The NHS Long Term Plan
The NHS Long Term Plan
In January 2019, NHS England published the NHS Long Term Plan, setting out its priorities for healthcare over the next ten years and showing how the NHS funding settlement will be used. The plan was unveiled by NHS England Chief Executive Simon Stevens and Prime Minister Theresa May, who said it was about “reshaping the NHS around the needs of patients”.
The publication of the plan follows the Prime Minister’s announcement of a £20 billion a year NHS funding increase in June 2018. This figure is equivalent to a 3.4% rise to NHS England’s budget for frontline services.
PSNC has published the following briefing which summarises the aspects of the Plan which are most relevant to LPCs and community pharmacy:
At the end of January 2019, NHS England published a five-year framework for GP services agreed with the British Medical Association (BMA) General Practitioners Committee (GPC) in England and supported by Government. It implements commitments in the NHS Long Term Plan for changes to the GP contract and sets the direction for primary care for the next five years. Further information on the framework can be found in the following PSNC Briefing:
Following the publication of the Plan, NHS England and NHS Improvement (NHSE&I) committed to publishing an implementation framework, setting out further detail on how it would be delivered. This implementation framework has now been published, containing guidance on the approach Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs) are asked to take to create their strategic plans to deliver the Long Term Plan.
What the plan says
A key theme of the plan is prevention, as NHS England says it believes 500,000 lives could be saved over the next ten years by focusing on prevention and early detection. The NHS will focus on its aim to make the population ‘fit for the future’ by:
- Enabling everyone to get the best start in life;
- Helping communities to live well; and
- Helping people to age well.
NHS England has also pledged to offer Primary Care Networks a new ‘shared savings’ scheme so they can benefit from actions taken such as to reduce avoidable A&E attendances and delayed discharge and to reduce over-medication through pharmacist review.
Other measures include:
- Improving out-of-hospital care by supporting primary medical and community health services;
- Providing better care for major health conditions, such as cardiovascular disease, respiratory conditions and diabetes;
- Supporting those admitted to hospital with smoking/alcohol addiction;
- Supporting older people through more personalised care and stronger community and primary care services; and
- Making digital health services a mainstream part of the NHS, so that in five years’ time, patients in England will be able to access online GP consultations.
NHS England has also promised to recruit tens of thousands more doctors, nurses and other health professionals, although its full workforce plan is now not expected until later in 2019.
Developments for pharmacy and pharmacists
For community pharmacy, the plan states:
- NHS England will work with Government to make greater use of community pharmacists’ skills and opportunities to engage patients;
- NHS England and the Government will explore further efficiencies through reform of reimbursement and wider supply arrangements;
- NHS England will work with community pharmacists and others to provide opportunities for the public to check their health, through tests for high blood pressure and other high-risk conditions; and
- From 2019, NHS 111 will start direct booking into GP practices across the country, as well as referring on to community pharmacies who can support urgent care and promote patient self-care and self-management.
NHS England also makes several mentions of pharmacists, in particular noting the role that they will play in local Primary Care Networks. Pharmacists may be involved in helping to identify and treat people with high-risk conditions, undertaking a range of medicine reviews, including educating patients on the correct use of inhalers, and offering medicine reviews to care home residents.
The report states that:
- Funding for primary care networks will be used to substantially expand the number of clinical pharmacists, who are now a key part of the general practice team; and
- Pharmacists will routinely work in general practice helping to relieve pressure on GPs and supporting care homes.
PSNC response to the Long Term Plan
Commenting on the publication of the NHS Long Term Plan, PSNC Chief Executive Simon Dukes said:
“It is good to see more of what the NHS, community pharmacy’s key customer, wants to achieve in the long-term and how it plans to get there. The crucial thing for pharmacy now is to work out how it fits into this, and our next step will be to work with the NHS and HM Government to explore what community pharmacy’s contribution to the plan will be. We are ready to begin those conversations, and with the NHS now clear on its own ten-year plan, we want to begin negotiations on a similar long-term plan for community pharmacy, setting out how pharmacies can do more, working closely with primary care colleagues, for the benefit of the NHS and patients.
“We are pleased that NHS England is committed to making greater use of community pharmacists’ skills and look forward to working with them to ensure that this happens. In our contributions to the NHS plan we and the other pharmacy organisations set out a range of ideas for how pharmacies could be used to help deliver on the key ambitions of the NHS – including case-finding and medication reviews – and we will continue to work together to make the case for those and to explore how they can be implemented.
“Community pharmacies ensure that millions of patients safely receive the medicines they need, when they need them. But we know that for community pharmacy to make a real contribution to this plan we will need to see transformative change in the sector, shifting our funding from a focus on the dispensing of medicines to patient care, and freeing up pharmacists’ time to offer more clinical services to patients. PSNC has been pressing for reform of community pharmacy’s reimbursement arrangements for a number of years so we are keen to begin discussions on this. Our ambition is to work with HM Government on a multi-year settlement for community pharmacy, setting out what pharmacies are working to achieve and what money will be available for doing so, and helping the sector to move towards a future in which pharmacies are fairly rewarded for providing a range of clinical services that benefit patients and the NHS.
“As well as this national work, there will be much to do at a local level to ensure that community pharmacy is involved in the development of Primary Care Networks and Integrated Care Systems. We will continue to work closely with LPCs to ensure that they have the skills and the tools that they need to lead that difficult local engagement and leadership work.”
The Long Term Plan describes 2019/20 as a transitional year, in which the local NHS and its partners will have a chance to shape local implementation of the plan. Local plans will be brought together in a detailed national implementation programme by the autumn.
The NHS and partners will also be moving to create Integrated Care Systems everywhere by April 2021, bringing together local organisations to deliver the ‘triple integration’ of primary and specialist care, physical and mental health services, and health and social care.
How PSNC fed into the plan
During the development stage, PSNC worked closely with the other national pharmacy organisations to coordinate pharmacy’s input into the plan, and, as part of that work, PSNC and the NPA submitted three briefing documents to NHS England and others. The briefings, written for specific working groups created to develop the plan, highlight how community pharmacy could help to meet the specific challenges that the NHS is trying to address.
The national pharmacy organisations also took part in a series of engagement events around the primary care workstream of the plan.
In October 2018, PSNC published its response to the online consultation on the NHS Long Term Plan, which highlighted the valuable contributions that community pharmacies can make in many key areas of healthcare. The response included a number of case studies and evidence of the success of pharmacy services, and called for further commissioning of services to enable community pharmacies to do more to help people to stay healthy and manage any minor or long term conditions.