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How will NHS services evolve in the next decade?

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Oli Hudson and Steve How, of the Wilmington Healthcare Consulting Team, explore some of the key goals set out in the Long-term Plan

NHS England’s Long-term Plan, which aims to ensure that extra funding announced last year to mark its 70th birthday is spent wisely over the next decade, provides a blueprint for local NHS organisations.

The plan reaffirmed the NHS’s commitment to integrated care and also gave more substance to other innovative ways of working, such as moving care out of hospitals and into the community and driving digital transformation, which have both been initiated in parts of the NHS.

Integrated care

The plan states that, by April 2021, all areas of England will be covered by an Integrated Care System (ICS) with typically just one Clinical Commissioning Group (CCG) per ICS area. It also promises £4.5bn of new investment to fund expanded community multi-disciplinary teams within ICSs, which will include organisations such as the police and the Citizens Advice Bureau. Acute care nurses in areas, such as mental health and cardio-vascular rehabilitation, are also expected to be seconded into community settings.

These multi-disciplinary teams will be aligned with Primary Care Networks (PCNs) based on neighbouring GP practices that work together. The networks will also have access to a new “shared savings scheme” tied to reductions in hospital activity, such as accident and emergency attendances, delayed discharge and avoidable outpatient visits and potentially medicines optimisation.

To engage with these joined up working systems, pharma must consider how its products can deliver cost savings across the whole care pathway, particularly in the shared savings scheme. This could involve helping the NHS to tackle problems such as overmedication through patient education or possibly reducing the need for outpatients’ appointments through remote monitoring devices. Pharma should also pay close attention to the findings of Getting It Right First Time (GIRFT) and the best practice case studies developed by NHS RightCare.

Illness prevention and health inequalities

The plan looks at preventing illnesses and tackling the inequalities that can cause them, such as mental health problems, learning disabilities and homelessness. In line with this, the NHS and government want to look at funding key public health services from the NHS budget. Indeed, the Long-term Plan states that they will consider “whether there is a stronger role for the NHS in commissioning sexual health services, health visitors, and school nurses, and what best future commissioning arrangements might therefore be”.

When thinking about the wider determinants of health, pharma needs to look at the bigger picture and consider where and how competition for money could come for illness prevention and management within ICSs – from improving damp housing conditions to education programmes in schools. Ideally, pharma needs to consider wrapping its value proposition around a service that adds real value to the NHS in this regard, rather than simply selling the product alone. Though it is important to realise that these integrated systems are varied in their state of development.

Budgeting

The plan states that the NHS will continue to support local approaches to blending health and social care budgets where councils and CCGs agree that this makes sense. The Government will also set out further proposals for social care and health integration in a forthcoming Green Paper on adult social care.

Overall, the majority of funding will be population-based to make it easier to redesign care across providers, support the move to more preventive and anticipatory care models, and reduce transaction costs. Many contracts have already been moving away from Payment by Results (PbR) to block contracts with outcomes metrics, as they head towards capitated budgets and risk share.

Key diseases

The plan also highlights the NHS’s aspirations to improve patient care for certain conditions. These include Cardiovascular Disease (CVD), where a National CVD prevention audit is planned. The plan also details a range of measures to prevent type 2 diabetes and reduce variation in the quality of diabetes care. Respiratory disease, strokes and cancer are also among the areas that are given particular attention.

Digital innovation

According to the plan, all patients in England will have access to online consultations by 2022-23 and the “right” to switch to “digital first” GP practices. The only “digital first” GP practice currently operating in the NHS is 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.
The plan also promotes a similar expansion of online consultations in secondary care to meet the ambition of avoiding a third of all hospital outpatient appointments within five years.

Conclusion

The success of local NHS organisations in aligning themselves with the plan remains to be seen but with an imminent deadline imposed for all STPs to become ICSs; and a clear direction of travel on tackling health inequalities and embracing digital transformation, they will be under intense pressure to make radical changes.
Pharma must align its proposition with the key principles that underpin the plan. For example, it must think more widely about illness prevention and management. Pharma should also try to align its products with optimal care pathways and help to deliver whole system benefits.