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Leading questions: Andi Orlowski

Andi Orlowski, director of the Health Economic Unit at Midlands and Lancashire Commissioning Support Unit and senior adviser to NHS England on population health management, shares his insights

What’s the current status of population health management (PHM) in England?
I started working on PHM at NHS England as part of the New Care Models programme more than five years ago and over the last three years it has become a critical building block for ICSs. PHM is a technique for local health and care partnerships, including PCNs, to design new models of proactive care, delivering improvements in health and wellbeing and making best use of collective resources. The challenge for PHM is using data to identify which interventions are most likely to succeed for an individual based on their wider circumstances and how interventions can be delivered in a way that is most likely to achieve a positive outcome. PCNs and organisations that really understand their populations are best placed to help tailor care to the best effect.

We know that getting lots of organisations to work together – some with differing priorities, goals and ways of measuring success – is a real challenge. But we also know that better partnership working using PHM and giving the right person the right care considerably improves outcomes, uses resources more effectively and reduces duplication.

What impact does it have on patients? 
PHM is affecting patients right now. I have seen bespoke approaches to delivering flu and Covid vaccines for different populations in an ICS, and diabetes care being tailored to address variations in outcomes.  

Who is responsible for PHM?
The responsibility lies with all of us. PCNs are critical, not only in the delivery of care but also in providing a deep understanding of local populations. PCNs can shape the care provided by local authorities, NHS providers, public health and beyond. If we are to address ‘health’ and not just healthcare, a wider understanding of what the population needs can only come from a local level. My advice for PCNs is not to wait for the ICS to come knocking but to actively engage with them now. This is the time to act and represent your population.

How will PHM change and shape the way primary care is done?
PHM ensures the right care is given at the right time by the right person. It allows primary care a greater opportunity to partner with other organisations to help address the health of the population. Also, PCNs and general practices may change the way they deliver their care, being liberated and resourced to design and deliver it according to the needs of their population. 

What impact will it have on PCNs, and on the way GP practice staff work with patients?
PHM, if done well, should have a profoundly positive effect on patients and primary care staff. Health and care professionals will be empowered to take a more proactive and tailored approach to supporting their population to live healthier lives. This is a key way to address health inequalities.

What is expected of PCNs in terms of PHM?
PCNs should be helping to direct care and support, ensuring the correct interventions are used and addressing unwarranted or harmful variation. PCNs are the engine room of PHM. Their insight and focus on populations will make all the difference.

What support and funding will they get to reach these aims?
There are numerous routes to funding for PCNs and for ICSs to develop as a system. The FutureNHS website has details and ICSs will know more. Organisations such as the Health Economics Unit, the Strategy Unit and the Midlands Decision Support Network all provide support and guidance on PHM. 

Is there a timescale for PHM goals and outcomes?
This is a key question. If we want to address the wider determinants of health, we have to be prepared to wait a little longer for our return on investment. Paying out on ‘lag’ markers like outcomes may not be conducive to reallocating resources. We could instead pay out on ‘lead’ markers for success, for example:

  • Individuals being prescribed and adhering to certain drug regimens.
  • People attending and completing education courses.
  • More exercise at schools.
  • More efficient boilers being fitted, helping people to heat their homes more cheaply.

Are PCNs important for PHM and do you think that is recognised at a system level?
PCNs are critical to successful PHM. Any ICS that does not engage with its PCNs will struggle to have a real understanding of its populations and will miss the key element of tailoring care – after all, how can anyone really understand all the differences in a population of 2-3 million patients? This is not a time to be passive. PCNs must make sure they are heard. If you are in a PCN, do you know who at the ICS you should be contacting? If not, find out.

How important is PHM for the future of the NHS?
It’s been 50 years since GP Dr Julian Tudor Hart showed the inequalities in our healthcare system with the ‘inverse care law’. Then 11 years ago, Professor Sir Michael Marmot of the Institute of Health Equity showed that inequalities had increased. Now, Covid-19 has demonstrated that those who most need support haven’t received it. PHM allows us to address the wider determinants of health and inequalities. PHM is here to stay. I hope you join me in rallying to support it. 

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Dave Haddock 3 February, 2022 2:27 pm

A more sophisticated variant of the top-down “we know what’s best for you” centralised planning that guarantees the NHS will continue to fail.