in partnership with the NHS to develop them. To achieve this, industry needs to understand how money flows through the NHS in the new funding structures and determine how it can deliver wider benefits to the system, rather than how it can sell individual products to individual clinicians.
Industry also needs to understand where blockages are occurring in the system, including those related to the pandemic such as the elective care backlog and undiagnosed long-term conditions. To achieve this, it will need granular data to risk stratify cohorts of patients, determine how they can be managed, who will be responsible for them and whether additional training and resources may be required.
Payer relationships are going to be critical going forwards and may well involve high level discussions that will need to be handled by healthcare development managers.
As 2020 draws to a close, the NHS continues to face unprecedented challenges. Yet, despite this, great strides have been made in terms of service design and delivery, and transformation has occurred at a pace that no-one would have thought possible at the start of the year.
The NHS Reset will be critical in enabling the NHS to capitalise on the progress that has been made in 2020 and to navigate the way ahead next year in line with key Long Term Plan aspirations.
Pharma has already shown how it can work in true partnership with the NHS during the pandemic and there is a real opportunity for industry to get involved in the changes that are now occurring across patient pathways. To achieve this, it must understand the joined-up system level approach and the pressing need to deliver holistic solutions that can help to transform whole pathways.
Oli Hudson is content director at Wilmington Healthcare. For information on Wilmington Healthcare, visit www.wilmingtonhealthcare.com