1. Sustainability and Transformation Plans (STPs)
As we all know the NHS is facing unprecedented demands on its already overstretched services and this is especially true for general practice. We have an ageing population, and there are more people living with one or more long term condition. In addition although people are living longer they are also living in ill health for longer.
Older frail patients are more depended on social care and the cuts to local authority funding all play a part in the current challenges.
If we do nothing and
continue to deliver services as we do now the predicted growth in demand will mean that the NHS will be over £20bn in deficit by 2020 with a current annual budget of £110bn.
In 2007 general practice received about 10% of the total NHS spend this has now fallen to below 8%.
NHS England has established 44 local areas where commissioners, hospitals, community providers, local authorities and general practice are expected to work together to formulate a plan that will deliver sustainable services and address the growing demand that all areas are experiencing.
The majority of GPs will not have heard of Sustainability and Transformation Plans (STPs); however going forward these will be the lynchpin of how NHS care is delivered in
light of the ageing demographic and financial situation; in particular to address 3 challenge gaps:
· Health and wellbeing
· Care and quality
· Finance and efficiency
For too long the NHS at a local level has worked in silos - recently I heard a quote - "silos are where intelligent people go to do dumb things!" We must end the silo working as it in inefficient, causes duplication and most things seem to be pushed back to general practice who not longer has the capacity to deal with it.
In Wessex we have 3 STPs and the LMC represented in each of these.
Seeks to address the challenge gaps with 3 programmes of work:
· Prevention at scale – helping people stay health and avoid illness
· Integrated community services – supporting high quality care in community settings
· One Acute Network – single acute care system across Dorset
Supported by two enabling
programmes to help deliver new models of care in an integrated health and care system:
· Leading and working differently: upselling the health and social care workforce
· Digitally enabled Dorset – to improve use of technology.
The STP requires Dorset to make critical decisions regarding:
• resourcing and co-ordination our approach to prevention at scale
• organisation of General Practice into larger groupings
• reconfiguration of community hospitals to optimise integrated
services at scale
• reconfiguration of acute hospitals to deliver quality emergency and planned care
Dorset STP is at an advanced state to some areas within the UK; largely as a result of the Clinical Services Review (CSR) which has prompted inter-organisational conversations and collaboration which have not occurred as much elsewhere. The STP, as with the CSR, has taken an acute medical focus which the LMC has advocated to re-focus upon General Practice as 90% of NHS contacts occur within General Practice and are key for ensuring effectiveness of more care delivered within the community. A senior leadership team with representation from all the involved organisations is meeting monthly to drive forward this agenda at board level.
Hampshire and Isle of Wight STP
Locally there is an NHS budget of about £3bn to look after all the needs of a population which is close to 2m. It is estimated that with the annual growth in demand if we carry on providing care in the way it is delivered now, by 2021 the local health economy will have a financial gap of over £700m.
This would largely be due to the growth in hospital based care. So no change is not an option.
There are a number of work streams to support the STP including:
1. New Models of Care
2. Acute Hospitals Alliance
3. North and Mid
4. Mental Health Alliance
5. Delayed Transfers of Care
Bath & NE Somerset, Swindon and Wiltshire STP
The BSW STP brings together three separate health economies without a strong history of working closely together. This puts it in a different position from the Hampshire and Dorset STPs. Therefore it’s June submission was a more strategic and high-level document with
no developed plans for significant service changes at this stage. Feedback to the June submission acknowledged that the STP was embryonic in development but NHSE were generally very positive about the direction of travel.
BSW footprint was at near breakeven position in 2015-16 (-6m deficit) so is seen as lower risk than some other STPs. However, if no action is taken, the forecast financial position is a funding gap of £337 million by 2020/21 due to population increases, the cost of the aging population and increase in cost of care delivery.
The June submission sets out 5 key priorities for change
1. The development of locality based integrated teams supporting primary care.
2. Shifting the focus of care from treatment to prevention and proactive care.
3. Redefining the ways we work together to deliver better patient care.
4. Establishing a flexible and collaborative approach to workforce.
5. Further enabling acute collaboration and sustainability.
The STP emerging vision is to place the citizen at the heart of the health and social care system.
The STP seeks to facilitate the development of an effective and responsive integrated community service provision that can deliver the care patients need closer to home, whilst maximising their wellbeing, ability to manage their own health, and reduce the need for secondary and specialised services.
The proposed models
will support earlier intervention, joined up social and health care planning, crisis management, enhanced self-care options, clearer sign posting, more tiered access to urgent care services, and clinically evidenced triage and treatment.
The initial priorities are being assessed and developed through three care work-streams and three enabling work-streams.
· Urgent and Emergency Care
· Planned Care
· Preventative and Proactive Care
The next iteration of the plan will be shared with NHS England on 21st of October.