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©British Medical Association BMA presentation The five year forward view March, 2015
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©British Medical Association
BMA presentation
The five year forward view
March, 2015
©British Medical Association2
Presentation overview• Background and implementation
• 5YFV overview
• New models of care
March, 2015
©British Medical Association3
Background• ‘Five Year Forward View’ (5YFV) published
October 2014 Vision for future of NHS in England by NHS NHS England; Care Quality Commission; Health
Education England; Monitor; Public Health England; Trust Development Authority
• ‘The Forward View into action: Planning for 2015/16’ published December 2014
First jointly produced annual planning guidance
March, 2015
©British Medical Association4
Implementation• Conservative party manifesto gave full support • Jeremy Hunt ‘biggest priority now is to
transform care outside hospitals’
• No formal implementation plan
• New groups/boards
• Forward view coalition group; Prevention board; New models of care board; Workforce advisory board; Primary care workforce commission
March, 2015
©British Medical Association5
Rationale for change• Close widening gaps in health of population,
quality of care and funding
• Rise to demographic and epidemiological challenges
• Coordinate care around people’s needs and wants
• NHS spending growth of past unlikely to be a feature of future
March, 2015
©British Medical Association6
Prevention• New approaches to improving health and
wellbeing
• Hard-hitting national action on tobacco, alcohol, junk food, excess sugar
• Enhanced powers for mayors and LAs on decisions relating to public health policy
• National diabetes prevention programme
March, 2015
©British Medical Association7
Empower patients & engage
communities• Support people to manage their own health (education)
• Integrated personal commissioning
• New/better ways to support carers
• Short alternative to standard NHS contract for charitable and voluntary organisations
March, 2015
©British Medical Association8
Strengthening primary care• Stabilise core funding nationally over next 2
years
• Give CCGs more influence over wider budget (i.e. co-commissioning with NHS England)
• Expand workforce: GPs in training, community nurses, other primary care staff
• Incentivisation for under-doctored areas to tackle health inequalities
March, 2015
©British Medical Association9
Information revolution• National Information Board (NIB) established
NHS, public health, clinical science, social care, local government and patient representatives
• Transform digital care Comprehensive transparency of data Fully interoperable electronic health records Online GP appointments and prescriptions Bring together hospital, GP, administrative and audit
data
March, 2015
©British Medical Association10
Efficiency and productive investment• Predicted gap of £30 billion per year by
2020/21 Growing demand, no further efficiencies, flat
funding
• Historic NHS efficiencies of 0.8% per year inadequate
• Close £30 billion gap by 2020/21 by– Target of 2-3% efficiencies per year – how?– Investment for new care models – from where?– Some funding growth – the £8bn figure!March, 2015
©British Medical Association11
New models of care• Break down divides between different parts of
health service, as well as between NHS and social care
• No one size fits all - nor should a thousand flowers bloom1. Multispecialty community providers (MCPs)
2. Primary and acute care systems (PACS)
3. Urgent and emergency care networks
4. Viable smaller hospitals/acute care collaboration
5. Specialised care
6. Modern maternity services
7. Enhanced health in care homesMarch, 2015
©British Medical Association12
Multispecialty community provider • Groupings of GP practices offering a wide
range of care• Take on as partners, or employ, wide range
of doctors, other clinical staff and social/care professionals
• Shift outpatient and ambulatory care out of hospital
• Develop new clinical roles ‘generalists/hospitalists’
• Potential for delegated, capitated budget for registered list of patients, including social care
• Eventually an integrated provider of out-of-hospital care
March, 2015
©British Medical Association13
Primary and acute care system • Single organisation providing NHS list-based GP
and hospital services, with mental health and community services Hospitals permitted to open GP surgeries with
registered lists (in some circumstances) OR
MCPs to run their main district hospital
• Reinforce out-of-hospital care – not a ‘feeder’ for hospitals
• Redefine workforce roles e.g. blend gen. physician with GP
• Potential for delegated, capitated budget for registered list of patients, including social care
• Likened to Accountable care organisations (ACOs)
March, 2015
©British Medical Association14
Vanguard• New models of care pilot programme – ‘the
vanguard’
• First wave of 29 sites announced in March 9 PACS; 14 MCPs; 6 Enhanced health in care homes
• Investment and support began in April
• Movement from ‘aspirant’ to ‘actual’ not guaranteed
• ‘Unofficial vanguard running in parallel at the same pace’
• Benefits and costs known by end of next Parliament
March, 2015
©British Medical Association15
Acute care collaboration• New vanguard announced in May - applications by
end July
• Extends/replaces ‘viable smaller hospitals’ model Incorporates some thinking from Dalton review
• Explore/create new options for FTs/NHS trusts• Accountable clinical networks• Specialty franchises• Management groups• Chains of multiple organisations
March, 2015
©British Medical Association16
Urgent & emergency care networks• New vanguard announced 3 June 2015
Picks up Urgent & Emergency Care Review (Nov 2013)
• Overhaul of NHS 111, GP out of hours services, minor injuries / urgent care centres, ambulance services, A&E
Pilot sites to cover 2 million patients - roll-out in 2-3 years
‘Collaborative exercise’ between hospitals, CCGs, social care services and primary care
• Review of performance indicators and payment systems
March, 2015
©British Medical Association17
Regulatory & financial backdrop• Competition and procurement
Monitor’s duty to prevent anti-competitive behaviour
• Payment systems National tariff/payment by results and perverse incentives
• Contracting/governance NHS standard contract rigid
Prime contractor; prime provider; alliance contracting
• Financial crisis in NHS
March, 2015
