The NHS 10 Year Health Plan, was published on Thursday 3 July, Londonwide LMCs’ initial comment can be seen here.
We are considering the measures set out in the Plan and taking time to look at how they will affect general practice in the Capital, and we will be reflecting on comments and reactions from London LMCs and GPs in due course. Our initial summary of notable points is as follows:
Chapter 1 (P17) – It’s change or bust
The Plan sets out three key health shifts the plan seeks to introduce:
- First, from hospital to community. More care will be available on your doorstep and from the comfort of your own home. It will be easier to see a GP and Neighbourhood Health Centres will be available in every community.
- Second, from analogue to digital. New technology will liberate staff from timewasting admin and make booking appointments and managing your care as easy as online banking or shopping.
- Finally, from sickness to prevention. We will reach patients earlier, to catch illness before it spreads and prevent it in the first place, by making the healthy choice the easy choice.
Chapter 2 (P25) – From hospital to community: the neighbourhood health service, designed around you
The Plan states that the NHS does not feel like a single, coordinated, patient-orientated service, but is hospital-centric, detached from communities, and organises its care into multiple, fragmented siloes. It goes on to set out the need to shift to provide continuous, accessible and integrated care via a new “neighbourhood health service”, which it says will bring care into local communities, convene professionals into patient-centred teams and end fragmentation.
The Plan says that it will revitalise access to general practice that the neighbourhood health service will embody the new preventative principle that care should happen as locally as it can: digitally by default, in a patient’s home if possible, in a neighbourhood health centre when needed, in a hospital if necessary. It says that the proposed changes will “end the 8am scramble by training thousands more GPs and building online advice into the NHS App. People who need one will be able to get a same-day GP appointment.”
It also references two new contracts in general practice (no details provided), with roll-out beginning next year, to “encourage and allow GPs to work over larger geographies and lead new neighbourhood providers.”
Neighbourhood health centres
Neighbourhood health centres (NHCs) are to be created in every community, beginning with places where healthy life expectancy is lowest – These ‘one stop shops’ for patient care will house multidisciplinary teams and be open at least 12 hours a day and 6 days a week. The Plan says that the neighbourhood health service “will restore GP access and ensure a far better experience of arranging care. People with complex needs will be offered a care plan and supported to personalise their care.” The Plan says that these centres “… will co-locate NHS, local authority and voluntary sector services, to help create an offer that meets population need holistically. … bringing historically hospital-based services such as diagnostics, post-operative care and rehabilitation into the community … they will also offer services like debt advice, employment support and smoking cessation or weight management services. NHCs could host a variety of services, such as fracture liaison services.”
Working at scale in general practice
It continues “Across the country, GPs told us how the burden of bureaucracy steals joy from work and time from patient care. We have already cut down central targets and, as a next step, we will deliver the recommendations of the ‘Red Tape Challenge’ – a programme to identify and then cut needless bureaucracy.”
It continues “Those who need it, will get a digital or telephone consultation for the same day they request it. Enhanced access could have wide ranging benefits, for example by reducing the need for parents to take children out of school for medical appointments. However, truly revitalised general practice will depend on more fundamental reform. Having served us well for decades, the status quo of small, independent practices is struggling to deal with 21st century levels of population ageing and rising need. Without economies of scale, many dedicated GPs are finding it difficult to cope with rising workloads. Far too often, that means work is causing chronic stress and mental illness among hardworking professionals. Many GPs are voting with their feet: 74% of fully qualified GPs were partners in 2015, compared to just 55% today. Where the traditional GP partnership model is working well it should continue, but we will also create an alternative for GPs. We will encourage GPs to work over larger geographies by leading new neighbourhood providers. These providers will convene teams of skilled professionals, to provide truly personalised care for groups of people with similar needs.”
Additional GP contract types
The same Chapter sets out two new contracts which it says will be rolled out from next year. “The first will create ‘single neighbourhood providers’ that deliver enhanced services for groups with similar needs over a single neighbourhood (c.50,000 people). In many areas, the existing primary care network (PCN) footprint is well set up as a springboard for this type of working.
“The second will create ‘multi neighbourhood providers’ (250,000+ people). These larger providers will deliver care that requires working across several different neighbourhoods (e.g. end of life care). Multi-neighbourhood providers will also be responsible for unlocking the advantages and efficiencies possible from greater scale, working across all GP practices and smaller neighbourhood providers in their footprint. They will support sustainability and professional autonomy by delivering a shared back-office function, overseeing digital transformation and estate strategy, and by providing data analytics and a quality improvement function. They will be large enough to create new commercial partnerships, including clinical trials, so that the Neighbourhood Health Service becomes a hotbed for innovation. And they will actively support and coach individual practices who struggle with either performance or finances – including by stepping in and taking over when needed. In some places this role is 32 already being played by GP federations, with excellent results. We will also give integrated care boards (ICBs) freedom to contract with other providers for neighbourhood health services, including NHS Trusts.”
