NHS England strategy development and the Primary Care Strategic Framework

The NHS belongs to the people – A call to action

On 11^th July 2013 NHS England called on the public, NHS staff and politicians to have an open and honest debate about the future shape of the NHS in order to meet rising demand, introduce new technology and meet the expectations of its patients. This is set against a backdrop of flat funding which, if services continue to be delivered in the same way as now, will result in a funding gap which could grow to £30bn between 2013/14 to 2020/21.

The publication The NHS belongs to the people: A call to action sets out these challenges facing the NHS, including more people living longer with more complex conditions, increasing costs whilst funding remains flat and rising expectation of the quality of care.  The document says clearly that the NHS must change to meet these demands and make the most of new medicines and technology and that it will not contemplate reducing or charging for core services.

The document sets out a number of the latest facts on the NHS, including demand, the changing  demographics of the patients being treated and the growth in long term conditions.  These include:

• Between 1990 and 2010, life expectancy in England increased by 4.2 years;
• The difference in life expectancy between the richest and poorest parts of the country is now 17 years;
• Around 80% of deaths from major diseases, such as cancer, are attributable to lifestyle risk factors such as smoking, excess alcohol and poor diet;
• One quarter of the population (just over 15 million people)  has a long term condition such as diabetes, depression, dementia and high blood pressure – and they account for 50% of all GP appointments and 70% of days in a hospital bed;
• Hospital treatment for the over 75s has increased by 65% over the past decade and someone over 85 is now 25 times more likely to spend a day in hospital that those under 65;
• The number of older people likely to require care is predicted to rise by over 60% by 2030;
• Around 800,000 people are now living with dementia and this is expected to rise to one  million by 2021;
• Since it was formed in 1948, the NHS has received around four per cent of national income; and
• Modelling shows that continuing with the current model of care will lead to a funding gap of around £30bn between 2013/14 and 2020/21.

NHS England along with other national partner organisations will be providing support for the organisation of local meetings to discuss these issues. These meetings will provide the mechanism for patients and the public to have a say in how the NHS of the future will look.

All feedback from these meetings, as well as national events and online contributions via NHS Choices, will be published and used to help shape a longer term strategy for the NHS.  This will need to be in place by early 2014 to feed into commissioning plans for GP-led Clinical Commissioning Groups in 2014/15 and 2015/16.

The call to action aims to:

• Build a common understanding about the need to renew our vision of the health and care service, particularly to meet the challenges of the future;
• Give people an opportunity to tell us how the values that underpin the health service can be maintained in the face of future pressures;
• Gather ideas and potential solutions that inform and enable CCGs to develop 3-5 year commissioning plans;
• Gather ideas and potential solutions to inform and develop national plans, including levers and incentives, for the next 5 – 10 years.

Primary Care Strategic Framework

NHS England’s commissioning development directorate is responsible for developing a primary care strategic framework which will sit alongside the wider strategy for the organisation.

The strategy is expected to try to define what aspects of policy and operation need to be undertaken centrally and what can be left to local AT discretion. There are thirteen workstream groups being formed to progress development of the framework, in some cases informed by existing policy and also by the policy priorities of the Secretary of State. The groups are largely populated by NHS England staff, but with some CCG input. Wider stakeholder input will be sought for the groups in due course. The groups are:

1. Vision
2. Empowering patients
3. Empowering clinicians
4. Data and transparency
5. Support for innovation and improvement
6. Incentives
7. Premises
8. Workforce
9. Safe, controlled investment in primary care
10. Market management
11. Pharmacy
12. Dentistry
13. Eye care

NHS England is aiming to get an initial framework completed by October 2013, but a more substantive document is likely to be published in April 2014.

To commence its public work on the development of a primary care strategic framework, NHS England launched Improving general practice – a call to action in mid-August 2013.

NHS England recognises that general practice and wider primary care services are facing increasing pressures, linked to an ageing population, increasing numbers of people with multiple long term conditions, declining patient satisfaction with access to services, and problems with recruitment and retention in some areas. General practice and Clinical Commissioning Groups (CCGs) are increasingly looking at how they can transform the way they provide services so that they can better meet these challenges.

NHS England says it wants general practice to play an even stronger role at the heart of more integrated out of hospital services that deliver better health outcomes, more personalised care, excellent patient experience and the most efficient possible use of NHS resources.

The main purpose of the call to action is to stimulate debate in local communities, among GP practices, CCGs, Area Teams, Health and Wellbeing Boards and other community partners, on the best way to develop general practice services.  NHS England is also inviting comments about how it can best support local changes, for example through the way national contractual frameworks are developed.

NHS England is also developing its strategic approach to commissioning primary dental, pharmacy and eye care services and will carry out separate engagement exercises at a later stage.