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Reaction: NHS England five-year plan

GP and NHS leaders on NHS England’s plans for a five-year out-of-hospital services overhaul.

Dr Richard Vautrey, deputy chair, GPC

Much of what is in the report has been stated many times before and whilst there is a lot of talk about investing in general practice, the time for talking is over, it’s now time to act and urgently invest in core general practice. 

The bottom line is that there is only 3/4 of the historical investment left in general practice and working at scale won’t help solve this problem. We need to get back to 11% of NHS funding spent on general practice to have any chance of addressing the current crisis.

We’re already supporting groups of practices who are working together in bigger groups but there is no one perfect model for this and one size does not fit all.

We have grave concerns about hospitals taking over practices. This may be necessary in exceptional circumstances such as some remote and rural area where it is not viable to sustain practices in any other way, but we know from experience that hospitals are good at sucking resources out of community services, not investing in them.

Dr Gavin Ralston, chair, NHS Birmingham CrossCity CCG

In our area we have started these changes, to an extent, already, via a couple of schemes which we are actively supporting via both management and with resources. To give you an idea of how much we have put into that, since September 2013 we have invested an additional £9 million. By March 2017 I think the accumulated investment, if our financial gurus are correct, will be in the region of about £27 million.

So that is an annual investment of around £9 million or £12.7 per patient so that is quite substantial. And we are also investing quite a large amount of money in management resources in encouraging and supporting practices to work in federations, merged partnerships or provider groups that are going to be necessary in order to deliver these services.

The resources have come from the CCG and we can afford it for a few years out of our current resources, but it is not going to be sustainable unless actually the scheme works and we see a smaller number of patients going to outpatients of hospital and A&E. If we ultimately actually improve care in general practice and the community and reduce emergency admissions. It is a shared risk between the CCG and practices.

But I think we are lucky to be able to do this currently because we are one of the largest CCGs in the country and probably some smaller organisations wouldn’t be able to have these resources at the moment and would need pump-priming centrally. There are CCGs in a less financially sound position.’

It is a refreshingly candid paper in some ways, but one area I’ve got slight anxiety about is that while they say quite clearly that we need adequate resources for general practice and that premises have got to be improved - something which has not been going on for quite a long time - they then talk about stabilisation whereas I think we are not in a stable situation at the moment and just stabilisation for two years is probably not what is required.

We probably need a substantial increase in resources now.

Dr Steve Kell, co-chair of NHS Clinical Commissioners and chair of NHS Bassetlaw CCG

The recognition that CCGs are now ‘harnessing clinical insight and energy to drive change in their local health systems in a way that has not been achievable before now’ is a statement we would echo.

Our publications ‘Taking the Lead’ and the upcoming ‘Leading Local Partnerships’ both showcase examples of where NHSCC members are driving change and innovative integrated care for the benefits of their patients and local populations.

We are pleased to see more support to ensure the stability and security of primary care. Giving CCGs more influence over the wider NHS budget is something that we have been calling for in our CCG Manifesto for Change, so that it has been taken up by NHS England is very welcome.

Giving CCGs that influence will mean they have the ability to invest in the new models of care for primary care and community services that are so crucial if we are to deliver the care needed for our patients out of hospital. CCG plans mean little without strong general practice, but we would want to see further alignment of these priorities in public health and specialised commissioning.’

Dr Amanda Doyle, co-chair of NHS Clinical Commissioners and chief clinical officer of NHS Blackpool CCG

The commitment to dissolve traditional boundaries and look towards new models of care that emphasise out of hospital care and integration, aligns with the direction of travel that CCGs are already taking as they move towards outcomes based commissioning that puts the patient at the heart.

This needs to be done by us all as a system, jointly and in true partnership. Aligned national leadership that supports and enables local decision making is what is needed, but that national alignment must not translate into extra oversight and performance management.

We welcome the idea of a new risk based CCG assurance regime, but we need to proceed with caution when thinking about bringing together the Monitor, TDA and NHS England local assessment and reporting models to make sure that does not impose further reporting and bureaucracy requirements on CCGs that will distract them from doing their job.

We will be working closely with NHS England as they develop their ‘special measures support regime’ for struggling CCGs, as the key to that will be how they will be judged and more importantly how they will be supported to improve.

