Intended for healthcare professionals


NHS long term plan: Care to be shifted away from hospitals in “21st century” service model

BMJ 2019; 364 doi: (Published 07 January 2019) Cite this as: BMJ 2019;364:l85
  1. Gareth Iacobucci
  1. The BMJ

The NHS in England will shift its emphasis from acute care hospitals towards a “new service model for the 21st century” based on community care, population health, and collaboration, service leaders have vowed.

The pledge is a key part of the much anticipated NHS long term plan, published on 7 January,1 which sets out how the NHS will use the extra £20.5bn (€23bn; $26bn) a year by 2023-24 it will receive from the government to drive improvements in the service over the next decade.

The plan commits the NHS to increasing investment in primary and community health services as a share of total NHS spend over the next five years. This means that spending on primary and community services will rise by at least £4.5bn by 2023-24.

NHS England said that this money would fund expanded community multidisciplinary teams aligned with new primary care networks to be based on neighbouring general practices working together, typically covering 30 000 to 50 000 people. The result would be the end the historical divide between primary and community health services, the plan said.

To support the changes, the upcoming new GP contract deal would see “significant changes” to the general practice Quality and Outcomes Framework (QOF), the plan said.

Health service leaders said that the shift in emphasis would reduce pressure on emergency hospital services and allow all local NHS organisations to focus more on population health and on partnerships with local government through new integrated care systems.

It would also enable digitally enabled primary and outpatient care to be rolled out across the whole NHS, give people more control over their own health, and allow people to access more personalised care, it said. A redesign of outpatient services will avert the need for 30 million outpatient appointments by 2024, saving £1bn.

The plan emphasises the need to remodel the medical workforce to achieve these ambitions, saying, “We want to accelerate the shift from a dominance of highly specialised roles to a better balance with more generalist ones.” It pledges to test “a wide range of new incentives” to facilitate this change, but further detail will not be available until the workforce implementation plan is published later this year.

To hasten the development of new models of care, the plan proposes repealing specific laws on competition and procurement that were introduced in the Health and Social Care Act 2012. The changes should include allowing NHS commissioners to decide the circumstances in which they should use procurement, to remove the “wasted procurement costs and fragmented provision” that the current rules have created, the plan says.

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