A summary of the NHS 10 year plan and some comments on local implications.

Below is a bullet point summary of the NHS 10 year plan written by one of Howbeck Healthcare's associates Sarah Laing for the GPs in the GP Federations we look after. Howbeck Healthcare supports GP federations and is always looking for new partners.

For me there are 2 key points for general practice -

1. Working in care communities (or Networks) is real.. Care communities is what locally we are calling small localities of practices with a population of 30-50K but actually because of geography sometimes more, sometimes less.

They are going to force this by putting money that used to go to individual practices to care communities as a group. They aren't forcing mergers but are forcing every closer working.

Practices need to make sure they get their fair shares of this money as it might be a clever way of moving primary care money to other providers which might destabilise primary care.. however there is a real opportunity for us to lead.. as the goal is accountable care organisations and all the evidence from them is they should be primary care driven and focused - though most take a while to understand this.. see Nuffield trust and Kings fund publications on this..and Prof B Starfield's work on role of general practice.

2. Digital registration is a real threat to traditional general practice – perhaps more so in cities but if large numbers of “well” rarely attending patient's deregister and go to online services that will destabilise us if the current funding formulas are kept. There are no signs of a PBR tariff for general practice and currently high frequency attenders are effectively subsidised by low attenders.

Locally this means we need to think about whether our GP Federation needs to offer its own online…cross practice digital service – perhaps as an expansion of our extended hours scheme which is itself an extension of the Wave 2 PM Challenge fund - Locally every patient in South Cheshire and Vale Royal has the opportunity to be seen in early mornings, evenings and at weekends in hub practices that offer this service. (We believe we are offering the most cost effective extended hours care in the country and the most activity) We have the IT setup to allow a central team to take calls.. and see records..its only a step to do video calls etc..

Im preparing another article on the current reorganisations to the NHS and the likely implications for primary care and those that work in and with primary care - if you are keen to see this... please comment and I'll priories finishing it!

Summary of NHS 10-year plan 

• The ￡4.5 billion of new investment will fund expanded community multidisciplinary teams aligned with new primary care networks based on neighbouring GP practices that work together typically covering 30-50,000 people.
• As part of a set of multi-year contract changes individual practices in a local area will enter into a network contract, as an extension of their current contract, and have a designated single fund through which all network resources will flow. 
• Most CCGs have local contracts for enhanced services and these will normally be added to the network contract.
• Expanded neighbourhood teams will comprise a range of staff such as GPs, pharmacists, district nurses, community geriatricians, dementia workers and AHPs such as physiotherapists and podiatrists/chiropodists, joined by social care and the voluntary sector. In many parts of the country, functions such as district nursing are already configured on network footprints and this will now become the required norm.The result will be the creation fully integrated community-based health care. This will be supported through the ongoing training and development of multidisciplinary teams in primary and community hubs.
• To support this new way of working we will agree significant changes to the GP Quality and Outcomes Framework (QOF)
• We will also offer primary care networks a new ‘shared savings’ scheme so that they can benefit from actions to reduce avoidable A&E attendances, admissions and delayed discharge, streamlining patient pathways to reduce avoidable outpatient visits and overmedication through pharmacist review.
• Guaranteed NHS support to people living in care homes
• Primary care networks will from 2020/21 assess their local population by risk of unwarranted health outcomes and, working with local community services, make support available to people where it is most needed. GP
• To support patients to navigate the optimal service ‘channel’, we will embed a single multidisciplinary Clinical Assessment Service (CAS) within integrated NHS 111, ambulance dispatch and GP out of hours services from 2019/20.
• We will fully implement the Urgent Treatment Centre model by autumn 2020 so that all localities have a consistent offer for out-of-hospital urgent care, with the option of appointments booked through a call to NHS 111. 
• over the next five years the NHS will ramp up support for people to manage their own health17. This will start with diabetes prevention and management, asthma and respiratory conditions, maternity and parenting support, and online therapies for common mental health problems.
• through social prescribing the range of support available to people will widen, diversify and become accessible across the country. Link workers within primary care networks will work with people to develop tailored plans and connect them to local groups and support services. Over 1,000 trained social prescribing link workers will be in place by the end of 2020/21 rising further by 2023/24,
• Digitally-enabled primary and outpatient care will go mainstream across the NHS
• Under this Long Term Plan, digital-first primary care will become a new option for every patient improving fast access to convenient primary care.
• Over the next five years every patient in England will have a new right to choose this option – usually from their own practice or, if they prefer, from one of the new digital GP providers.
• Local NHS organisations will increasingly focus on population health – moving to Integrated Care Systems ICS everywhere ICSs will be central to the delivery of the Long Term Plan and by April 2021 we want ICSs covering all of the country. A
• Funding flows and contract reform will support the move to ICSs
• We are delivering on our commitments to expand mental health services for children and young people.
• Research and innovation to drive future outcomes improvement. We will work to increase the number of people registering to participate in health research to one million by 2023/24.
• New NHS roles and careers will be shaped to reflect the future needs and priorities set out in the rest of this Plan. As we invest in our workforce, we need to ensure the NHS has primary care and generalist skills, to complement what has been a major move to more specialised hospital-based care in recent decades
• newly qualified doctors and nurses entering general practice will be offered a two-year fellowship
• The government has also committed to a new state-backed GP indemnity scheme from April 2019, as part of a five-year funding and reform package. The purpose of the indemnity reform is to address concerns about rising NHS indemnity costs, in a cost neutral way, as well as extending the scope of coverage to support the expanded multidisciplinary teams described above.
• we will back the Helpforce programme with at least ￡2.3 million of NHS England funding to scale successful volunteering programmes across the country, part of our work to double the number of NHS volunteers over the next three years.
• Digitally-enabled care will go mainstream across the NHS
• Over the next five years, every patient will be able to access a GP digitally, and where appropriate, opt for a ‘virtual’ outpatient appointment.