STPs and accountable care

Supporting providers: STPs and accountable care | NHS Providers

NHS Providers are working to develop a programme of support that helps provider organisations adapt to the challenges and opportunities presented by the move to accountable care.

The programme, Supporting Providers: STPs and accountable care, will be developed in close collaboration with NHS trusts over the next six weeks. The programme aims to ensure there is the right support and a strong advocate making the case for NHS trusts as they move to accountable care structures that deliver more integrated care for the public.

Elements to support trusts will include:

  • Developing new and effective relationships with local authorities, primary care and commissioners
  • Responding to specific challenges such as moving care closer to home, prioritising mental health, workforce strategy and getting the most out of the NHS estate
  • Exploring new ways to support change, identifying “enablers” including new approaches to contracting, different financial flows, adopting risk stratification and whole population health management approaches, and developing STP level governance arrangements.

More detail at NHS Providers

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Nine in 10 GPs rated good or outstanding following CQC inspection

Care Quality Commission (CQC) report finds that at the end of its first inspection programme of general practices 4% were rated ‘outstanding’, 86% were ‘good’, 8% were ‘requires improvement’ and 2% were ‘inadequate’.

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Image source: http://www.cqc.org.uk

The state of care in general practice 2014 to 2017 presents findings from CQCs  programme of inspections of GP practices. This detailed analysis of the quality and safety of general medical practice in England has found that nearly 90% of general practices in England have been rated as ‘good’, making this the highest performing sector CQC regulates.

Full document: The state of care in general practice 2014 to 2017

Choice in end of life care

How the National End of Life Care Programme Board is delivering personalisation and choice in care for people at or near the end of life. | Department of Health

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This report sets out the progress the National End of Life Care Programme Board has made in implementing the government’s choice commitment.

The measures include:

  • supporting the roll-out of digital palliative and end of life care records to all areas by 2020
  • inspecting and rating NHS hospital and community services for end of life care
  • providing support to trusts to help them improve end of life care services
  • testing personal health budgets for people approaching the end of life to give them choice and control over their care
  • developing metrics to assess quality and experience in end of life care
  • working to change the nursing and medical undergraduate and postgraduate curricula to improve patient choice and quality of care

Full report: One Year On: The Government Response to the Review of Choice in End of Life Care

Large scale general practice

Rosen, R. Kumpunen, S. Curry, N. Davies, A. Pettigrew, L. Kossarova, L. (2017) Summary booklets on lessons for large-scale general practice. | Nuffield Trust

In July 2016, the Nuffield Trust published Is bigger better? Lessons for large-scale general practice  which examined the factors affecting the evolution of general practice and its impact on quality, staff and patient experience.

The Nuffield Trust has now released four booklets which sit alongside this main report covering:

 

Electronic NHS referrals

Two hospital trusts and their referring GP practices have become the first in the country to adopt a digital process for booking patient hospital appointments

Sherwood Forest Hospitals NHS Foundation Trust and County Durham & Darlington NHS Foundation Trust are now processing all of their hospital referral appointments electronically via the NHS e-Referral Service. Patients are also able to change or cancel their appointments through the system with analysis showing that use of electronic referrals has halved the rate of patients missing appointments from 10% to 5%.

The future of the mental health workforce

 The future of the mental health workforce | Centre for Mental Health

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Image source: http://www.centreformentalhealth.org.uk

This report is based on insights from service users, carers and professionals and outlines a list of recommendations for a sustainable mental health workforce.

It emphasises the importance of prevention, including the role of GPs in supporting people before they reach crisis point. It describes commissioning of mental health services as in “crisis” with a “shrinking workforce, growing expectations and exhausting demands” putting pressure on staff across the country.

The report makes 22 recommendations for policy, practice, education and training, highlighting 4 key calls to action:

  1. For mental health careers to be promoted in schools and colleges: to build on growing awareness and understanding about mental health to encourage young people to aspire to work in the sector when they’re considering their career choices
  2. For all mental health service providers to support the mental health and wellbeing of their staff: to become ‘compassionate organisations’ that care for the people who work in them
  3. For mental health workers to get training in the skills they will need in the future, including in coproduction, community engagement and psychological interventions
  4. For people to be able to build their careers more flexibly, working in a range of different settings and sectors, and taking on new roles as they get older

Download the full report: The future of the mental health workforce

Getting into shape: Delivering a workforce for integrated care

This paper focuses on the structural barriers to delivering integrated care. It studies issues such as the medical labour market, devolved workforce planning and pay, and professional boundaries | Reform

reform
Image source: Reform

The Government is rightly committed to a radical reshaping of NHS delivery, based on a shift to new care models and treatment in the community. Its management of the NHS workforce, however, has not delivered with nearly three times more doctors, and four times more nurses in the acute sector than in the community. Since 2009, the number of consultants has risen by nearly a third, whilst the number of GPs has fallen.
Freedom of Information requests made for this report found that, across 61 acute trusts, only 6 per cent of consultants work in the community for at least one session per week.

As the Government and the NHS leadership have repeatedly said, the priority for the NHS is to increase its speed of innovation. To do this, the NHS is rightly seeking to devolve decision-making and to deregulate. For the workforce, however, policy remains highly centralised and tightly regulated. This paper shows how to bring the same reform ideas to the workforce as the NHS is applying to other areas.