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What do the Five Year Forward View's 'next steps' mean for general practice?

NHS England's Next Steps on the Five Year Forward View sets out its vision for the NHS over the next two years, including changes for general practice.

On Friday, NHS England unveiled its latest package of measures to implement its Five Year Forward View over the next two years, which has major implications for general practice in England.

So what are the key plans that will affect GPs and their practices?

Access

  • During 2017/18 practice profiles will be published that will include patient survey results and details about how easy it is to make an appointment.
  • By March 2018, NHS England is aiming for 50% of the country to have access to GP appointments in the evenings and at weekends, which will extend to 100% of the country by March 2019. This does not mean every practice needs to provide the appointment, but practices will have to arrange this across a network or federation so that every patient can book an appointment at these times if they wish.

Multidisciplinary team

  • NHS England wants to increase the number of clinical pharmacists working in GP practices from 491 at present to over 900 by March 2017 and over 1,300 by March 2019.
  • 800 mental health therapists will be placed in primary care by March 2018 rising to over 1,500 by March 2019. These therapists will help integrate physical and mental healthcare.
  • Health Education England is aiming to train 3,000 physician associates by 2020, 1,000 of these will be 'incentivised to work in general practice'.

Working at scale

  • Practices will be offered financial incentives to join local hubs serving up to 50,000 patients.
  • NHS England says it wants every practice in England to be part of a 'place-based local care network' of around four or five practices, that will bring together communities of GPs, physicians, nurses, pharmacists, therapists and social care workers to deliver a single health and care system for neighbourhoods of typically 30,000-50,000.
  • The document says this model ‘does not require practice mergers or closures and does not necessarily depend on physical co-location of services’.
  • Funding incentives, including for extra staff and premises development, will support this process.

GP contract

  • The QOF will be replaced. NHS England says it wants to develop and agree ‘a successor to QOF, which would allow the reinvestment of £700m a year into improved patient access, professionally-led quality improvement, greater population health management and patients’ supported self-management, to reduce avoidable demand in secondary care.’

STPs and local integration

  • NHS England says its aim is ‘to use the next several years to make the biggest national move to integrated care of any major western country.’ This will be via sustainability and transformation plans (STPs).
  • To succeed, all STPs need a basic governance and implementation ‘support chassis’, NHS England says, so from April all NHS organisations will form part of a Sustainability and Transformation Partnership.
  • This partnership will form an STP board drawn from its constituent organisations, which will include participation from GPs and local government where appropriate. The board will establish ‘appropriate decision-making mechanisms where needed for strategic decisions between NHS organisations'.
  • As STPs move from proposals to more concrete plans, NHS England expects them to involve local people in what these plans are and how they will be implemented
  • Accountable care systems will be an ‘evolved’ version of an STP that is working as a locally integrated health system, the document says. In these systems NHS commissioners and providers, often in partnership with local authorities, take on collective responsibility for resources and population health. This will effectively end the purchaser/provider split. The document explains how these systems could work, what their responsibilities will be and what NHS England will do in these areas. These may eventually develop into full accountable care organisations, with a single provider contract.

Public health

  • The Diabetes Prevention Programme will be expanded. In 2017/18 there will be an estimated 130,000 referrals and around 50,000 people on programmes. In 2018/19 this could rise to as many as 200,000 referrals and more than 80,000 people on programmes.
  • By 2018/19, Public Health England will lead work with local authorities to reach over 2.8m more people with an NHS Health Check.
  • There will be further work to promote healthy communities, help people with long-term conditions manage their own health and an extension of the Integrated Personal Commissioning model will reach over 300,000 people by the end of 2018/19. The number of disabled people or patients with complex health needs who have access to personal health budgets will expands from over 20,000 individuals in 2017/18 to over 40,000 people in 2018/19.
  • NHS England also wants to ‘design a common approach to self-care and social prescribing, including how to make it systematic and equitable.’
  • There are plans to develop quality markers for 'carer-friendly' GP practices that promote carer identification, health checks, flu jabs and referral/signposting to advice and support.

Urgent care

  • NHS England plans to develop 150 new urgent treatment centres by spring 2018. These will open 12 hours a day, seven days a week and be integrated with local urgent care services. They will offer appointments that are bookable through 111 as well as GP referral.

IT

  • NHS England will launch the NHS Digital Apps Library in spring 2017, initially with around 20 apps. There will be three tiers of apps, NHS-approved apps (which will have a published evidence-base), NHS-connected apps (which will allow people to download information from NHS systems into the app) and health apps (a directory of other apps).
  • From April 2017 parents in London will have access to their child's 'red book' online.
  • By summer 2017 GPs will be able to electronically seek andvice and guidance from a hospital specialist without a patient needing an appointment.
  • In summer 2017 an updated online patient appointment system will be launched to enable patients to book their first outpatient appointment online.
  • By October 2018 all referrals will be made via the NHS e-Referral Service.
  • By December 2017 every A&E, urgent treatment centre and ePresscribing pharmacy will have access to extended patient data either through the summary care record or local care record sharing services. 40% of A&Es and urgent treatment centres will also have access to primary care records, mental health crisis recods and end-of-life plan information by this time.

Reaction to the plans

RCGP chair Professor Helen Stokes-Lampard said the Next Steps document provided ‘a lot of promise and potential that, if delivered, will be good news for general practice.’

‘All in all the college is encouraged by this plan announced today – particularly the news that our profession is on track to receive the extra funding expected this year,’ Professor Stokes-Lampard said. ‘We will continue to work with NHS England and others to ensure the GP Forward View is delivered in a way that benefits hardworking GPs and our teams at the frontline, as well as our patients.

’As a profession we need to explore and adopt different ways of working – but we must never lose the essence of general practice and the excellent care that GPs strive to provide to our patients.’

You can download the full report here.

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