CVDPREVENT - primary care audit

CVDPREVENT
NHS England

• CVDPREVENT is a regular national primary care audit making it easier for practices to systematically identify people whose treatment could be improved, and risk reduced. It will automatically extract routinely held GP data covering diagnosis and management of six high risk conditions that cause stroke, heart attack and dementia: atrial fibrillation, high blood pressure, high cholesterol, diabetes, non-diabetic hyperglycaemia and chronic kidney disease. It will support primary care in understanding how many patients with the high-risk conditions are potentially undiagnosed, under treated or over treated. 
• Find out more  on the NHS Benchmarking platform including a quick guide and key dates

The English local government public health reforms: an independent assessment

The English local government public health reforms: an independent assessment
Kings Fund 10 January 2020

• This report, commissioned by the Local Government Association, assesses the success of the 2013 reforms to public health in England, which were part of the Coalition government’s wider health reform programme. 
• The report also looks at the effects of the reforms in both the short and longer term and looks at the impact of the changes, and looks into the future and the implications for public health in the context of the NHS long term plan, the government’s prevention consultation and the wider shift to population health systems.

The state of the NHS Provider sector

The state of the NHS Provider sector
NHS Providers October 2019

• This report sets out the scale of the challenge and opportunity facing trusts, and the wider health and care sector, as they seek to deliver the aspirations of the long term plan. Themes are
• quality and performance
• workforce
• funding and finances
• system working, transformation and integration.

NHS Long Term Plan Implementation Framework

NHS Long Term Plan Implementation Framework 
NHS England 27 June 2018

(Accompanying NHS England/ NHS Improvement Board paper)

• On publication of the LTP in January 2019, an Implementation Framework was promised which would support sustainability and transformation partnerships (STPs) / integrated care systems (ICSs) to undertake strategic planning. Five year strategic plans, 2019/20 – 2023/24, are expected by November and will be fed into the national plan by the end of 2019. Plans must set out how STPs will develop to become an ICS by April 2021.
• The Framework sets out expectations and the support available to systems from national and regional teams and will put into practice the new operating model for NHS England and Improvement.
• Expectation are that plans ”explicitly set out how the additional funding being invested will deliver real improvements for their populations”, and that plans are:
• Clinically-led
• Locally owned
• Based on realistic workforce planning
• Financially balanced and delivering financial recovery
• Delivering all the commitments within the Long Term plan
• Phased over the full five years reflecting local priorities and different starting points
• Reducing local health inequalities and unwarranted variation, (including disadvantaged or vulnerable groups and those with learning disabilities/autism).
• Focused on prevention
• Engaged with Local Authorities
• Driving innovation
• Other key areas for consideration include workforce, digitally enabled care, and financial planning assumptions to meet the financial tests set out in the Long Term Plan.

The changing face of clinical commissioning

The changing face of clinical commissioning
NHS Clinical Commissioners 23 May 2019

• The report highlights the work of CCGs to drive through innovations and improvements across health and social care and the key strengths which should be retained within the new structures proposed by the NHS Long Term Plan.

NHS X website, twitter and LinkedIn

NHS X https://www.nhsx.nhs.uk/

• A new website to support the work of NHSX to deliver the Health Secretary’s Tech Vision, building on the NHS Long Term Plan, and speeding up the digital transformation of the NHS and social care.
• Brings together Standards, guidance and support resources for digital teams.
• Read more about Matt Hancocks vision for NHSX.
• NHSX LinkedIn
• NHSX Twitter

CCGs - House of Commons Public Accounts Committee

Clinical Commissioning Groups 
House of Commons Committee of Public Accounts, 8 March 2019

• An examination of the work of CCGs and the impact of the NHS Long Term Plan on the future of CCGs.
• Recommendations relate to CCG performance and accountability, an update on the relationship between CCGs and Integrated Care Systems, expected number of CCGs, estimate of CCGs redundancies, input of local GPs into CCG decision making, CCG focus on the needs of larger population groups, and legislative changes.

Report summary and recommendations:

Some Legal Implications of the NHS Long Term Plan

Some Legal Implications of the NHS Long Term Plan
Hempsons 19 February 2019

• In order to improve access to services, the Long Term Plan (LTP) sets out ambitions for better integration between primary, secondary and community services for patients. 
• This note highlights some of the legal implications of the LTP in particular around procurement, competition, workforce, and Primary Care Networks / Sustainability and Transformation Partnerships / Integrated Care Systems.

