Following the publication of the NHS long-term plan at the beginning of the year, the pressure is on Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs) to deliver the government’s promises.
As part of this, NHS England and NHS Improvement released a long-term plan Implementation Framework yesterday (27 June) setting out what they think should be included in STPs and ICSs’ five-year strategic plans, covering a period from 2019/20 to 2023/24.
They have until the end of September to share their plans which will then be agreed by 15 November. They will be considered at a national level and will be aggregated and published as part of the national implementation programme for the long-term plan in December.
STP/ICS plans should be ‘clinically led, locally owned, built on a good understanding of workforce requirements’ and ensure that ‘those requirements are realistic, and have prevention and inequalities right at the heart of their planning process’, according to Matt Tagney, programme director for the NHS long-term plan, speaking at a joint board meeting on 27 June.
What should be at the heart of the ICS or STP five-year plans? Here is our pick of the five most important elements:
- Focus on primary, community care and mental health
The long-term plan sets investment guarantees for primary, community and mental health services.
Speaking at the NHSE and NHSI joint board meeting on 27 June, NHS chief financial officer Julian Kelly said that there are ‘one or two areas where absolutely we are not going to give [ICSs] the kind of flexibility [on allocations to meet their local needs].
‘Mental health is number one and even for primary and community care we have specified the amount of money that we are going to be spending by 2023/24 and we think [ICSs/STPs] will need to spend that money to deliver the workforce that is required’.
In their five-year plans, ICSs and STPs will need to show how they will:
- meet the new funding guarantees for primary medical and community health services
- support the development of their primary care networks (PCNs), helping them building relationships with their community partners
- improve ‘the responsiveness of community health crisis response services to deliver the services within two hours of referral, and reablement care within two days of referral’
- set out what services their plans will improve
- Specify how to become an ICS
The long-term plan envisages that England will be covered by ICSs by April 2021. At present, 15 areas are working as ICSs, while Surrey and Greater Manchester operate as devolved areas.
In their five-year plans, STPs and ICSs must specify how they will become a ‘mature’ ICS by 2021, according to the implementation framework.
According to the framework a ‘mature’ ICS has the following key characteristics:
- a collaborative and inclusive system leadership
- an integrated local system, with strong PCNs and integrated teams delivering the long-term plan
- a strong system financial management and planning
- a track record in meeting nationally agreed outcomes
- a defined population – systems wishing to change their geographical setting will need to notify the two NHS national bodies via their regional director by 31 July
NHSE and NHSI will release an integrated care provider contract during the summer, which they hope will ease integration of primary services and other services.
- Consider prevention at a local level
Prevention featured prominently in the long-term plan. Among other measures, the plan pledged to offer smoking cessation services to inpatients by 2023/24 and reduce obesity by increasing the number of patients taking part in the Type 2 NHS Diabetes Prevention Programme.
Local systems are being asked to work with regional and local directors of public health to ensure the national focus on prevention is reflected within their local five-year plans.
The implementation framework says that local areas will be supported to deliver preventative actions through some additional funding. This includes:
- additional funding from 2021/22 to implement smoking cessation services for inpatients
- extra funding being allocated to selected areas for 2020/21 and 2021/22 ‘to test and refine an enhanced weight management support offer’
- funding from 2020/21 to support heavy drinkers in hospitals with the highest rates of alcohol dependence-related admissions
- Think digital
Local systems will also need to specify in their plans how they will use digital tools to transform outpatient appointments.
As set out in the long-term plan, each GP practice should offer online consultations by April 2020 and video consultations by April 2021.
ICSs and STPs need to decide how they will work with CCGs and GP practices to meet NHS England’s requirements for a digital primary care, as set out in the NHS Operational Planning and Contracting Guidance 2019/20, GMS contract for 2019/20 and GMS contract framework.
- Take on workforce responsibilities
As part of the recently published NHS people plan, ICSs are expected to take on greater responsibility for their local workforce.
The implementation framework asks local systems to specify in their plans how they will make the NHS the best place to work, including setting new targets for BME representation across their system by 2021/22.
ICSs and STPs will also to explain what cultural values and behaviours leaders in their systems should hold and how their workforce should grow according to each different group.
