GP practices have been joining forces to create integrated units that can each serve a patient population of around 30,000-50,000 – about the same reach as a large supermarket and the agreed optimal size for Accountable Care Organisations internationally.
These integrated units are designed to enable staff from local community, mental health and acute trusts, social care and the voluntary sector to unite, and work together alongside GPs in order to provide joined up care closer to patients’ homes and reduce hospital admissions.
Known as “neighbourhoods” of care these units have become the local delivery vehicles for Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs).
Neighbourhoods of Care
There have been various routes to achieving neighbourhoods so far, with GP practices uniting to form hubs, local integrated care partnerships, federations, super-surgeries and NAPC’s primary care homes.
Neighbourhoods are beginning to take services out of hospitals and into the community for conditions, such as diabetes, musculoskeletal (MSK) disorders and mental health, and their multi-agency membership is key to achieving this goal.
The NHS is also encouraging inter-practice referrals within these neighbourhoods and enabling the creation of ‘super health centres’ within neighbourhoods that specialise in particular therapy areas, such as diabetes, in order to provide care more effectively within the community.
Furthermore, these neighbourhoods allow multidisciplinary teams from different organisations to work together. Consequently, mental health teams, district nurses, social workers, housing officers, employment advisors, Citizens Advice, and even the police can work together to provide a care plan for patients to help prevent health crises.
Engaging with key stakeholders in neighbourhoods
As more care is provided via neighbourhoods, and hospital outpatients’ departments become less important for ongoing long-term condition management, local NHS staffing roles are evolving. However, they are being dictated to a large extent by issues over recruitment, which is the biggest issue facing the NHS.
This means, for example, that in a diabetes super centre, there could be just one diabetes specialist nurse (DSN) supporting a group of practice nurses and pharmacists to manage care. Therefore, some nurses and practice pharmacists may take on wider roles in neighbourhoods and have more responsibility for prescribing.
Indeed, practice pharmacists are becoming increasingly prominent. More than 490 of them were placed in more than 650 practices across England in a pilot project which aimed to have over 2,000 clinical pharmacists working in general practice by 2020/21 – a ratio of one per 30,000 patients, which is equivalent in size to a neighbourhood. Even though the funding is due to end in 2020/21, it is expected that the majority of GP sites involved in NHS England’s clinical pharmacist programme will still continue to employ practice-based pharmacists.
Pharma must take a tailored approach when dovetailing its national market access strategy with neighbourhoods, since each one has unique needs, challenges and priorities. To understand them, pharma sales and key account teams must be familiar with the individual plans of neighbourhoods and keep abreast of the latest developments via sources such as board meeting minutes and operational plans. This type of information can be obtained via digital tools that provide regular email updates.
It is essential that pharma’s own sales and key account teams working in secondary care, primary care and local market access are integrated and that they are thinking holistically across the whole patient pathway as a variety of organisations increasingly work collaboratively with the NHS. In line with this, any value proposition must offer good value to the wider integrated commissioner and provider community as well as the hospital.
Value propositions that demonstrate a reduction in handoffs or clinician time are of particular interest for local integrated care pathways. A classic example of the way in which this can be achieved can be seen in the development of some biosimilar medicines, which are moving away from infusion to subcutaneous injections that can be easily administered by a less specialised workforce and in a community setting.
Services that engage patients in order to help them get the most out of their treatments are likely to play an increasingly important role in keeping them out of hospital and reducing their overall reliance on the NHS in the long-term.
In order to help the NHS deliver integrated care within local communities and reduce costly hospital stays and outpatient attendances, pharma must think holistically across the whole care pathway and ensure that its products meet the needs of the wide variety of stakeholders in the new health and care neighbourhoods.
This requires an in-depth knowledge of the needs and priorities of individual local health economies in tandem with a strategic understanding of where a product fits into the overall care pathway and how it could bring cost savings and improve patient outcomes in the long-run.
Steve How is a member of Wilmington Healthcare’s Consulting Team.