Genomic data and expansion of the NHS App are central to the government’s 10 year plan for a Neighbourhood Health Service, published today.
Prime Minister Keir Starmer hailed a health service capable of seizing the ‘enormous opportunities’ in science and technology, in genomics, in artificial intelligence and advanced robotics at the launch of the plan at a Neighbourhood Health Centre in Stratford, East London, along with health secretary Wes Streeting, and chancellor Rachel Reeves.
‘This plan – backs technology to deliver. Because it can and will save thousands of lives. But it’s not just about saving lives. AI and technology is an opportunity to make services more human,’ he said, adding that while it ‘sounds counterintuitive’ it gives NHS staff ‘more time to care’ and ‘do the things that only human beings can do’.
Genomics
Fit for the Future – 10 year health plan for England, states that genomic testing will be used to create risk scores as part of a new genomics population health service by 2035.
‘We will implement universal newborn genomic testing and population based polygenic risk scoring alongside other emerging diagnostic tools, enabling early identification and intervention for individuals at high risk of developing common diseases,’ it states.
It will launch a new large-scale study to sequence the genomes of 150,000 adults this year – and assess how genomics can be used in routine preventive care. And a ‘globally unique’ set of studies will explore personalised prevention of obesity, applying genomic and other insights to identify people who are at the highest risk of developing obesity.
The Neighbourhood Health Service will also push towards prevention through use of technology and genomic insights according to the plan. By 2035 it will have ‘evolved to fully incorporate genomic data, digital tools and technology and a single patient record supplemented by advances in genomic data, will enable personalised predictive care’.
‘Instead of spotting a symptom and joining a long waiting list, neighbourhood care will increasingly happen before a disease happens, enabling a real and transformative shift to prevention,’ it states.
Ways the government plans to make this a reality include training genomics champions in the neighbourhood in conjunction with the NHS Genomic Medicine Service, to increase uptake of genomic testing and to adjust neighbourhood skill mixes to reflect genomic data.
Five transformative technologies
Genomics is one of five ‘big bets’ when it comes to technology in the plan. The others are data, AI, wearables and robotics. As part of this the plans include the creation of a new Health Data Research Service in partnership with the Wellcome Trust backed by up to £600 million of joint investment.
It also plans to make wearables standard in preventative, chronic and post-acute NHS treatment by 2035 and provide devices where health need and deprivation are highest.
NHS App
Patients are set to have a ‘doctor in their pocket’ in the form of the NHS App which will be expanded to allow patients to book appointments, communicate with professionals, receive advice, draft or view their care plan, and self-refer to local tests and services.
By 2028, it states the NHS App will be a ‘full front door to the entire NHS’ as a range of ‘My’ services are added to its functions.
Patients will be able to book directly into tests, where clinically appropriate, through My Specialist, and hold consultations through the app with My Consult. They will also be able to manage long term conditions through My Care and manage their children’s healthcare through My Children, or co-ordinate the care of a loved one or relative through My Carer.
New operating model
Work has already begun on the new operating model with the plan to abolish NHS England, cuts to ICBs and the axing of more than 200 NHS organisations.
The plan goes further. Commissioning support units are also to be abolished along with Integrated Care Partnerships as neighbourhood health plans will be drawn up by local government, the NHS and its partners led by Health and Wellbeing boards.
It also calls for ICBs to be coterminous with strategic authorities wherever possible by 2035.
Single neighbourhood providers
A new contract for ‘single neighbourhood providers’ will be rolled out early next year according to the plan.
It will deliver enhanced services for groups with similar needs over a single neighbourhood of around 50,000 people and GPs will be encouraged to lead these neighbourhood providers as an alternative to working in general practice, it states.
Multi neighbourhood providers
A second contract will create ‘multi neighbourhood providers’, covering 250,000 or more people, for care that requires a scaled-up approach across several different neighbourhoods in areas such as end-of-life care.
Multi neighbourhood providers are to work with GP practices and smaller neighbourhood providers in their footprint to create new commercial opportunities including clinical trials and they can also support or take over struggling GP practices.
They will cover functions already being provided in some areas by GP Federations, such as shared back-office functions, overseeing digital transformation and estate strategy, and will provide data analytics and quality improvement.
Smaller neighbourhood teams will bring staff together from primary, community and acute sectors and include other staff such as those working in hospice outreach services.
Neighbourhood Health Centres
The plan states that Neighbourhood Health Centres will be in every community starting with places with the lowest healthy life expectancy and where possible by repurposing poorly used, existing NHS and public sector estate.
Staffed by NHS, local authority and the voluntary sector, these centres will be open 12 hours a day, six days a week, and aim to remove ‘the need to go to hospital for urgent care’.
The will provide diagnostics, post-operative care, rehabilitation into the community, debt advice, employment support, smoking cessation and weight management services.
NHS Foundation Trusts
By 2035 the government aims for all NHS providers to be foundation trusts (FTs) with the ability to retain surpluses and reinvest them as well as borrow for capital investment.
‘FTs will use these freedoms and flexibilities to improve population health, not just increase activity’. The best of these will hold the whole health budget for a defined local population as an new integrated health organisations (IHOs). A small number will be designated next year with a view to becoming operational in 2027.
IHOs will align investments and savings so the cost benefits of innovation are realised and ‘never blocked’ the plan explains.
Financial incentives
The government aims to ‘reinvent the NHS’ financial model’ as it has ‘developed an addiction to deficits’ the plan states.
‘To restore financial discipline, we will end the practice of providing additional funding to cover commissioner and provider deficits. This year, the £2.2 billion in deficit support funding will not go to systems that fail to meet their agreed financial plans. Deficit support funding will be phased out from financial year 2026 to 2027,’ it states.
Instead, this year there will be a ‘transparent financial regime which holds leaders to account’ and by 2029 to 2030 most providers will be expected to deliver a surplus.
All organisations are asked to provide five year plans to help a shift to long term financial planning. And ICBs will withhold funding for poor quality care and pay bonuses for high quality care.
To support the shift of care out of hospital, year of care payments (YCP) will be developed to allocate a capitated budget for a patients’ care over a year rather than a fee for a service.
It will be calculated based on the health need of the population being served. It could cover primary care, community health services, mental health, specialist outpatient care, emergency department attendances and admissions in one consolidated single payment.
They will be an ‘important feature’ of the neighbourhood provider contracts for specified populations or services.
The plan states: ‘The YCP will provide a sharp incentive to keep patients healthy and out of hospital because local NHS organisations will benefit from reducing emergency visits and reinvesting in community services.’
From April next year, ‘intensive’ work will begin with ‘pioneer’ systems which are already advanced in designing their new care model to implement notional YCPs.
