Labour Party conference: future-fit NHS
Researcher
With the Government’s long-awaited 10-Year Health Plan published a few months ago, events at Labour Party Conference this year therefore majored on the delivery and implementation questions of the Plan.
Our flagship panel, ‘Future-fit NHS: the next ten years’, kindly supported by Community Pharmacy England, explored these questions with a particular focus on neighbourhood health.
We were delighted to be joined by a truly exceptional panel: Stephen Kinnock MP, Minister for Care; Janet Morrison OBE, Chief Executive of Community Pharmacy England; and Sarah Woolnough, Chief Executive of The King’s Fund.
My three key takeaways from the discussion were:
Fragmentation to integration
Our panellists all emphasised the importance of shifting from a health system characterised by fragmentation to one of integration, especially important for delivering an effective vision of neighbourhood health. Stephen Kinnock even dubbed ‘fragmentation to integration’ the unofficial fourth shift for the NHS, contrary to advice from his comms team!
Greater integration has long been pursued in the NHS, but remains somewhat elusive. Achieving it will require a cultural change across organisations, improved digital infrastructure, and new ways of working. Although it won’t be easy to achieve, it’s essential to improve quality of care, enhance patient experience and improve efficiency.
Funding flows are essential
Flaws in funding flows are pervasive in the current system. Janet highlighted, for example, that flu and covid vaccinations are remunerated at a higher amount if delivered in a GP surgery versus in community pharmacy. This disincentivises the efficient allocation of resources, where GP surgeries focus on treating more complex patients and community pharmacies deliver the vast majority of such vaccines; instead, the two organisations are in competition. This highlights how illogical funding flows undermine efficiency and integration.
Shifting care into the community and delivering the Government’s vision of neighbourhood health will require complementary financial flows. This means addressing unintended consequences present in the model currently. It also requires shifting political power and noise away from hospitals and secondary care.
One way this can be achieved is ensuring savings generated in primary and community care stay within those parts of the health system. Typically, these savings go back to the centre, but trials are underway in which such savings are reinvested in primary and community care. Innovations to funding flows, such as this, will be crucial for delivering a leftwards shift and achieving the neighbourhood health vision.
The importance of standardisation in quality when tailoring neighbourhood health to local populations
The panel agreed that an effective form of neighbourhood health should be tailored to the local community and delivered in a bottom-up way. Factors such as levels of socio-economic deprivation, how rural or urban an area is, and age demographics will impact an area’s type of clinical demand. There must be a balance between the importance of a place-based approach and the need for a coherent national offer.
Inconsistencies are already seen place-to-place, exemplifying this very tension. In some areas, GP surgeries are highly collaborative with other strands of primary care, referring patients to pharmacies using Pharmacy First and utilising GP Connect, which enables health and care workers in non-GP settings to view and update patients’ GP care record. In other areas, GP practices have never turned on GP Connect, preventing meaningful collaboration across primary care and limiting what community pharmacists, for example, are able to do for their patients.
The Minister clarified that the overall vision for neighbourhood health should be centrally set, including a requirement for integration, collaborative working and multidisciplinary teams as the norm. Similarly, desired outcomes should be centrally set, ensuring a national standard. Meanwhile, how these are delivered and achieved should be locally determined.