The NHS long-term plan explained

The NHS long-term plan explained
Kings Fund 22 January 2019

• In this explainer, Kings Fund sets out the main commitments in the plan and provides their view of what they might mean, highlighting the opportunities and challenges for the health and care system as it moves to put the plan into practice.
• Contents
• Introduction 
• Improving services 
• Clinical priorities
• Primary and community services 
• Mental health and learning disabilities
• Acute services 
• Resources 
• Finance and productivity 
• Workforce 
• Digital 
• Leadership and support for staff 
• System priorities 
• Role of patients and carers
• Integrated care and population health
• Prevention and health inequalities
• Implementation
• Reflecting on the plan

NHS Long Term Plan

NHS Long Term Plan https://www.longtermplan.nhs.uk/
NHS England 7 January 2019
“how the NHS will move to a new service model in which patients get more options, better support, and properly joined-up care at the right time in the optimal care setting.”
The Long Term Plan contains aspirations, commitments, milestones and priorities for the NHS across the next ten years. It includes:

• A new service model for the NHS aims to increase primary and community based care, reduce emergency care in hospital, increase personalised care, increase use of digital technology and develop Integrated Care Systems (ICS) to support population health management.
• A renewed NHS prevention programme will prioritise smoking, poor diet, high blood pressure, obesity, and alcohol and drug use. In addition there will be a concerted and systematic approach to reducing health inequalities and addressing unwarranted variation in care.
• New and revised care quality and outcomes measures are presented relating to health and wellbeing of children and young people, maternity and neonatal services, learning disabilities and a number of major health conditions (cancer, cardiovascular disease and stroke (inc diabetes), respiratory conditions, dementias, and self-harm).
• A new Workforce Implementation Plan will underpin workforce development.
• The Plan places a strong emphasis on the upgrade and development of digital technology across the NHS.
• The Plan lays out five tests for NHS financial architecture, payment systems and incentives.
• There are a number of case studies demonstrating models and approaches outlined in the Plan.

Responses

• Spotlight on The NHS Long Term Plan - Nuffield Trust
• The NHS Long Term Plan in summary Health London Partnership
• The NHS long-term plan:five things you need to know, Kings Fund 8 January
• The NHS Long Term plan: A member briefing. NHS Confederation, 9 January 2019
• Caution needed over ambitions for new primary care networks BMJ Opinion 17 January 2019
• The NHS long-term plan explained, Kings Fund 22 January 2109
• Budget and the NHS Long Term Plan - Health and Social Care Committee, oral evidence from Matt Hancock, Simon Stevens and Prof Ian Cuming. 28 January 2019

HSJ coverage here. [subscription required]

Read Cowper’s Cut: A brief history of NHS plans (HSJ 7 Jan 2019, subscription required) for a brief history of previous plans for the NHS.

NHS Long Term Plan – highlights for ECM

NHS Long Term Plan – highlights for ECM
NHS England 7 January 2019

• An outline of the engagement activity, including stakeholder engagement report, which supported development of the Long Term Plan, is available here. 
• While the plan does not detail communications and engagement activity, the increasing focus on person-centred care will require a systematic approach to engaging public and patients in discussions about services. (1.37) 
• Specific opportunities where engagement activities will be important include: 
• Integrated Care Systems (ICSs) will be rolled out across England by April 2021 (1.51). The new ICS accountability and performance framework, will incorporate ‘integration index’ to be developed jointly with patients groups and the voluntary sector which will measure the extent to which the local health service and its partners are genuinely providing joined up, personalised and anticipatory care. (1.55) 
• Local health systems will receive five-year indicative financial allocations for 2019/20 to 2023/24 and be asked to produce local plans for implementing the commitments set out in the Long Term Plan. They will be expected to engage with their local communities and delivery partners in developing plans, which will be based on a comprehensive assessment of population need (7.3)

NHS Long Term Plan – Workforce development highlights

NHS Long Term Plan – Workforce development highlights
NHS England 7 January 2019

• The NHS Long Term Plan sets out a New Service Model for the NHS. Of note to HR is the move to integrated care systems (ICSs) across the whole country by April 2021, supported by primary care networks (PCNs), formed of GP practices typically covering 30-50,000 patients. 
• Under this Long Term Plan, digital-first primary care will become a new option for every patient giving patients the right to access telephone of online consultations from their own practice or, if they prefer, from one of the new digital GP providers. NHS England will review
• current out-of-area arrangements and adjust the GP payment formulae to ensure fair funding without inequitably favouring one type of GP provider over another, and also 
• GP regulation and terms and conditions to better support the return to practice and increased participation rates by GPs wanting to work in this way. (1.44)
• Chapter 4 describes a range of workforce development initiatives, notably a new Workforce Implementation Plan due to be published later in 2019 (4.10) supported by a national workforce group to endure the actions are delivered quickly. Themes of note in the implementation plan mentioned in the LTP include
• accelerate the shift from a dominance of highly specialised roles to a better balance with more generalist ones (4.24)
• increase the number of doctors and other healthcare professionals working in general practice (4.26)
• new national arrangements to support NHS organisations in recruiting overseas. (4.32) 
• Enabling staff to work smarter and make the most of their skills and expertise, in particular how digital technology can support free up staff time. (4.47)
• A new deal for staff to address harassment, bullying or abuse from other staff. (4.40)
• Set out workforce specific requirements for individual specialisms eg mental health, stroke. (Box p90)
• Work of the new national workforce group will include commissioning a review of NHS workforce data, to ensure that the information available on the electronic staff record, NHS workforce data collections and other sources such as the Model Hospital databases, provide both local and national bodies with real time access to a single source of trusted information to guide and support both day-to-day and strategic workforce decision making.
• The LTP stresses the importance of workforce development and career progression to increase staff retention (4.37) in particular multi- professional credentialing to enable clinicians to develop new capabilities (4.38) 
• Newly qualified doctors and nurses entering general practice will be offered a two-year fellowship offering a secure contract of employment alongside a portfolio role tailored, where possible, to the aims of the individual and the needs of the local primary care system. (4.27)

