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NHS chief hints at imminent major reorganisation to GP-led commissioning

There could be major upcoming changes to GP-led commissioning in parts of England in a matter of weeks, when NHS ‘transformation’ areas will receive ‘governance rights’.

Questioned today by the Public Accounts Committee (PAC), NHS England chief executive Simon Stevens announced that sustainability and transformation plan (STP) footprints would be put in charge in regional areas, and be able to ‘marshall’ CCGs and NHS England regional teams.

He said NHS England would be setting out ‘a lot of the details’ in about four weeks’ time, but as a preview he could also tell the PAC that between six and ten STP areas would be launching as so-called accountable care organisations (ACOs).

Accountable care organisations are a concept tried in the USA, and leading health think-tank the King’s Fund has described them as an organisation that ‘brings together a number of providers to take responsibility for the cost and quality of care for a defined population within an agreed budget’.

Mr Stevens said: ’[In] the 44 STPs, we’re going to formally appoint leads to those STPs. We’re going to give them a range of governance rights over the organsiations within their geographical areas, including the ability to marshall the forces of the CCGs, the local NHS England staff.

’We are going to, for probably between six and ten of them, get them going as accountable care organisations or systems.

’Which, for the first time since 1990, will effectively end the purchaser provider split bringing about integrated funding and deliver for a given geographical population.

‘So this is pretty big stuff, and people are pretty enthusiastic about it.’

The statement indicates a new reorganisation of how NHS services are commissioned, just a few years since the Health and Social Care Act came into force in 2013.

Deputy GPC chair Dr Richard Vautrey said: ‘It really is about time that NHS England and the Government admitted that the massive reorganisation caused by the NHS Health and Social Care Act has been a scandalous waste of time and money as they are clearly in the process of recreating SHAs and PCTs.

‘CCGs across the country are merging back to the equivalent size of their previous PCT, STPs are taking on management roles and in many cases GP influence in decision making is also reducing. As this latest reorganisation takes place it’s important to secure the recurrent management resource currently in CCGs to use it to support developing GP provider groups.’

But Dr Dean Eggitt, Doncaster LMC medical secretary, suggested that NHS England and the Department of Health had failed to be transparant about what they were planning and said that the move would ‘seriously harm any relationship that NHS England think they may have with the GP community’.

He said: ‘I believe this is a move toward an American style healthcare system that has a track record in an insurance-based economy but is untried and untested in a state-funded system such as we have in the UK. I believe this to be reckless gambling with lives.

‘To make yet another costly change to the NHS when we are struggling to deliver care in a debt riddled NHS is, quite frankly, stupid.’

What are STPs?

At the end of 2015, NHS England tasked regional teams, CCGs, trusts and local authorities with forming regional footprints, and then write plans for how the NHS Five Year Forward View would be delivered within them.

The Forward View, published in 2014, set out plans to achieve savings worth £22bn from the NHS budget between 2015-2020, in part by investing ‘a much higher proportion’ of its budget on GP services.

Some 44 footprints were formed, and the Sustainability and Transformation Plan (STP) were prepared and submitted to NHS England during 2016.

As previously reported by Pulse, each plan had to adress ‘sustainability and quality’ of general practice, including both ’workforce and workload issues’.