Key to the Five Year Plan is the commitment to no more distracting structural or top down reorganisation of the NHS. A sustainable NHS for the future can only be realised if we all have a stable environment in which to work together, with the freedoms and flexibilities to allow CCGs to work both within the health sector and with other sectors to make clinically led decisions in the best interests of their patients and local populations.

Clinical commissioning is maturing and developing into a system that is focused on patient wellbeing as well as illness, and we look forward to working through the details of how our members can bring the NHS England vision to life for their patients and local communities.

Nigel Edwards, chief executive of Nuffield Trust

This important report makes crystal clear that the NHS cannot continue with ‘business as usual’ if it is to meet the needs of a diverse and ageing population. It sends a firm signal to MPs of the dangers of any future NHS reorganisation and offers a starting point for politicians considering how to reform the NHS in the future.

The Forward View sets out a radical vision of the different approaches that local areas can take to adapt for the future - from hospitals running GP surgeries, to groups of medical professionals, therapists and social workers buying health services for patients in their area.

Unlike previous centrally imposed blueprints for the NHS, Simon Stevens expects this transition to be driven by local clinicians and managers working closely with patients.

‘The report also acknowledges the scale of the financial challenge ahead. It recognises that there are big opportunities to improve the efficiency of the NHS but that there is a limit to how far these alone can fill the gap. The concept of ‘flat-real per person’ funding is an important one as it reveals the true costs of caring for an ageing population. It would show politicians how much more they’d need to increase health spending above inflation to maintain high-quality services.

Chris Ham, chief executive of The King’s Fund

Today’s announcement is a significant moment for the NHS - it should set the agenda for the next parliament in the same way that the commitment to find £20 billion in efficiency savings has set the tone for the last five years. It throws down the gauntlet to the political parties to back fundamental changes to health services that could significantly improve care for patients.

The report makes a compelling case for change and articulates a clear vision of the future, with services organised around the needs of patients rather than outdated professional boundaries. The focus on prevention is particularly welcome - for too long the NHS has remained a service that diagnoses and treats sickness, rather than one that predicts and prevents it.

The emphasis on developing new models of care by scaling up primary care and developing community-based services will also be widely welcomed, although more detail is needed on how this will be taken forward.

But attention will rightly focus on the funding options. While it is right to emphasise a three-pronged approach which focuses on managing demand and improving productivity as well as the need for additional funding, there is no escaping the size of the financial challenge facing the NHS.

Even if the very challenging estimates for productivity improvements outlined here can be achieved, an additional £8 billion a year in funding would be needed by 2020.

With the national leaders of the NHS speaking with one voice on this issue, politicians now need to explain whether and how they will find this money. With deficit reduction still a high priority, this will not be easy, but today’s report is a reminder of how important it is to ensure the NHS is adequately funded in the next Parliament.

David Bennett, chief executive of Monitor

If the NHS is to provide the best service it can to the public, and live within its means, it has got to change the way it delivers care to people. The Forward View sets out our vision of an NHS which can deliver better care and a better experience for patients, and is able to do more of this for however much money we can give it, and is therefore sustainable.

The NHS will do its best to achieve this, but we do need to ensure that funding reflects our growing population, and to invest in making this change happen in order to get all the productivity improvements we could achieve.

David Flory, chief Executive of the NHS Trust Development Authority

The NHS has shown real and significant improvement over the last 10 years but to ensure those improvements can be sustained and built upon we need to address the challenges of the future. The Forward View gives us a strong platform to begin the conversation about how we meet those challenges.

Duncan Selbie, chief executive of Public Health England

We are fully aligned with the actions set out here and agree that all this is possible with determined leadership from all of us.

Ian Cumming, chief executive of Health Education England

We simply cannot respond in the same old ways if we are to respond to the challenges of the new. That is why we have worked with other partner organisations to take a five year forward view and agree the actions we need to take together to secure the necessary improvements.

At HEE we will ensure we have enough staff with the right skills and behaviours to deliver the future set out in the Five Year Forward View.

David Behan, chief executive of CQC

Our inspections are continuing to tell us that there is too much variation in the quality and safety of health and social care. This is why we support the Five Year Forward View for the NHS, which sets out how the service needs to evolve, so that the needs of patients can be met and so that we can close the care gap.

As the regulator of health and social care, our role is to use our inspections and what people tell us, to identify what is working well and why, and what does not work. We want this to drive improvement, with providers learning from the services that we rate as good and outstanding.

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