CCG admin budgets to be cut by 20 per cent

CCG admin budgets to be cut by a fifth
HSJ 26 November 2018 (subscription required)

• HSJ has reported that a letter sent to CCGs by NHS England ahead of the long term plan, has said that “administration” limits will be introduced for each CCG in the next financial year, and they must reduce admin budgets by 20 per cent.
• According to the letter one of the ways "suggested" by NHS England is closer working with CSUs to cut costs, CCGs must simplify payments to CSUs and move away from payment by results.
• The letter from Matthew Swindells, deputy chief executive at NHS England, and regional directors, said CCGs can save money by “exploring mergers and joint ways of working”. To support this, it said it will now approve mergers throughout the year rather than once a year, as is currently the case. It said: “[It] will particularly support approaches which align a single CCG with a single ICS.”
• The letter also confirmed the new regional NHS England structure will support the development of ICS and sustainability and transformation partnerships.

Record NHS funding to give patients a better alternative to hospital - press release

Record NHS funding to give patients a better alternative to hospital - Press release
Prime Minister's Office, 10 Downing Street, Department of Health and Social Care, NHS England, The Rt Hon Matt Hancock MP, and The Rt Hon Theresa May MP 21 November 2018

• The Prime Minister set out a major new investment in primary and community healthcare – worth £3.5 billion a year in real terms by 2023/4 – which builds on the existing NHS budget for these services" and "forms a key part of the Long Term Plan for the NHS".
• "The PM announced the national roll-out of a successful pilot that sees healthcare professionals assigned to care homes where they get to know individual residents’ needs and can provide tailored treatment and support. The teams include pharmacists and GPs who can also offer emergency care out of hours."

The NHS long-term plan: Lessons from the Lord Darzi Review of Health and Care

The NHS long-term plan: Lessons from the Lord Darzi Review of Health and Care
Institute of Public Policy and Research 20 November 2018

• An outline of the challenges for the Long Term Plan.

Long Term Plan under development

Mackey, Deegan and Marsh among chiefs selected to develop 10 year-plan
HSJ 9 August 2018

• Workstreams contributing to the 10 year Long Term Plan are being jointly led by prominent provider chief executives, arms-length body, commissioning and third sector leaders. They will be expected to come forward with initial proposals by the end of September. Following consultation the plan is due to be published in November.

Matt Hancock Health Select Committee 24 July 2018

Highlights from the oral evidence given to the Health Select Committee by Matt Hancock, Secretary for State for Health and Social Care, 24 July 2018

Highlights by Anne Gray, Knowledge Officer.

Watch the oral session here

• Matt Hancock (Secretary of State for Health and Social Care (SOS))has already outlined his three priorities; workforce, IT and prevention, in a speech on 20 July (ref1). He emphasised that these priorities cut across many of the existing target areas eg mental health and childhood obesity. 
• Many of Mr Hanckck’s answers referred to the Long Term Plan (LTP) scheduled for autumn 2018, and forthcoming Spending Review which will identify finance available for non-NHS aspects of the LTP (including prevention, social care and transformation). Funding for the NHS and technology transformation has already been announced. There is no firm date for the Spending Review. The health inequalities agenda will be a core part of the LTP. 
• NHS England has developed a skeleton outline of the LTP. In Sept/October an engagement exercise will be held with stakeholders on the three priorities which will then feed into development of the LTP due for publication in November 2018. 
• The available funding will not cover all current target areas, and these will be reviewed in light of the new priorities “The [Long Term] Plan has to be realistic and deliverable”. 
• Themes which the Secretary of State (SoS) repeated during the session: 
• 1. Mr Hancock is not interested in top down reorganisation but looking to integration and interoperability. Improvement is about better ways of working around competencies, empowering staff, technology, culture, fewer barriers, faster uptake and spread of good practice. Removing "old school" practices.
• 2. When responding to questions relating legislation to make collaboration easier, the SOS said he was “open minded” and repeated that he wanted "consensual change not legislative shake up". “Over interpretation” of the legislation may be the issue. 
• 3. Prevention is about more than public health (PH). Workforce development is not just HEE. 
• 4. There are ways of delivering better outcomes within a tight financial envelope. There is enormous variance in delivery – the best can be working to tight budgets. The improvements are not only in relation to transformation, it can be around leadership, improved ways of working.