Chapter 3 (P45) – From analogue to digital: power in your hands
The Plan sets out ambitious goals for the use of technology and AI to make the move ‘from bricks to clicks’, with measures spanning transformation of the NHS App, scaling the use of technology such as AI scribes and other AI technology, and the Single Patient Record (SPR). Specific to proposals around the SPR, on p48 the Plan says “The SPR will bring together all a patient’s medical records into one place. Clinicians will be able to securely access it in order to deliver higher quality care – and patients will be able to add their own data from clinically validated wearables. The SPR will operate as a patient passport, making sure patients get seamless care no matter where they are in the NHS.”
Chapter 4 (P57) – From sickness to prevention: power to make the healthy choice
With an aspirational goal of halving the gap in healthy life expectancy between the richest and poorest regions, the Plan highlights a range of interventions around food, weight loss medication and new partnerships with industry to provide access to new treatments on a ‘pay for impact on health outcomes’ basis along with new health reward scheme to incentivise healthier choices. It also sets out plans to “… test new delivery models for secondary prevention through the Neighbourhood Health Service.
These new ‘Prevention Accelerators’ will initially run in selected ICBs and will focus on community-led methods to tackle variation in uptake of highimpact cardiovascular disease and diabetes interventions. Estimate that increasing the proportion of people with hypertension who are well-managed from 70% to 80% in 3 years would lead to nearly 2.24 million fewer healthcare episodes167 across primary care, outpatients and inpatients over a 10-year period, freeing up GPs and contributing to progress on elective waiting times.”
Chapter 5 (P75) – New NHS operating model
Alongside the previously announced reforms regarding combining the headquarters of the NHS and the Department of Health and Social Care, and changes to ICBs, the Plan sets out plans to trial new ‘patient power payments’, in which patients are contacted after care and given a say on whether the full payment for the costs of their care should be released to the provider. This Chapter also states “We will support ICBs to develop a provider landscape that actively encourages innovation and is not bound to traditional expectations of how services should be arranged. That could mean GPs running hospitals, nurses leading neighbourhood providers or acute trusts running community services.”
Chapter 6 (P85) – A new transparency and quality of care
Alongside plans to introduce league tables ranking providers based on patient feedback, the Plan shares an intention to reform CQC towards “a more data-led regulatory model”. This will be achieved by “shifting the CQC to a new intelligence-led model, supported by expansive new access to data. It will be given statutory powers to access all NHS and publicly held datasets relating directly or indirectly to care quality.”
Chapter 7 (P95) – An NHS workforce, fit for the future
Along with plans to reduce headcount and increase use of AI in healthcare, the Plan sets out aspirations around the levels of international recruitment in healthcare. It includes plans to reform mandatory training and redesign appraisal and revalidation processes.
Chapter 8 (P111) – Powering transformation: innovation to drive healthcare reform
The Plan sets out a number of proposals around the use of NHS data and support for life sciences. Particularly focussing on 5 transformative technologies – data, AI, genomics, wearables and robotics – that will personalise care, improve outcomes, increase productivity and boost economic growth. This includes plans to “… make wearables standard in preventative, chronic and post-acute NHS treatment by 2035. All NHS patients will have access to these technologies, which will be part of routine care. … will provide devices for free in areas where health need and deprivation are highest”. The Plan also sets out plans to pilot new ‘Regional Health Innovation Zones’ to test changes in delivery, pathways and commissioning.
Chapter 9 (P129) – Productivity and a new financial foundation
Sharing intentions to ‘retarget finance from hospitals into community provision’, the Plan aspires to reduce hospital admissions, achieve year on year financial savings, and deconstruct block contracts. It also shares Government plans to develop a business case for the use of Public Private Partnership (PPP) for Neighbourhood Health Centres, ahead of a final decision at the autumn budget.
The Plan also sets out the Government’s intent to develop “year of care payments (YCPs)”, allocating a capitated budget for a patient’s care over a year, instead of paying a fee for a service. The new payment mechanism will be calculated according to the health needs of the population being served and could include all primary care, community health services, mental health, specialist outpatient care, emergency department attendances and admissions, consolidated into a single payment.
The Plan says that the Government will ask the Advisory Committee on Resource Allocation (ACRA) to independently review the findings of the Chief Medical Officer’s recent reports on health across different communities and in an ageing society in time to inform allocation of resources to and by ICBs in 2027 to 2028 and, target extra funding to areas with disproportionate economic and health challenges. They will also review how health need is reflected in nationally determined contracts, including the Carr-Hill formula.