The NHS reaffirmed its commitment to integrated care systems in its highly-anticipated ‘Long-term Plan’, which provides a blueprint for the design and delivery of services in the coming decade.
The document, which will provide the basis for local NHS organisations’ plans, states that, by April 2021, all areas of England will be covered by an Integrated Care System (ICS), with typically one Clinical Commissioning Group (CCG) per ICS area.
ICSs will have multi-organisational components that will see a wealth of different stakeholders getting involved in improving patient care and outcomes across England from the police to local authority housing departments and the Citizens’ Advice Bureau.
Integrated care systems
CCGs will merge across the ICSs and play a highly strategic role in service commissioning. They will also help to unite external organisations, such as local authorities and social care within ICSs, and ensure smooth working relationships with secondary care which will also fall under the ICS banner. This integrated style of working will alter the way that services are staffed and resourced, and where and how clinical services are provided, bringing big changes to the pharma customer base.
The plan also promises £4.5bn of new investment to fund expanded community multi-disciplinary teams within ICSs, which will comprise a range of staff such as GPs, pharmacists, district nurses, community geriatricians, dementia workers and Allied Health Professions (AHPs), such as physiotherapists and podiatrists/ chiropodists, joined by social care and the voluntary sector. These multi-disciplinary teams will be aligned with Primary Care Networks (PCNs), based on neighbouring GP practices that work together, typically covering populations of between 30,000 to 50,000 people.
As part of the NHS’s bid to take more services out of hospitals and into the community, 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. This could also include medication reviews.
Elsewhere in the NHS, many service contracts have already been moving away from Payment by Results (PbR). Overall, ICSs will introduce whole population budgets, with increasing amounts of risk share and outcome parameters. Care will be contracted by the strategic CCGs covering the ICSs, and often delivered by integrated care providers with a lead provider which will probably be the local trust.
Integrated care in action
The way in which integrated, multidisciplinary teams enable the NHS to take a much more holistic and joined-up approach to care has already been exemplified in some of the ICSs that have been leading the way in delivering new ways of working. For example, in Nottinghamshire, the district nurse lead, social care lead, housing lead and Citizens’ Advice Bureau representative are all based in the same office and work together, although they are employed by different organisations. They discuss case-loads together and hold joint meetings with patients in order to provide a completely integrated service.
This means that a diabetic patient who has lost a limb, could have all their health and social care needs assessed and managed by a single integrated team which would look at housing, social care and home help requirements, as well as diabetes care and insulin management. It could also arrange for district nurse care for serious necrotic ulceration, if needed.
When thinking about how this integrated approach works in practice, it is easy to see how competition for money for patient care could come from unexpected quarters in future. For instance, it could be argued that improving conditions in damp housing, e.g. with the use of anti-fungal paint, would be more effective for people with respiratory problems than drugs, and critically both approaches are funded from the same budget and strategic plan.
To engage with key stakeholders in new integrated care systems, pharma needs to keep the holistic, population health agenda front of mind and think about wrapping its value proposition around a service that adds real value – such as an education programme for schools that promotes healthy eating and exercise to reduce the risk of diabetes – rather than simply providing a product.
It must also consider how its products can deliver cost savings across the whole care pathway, particularly with regards to helping the NHS reduce demand on hospital beds and outpatients’ services. This could involve helping the NHS to tackle problems such as overmedication through patient education or 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 since both of these initiatives focus on reducing unwarranted variation in quality and outcomes, which will be a key test of whether the plan is working.
To help pharma better understand the implications of the plan for industry and determine how it can engage with the variety of key stakeholders who will be involved in ICSs, Wilmington Healthcare will host a free webinar on Monday 28 January from 1.30pm-2.15pm.
Our guest speaker will be Phil Richardson, Chief System Integration Officer, Dorset Integrated Care System, who will be joined by speakers from Wilmington Healthcare’s Consulting Team.
Register here to listen to the webinar live or on demand at a later date.