Population Health Management and the NHS Workforce Plan.

I did a search for the term ‘Population Health Management’ in the NHS Long term Workforce Plan. It returned a blank[1]. Does it matter??No, because the plan is suffused with the principles and practice of Population Health Management. Identification of need using data, proactive anticipatory care using multidisciplinary teams, care which is person centred and orchestrated from primary care.

One of the missed opportunities of the huge investment made into the NHS in the first decade of this century was it focussed resources into specialist care. It emphasised and reinforced a 20th century, reactive, condition based, bio-medical model which, as this plan subliminally points out, is no longer fit for purpose.

The case for change is self-evident: an ever-older population with multimorbidity being the dominant issue. Maybe they don’t want to scare people, but they never provide a baseline number for the population over the age of 85 that is going to increase by 55% by 2037. I looked it up. It is 1.7million people at present. By 2037 two thirds of people over the age of 65 will be multimorbid.

Without calling it Population Health Management the plan proposes ‘we will need to continue the shift over the coming years away from episodic care, towards a newer paradigm of ongoing, chronic care to support the increasing number of people with multimorbidity, frailty and complex needs.’

It makes a powerful statement supporting this (but then seems to promote the old way of doing healthcare?): ‘Multimorbidity challenges the specialised approach to medicine, which has improved our ability to successfully treat single diseases. As we move forward, we will increasingly need medical and other clinical professionals with generalist and core skills to manage and support patients with seemingly unrelated diseases. Additionally, government intends to publish a new major conditions strategy that will aim to improve prevention, diagnosis and treatment of six major conditions (cancer, cardiovascular diseases including stroke and diabetes, chronic respiratory diseases, dementia, mental ill health, musculoskeletal disorders).’

The good thing is that the plan recognises that ‘Scaling of NHS care delivered in the community requires rapid expansion of the necessary workforce and the development of more flexible and integrated teams.’[2]

There is also a window of opportunity to be seized. ‘There will be a ‘bulge’ in the 18- year-old population over the next few years, which possibly will not be seen again for the rest of the century. As such, there is an imminent narrow window to offer as many routes as possible to school leavers into careers in healthcare.’

The plan goes into great detail about the types and numbers of professionals required and acknowledges the need for ‘personalised care roles’ as, ‘It is estimated that one in five people who go to their GP do so with concerns that cannot be addressed with medical treatment.’?This move beyond a bio-medical focus is essential for PHM. The plan also highlights the importance of social care and the limitations this plan has in not being able to address that.

It is a workforce plan and light on the capital infrastructure, for instance, needed to deliver the transformations sought. It does, however, place an emphasis on harnessing digital transformation and draws attention to the potential for AI to alleviate administrative burdens, support diagnostic capacity and for processing information ‘making it easier for staff to access the information they need in a safe and secure environment so that they are better able to co-ordinate, plan and deliver high quality care…..The ICS workforce will have the insights they need to proactively plan services around people’s needs and co-ordinate care across the services in their geography.’ i.e. deliver Population Health Management.

There will be some contentious headlines from this plan such as ‘medical apprenticeships’. I would urge colleagues to look beyond the clickbait headlines and read the detail which, to me, makes a lot of sense[3].

I went to read this plan with scepticism having read a somewhat antipathetic commentary on it[4]. I finished it much less sceptical, more hopeful and encouraged that without being named the plan underpins what is needed to deliver Population Health Management. If this is the course charted, then ‘make it so’.

[1] To be fair it does mention ‘population health’

[2] See Atul Gawande’s Cowboys and Pit Crews | The New Yorker published in 2011 describing the need for this to happen.

[3] Medical Doctor Degree Apprenticeship | Health Education England (hee.nhs.uk)

[4] The mythbuster: The birthday gift the NHS didn’t need | Daily Insight | Health Service Journal (hsj.co.uk)