Long Term Ambition in the NHS Long Term Plan

In January 2019, NHS England published the NHS Long Term Plan, promising to right the past wrongs of structural change, and place more emphasis on joined up, preventive care. With more services being provided in the community, closer to patients’ homes. I’ll be writing a few blogs through the year, mapping the plan against some personal insight and some of the patient insight we collect at Aurora.

The plan was roundly welcomed – with pundits calling it ambitious and a game-changer. That was before reality came back into play, when the National Audit Office (to quote the BBC) threw “cold water over the project” because, it claims, the plans are not affordable. Addressing the current challenges of our elderly population, disjointed service provision, and access to innovation, the NHS Long Term Plan admits it is a challenge.

Looking at the broad aims, the NHS Long Term Plan builds on the NHS Five Year Forward View and in particular the Integrated Care Systems already in place. Aiming to deliver a fully integrated, multidisciplinary community-based health system, offering more coordinated care pathways, with funding for primary care being ring-fenced for the first time. The NHS Long Term Plan targets specific disease areas that are the major causes of mortality and morbidity, setting out objectives for better coordination of care, simplifying the process for patients, collaboration between networks of GPs, and between hospital and community-based teams. Improved technology will have to be prioritised for this to succeed.

There is a strong focus on proactive population and preventive health, building on the Government’s paper published late last year. The NHS Long Term Plan looks further at ways to predict and test for likely disease or disease progression. To support this, there are plans to recruit more staff – especially and interestingly – with more roles traditionally associated with hospital, to be based in as part of a community team, supporting GPs, and linking patient care from secondary to primary care.

As the King’s Fund comments in its summary of the report, the plan is an evolution of where we currently are, with emphasis on improvement through continuity, rather than broad brush change.

The NHS Long Term Plan builds on the work other organisations have done, e.g. Primary Care Respiratory Society (PCRS) leading and sharing innovative care models for respiratory disease. As Neil mentioned in his blog last week, replicating best practice is a sure-fire way to enhance services, based on working models with successful outcomes. The PCRS recommends sharing best practice and a collaborative approach to ensure successful approaches to care are replicated easily.

The collaborative approach is seen in spades when we look at the recruitment drive and location of these roles. Physician assistants, pharmacists, physiotherapists and link workers all working in the community and linking up secondary care treatment to primary care maintenance, monitoring and self-management. A stated ambition of the NHS Long Term Plan is to bring together different professionals to coordinate care better, building on vanguard sites already in operation. This is admirable, but in practice is has its own issues. We know from our experience, to collaborate successfully, it’s essential to have a shared vision and purpose and compromise is required among involved parties. I’ll touch more on this in another blog when I look at the patient view of the NHS Long Term Plan.

To learn more Aurora collaboration download our report here

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