NHS England is in the process of implementing the Sustainability and Transformation Plans (STP), which draws together Clinical Commissioning Groups, local authorities and providers to show “how local services will evolve and become sustainable over the next five years”. In each geographical area there is a STP board who are considering the nine “must do’s” which range from meeting access targets for A&E and ambulance waiting times, ensuring that referral to treatment targets are met, plus other treatment targets such as waiting time for patients with suspected cancer and mental health access targets. Included within the list is a “must do” to address the sustainability and quality of general practice but probably the biggest challenge is to move the whole NHS into financial balance on a backdrop that most provider trusts are in significant financial deficit.
Emerging information from STP boards is that plans are heavily swayed by the need to meet financial balance and to meet specific targets such as A & E access times. There is also concern that many STP leaders have conflicts of interest as chief executives of large provider trusts or local government organisations.
A recent joint LMC/RCGP workshop in the West Midlands looked at what engagement there had been with general practice. It was disappointing to find that many STP boards had limited or no input from general practice but probably the biggest concern that emerging plans did not take a whole system approach and in particular consider whether general practice and the wider community services has the current capacity to manage a larger patient volume as hospital services change. A separate question was about whether some of the patients would be better predominantly treated in a secondary or primary care setting. One delegate succinctly described matters as “plans are being made about us, but without us”.
The view from the West Midlands workshop was very clear that unless there is a clear plan to increase capacity in the community services as hospitals change, then patient harm will occur. These plans need to be greater than “working at scale and integrate” as whilst economies of scale will help, they will not address sufficiently the overall capacity of general practice and the community services to manage more patients who are currently seen in a secondary care setting. There was also a significant concern that increasing the workload within general practice was likely to make current concerns about the retention and recruitment of primary care staff worse.
What is therefore key as STP boards make their plans is that they need to consider a whole system approach and incorporate the voice of general practice at a strategic level. This voice needs to understand and articulate the views of general practice and the wider community services with the requirement that system changes are only made once it is clear that these services can appropriately manage the greater number of patients in a community setting.