NHS long term plan: all patients to have access to online GP consultations by 2023-24BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l87 (Published 08 January 2019) Cite this as: BMJ 2019;364:l87
On Monday NHS England published its long term plan for the NHS.1 Here we summarise how it intends to prioritise services over the next 10 years in specific areas.
By 2023-24 every patient in England will be able to access “digital first” NHS primary care consultations from either their own GP or a digital GP provider. Outpatient services will be redesigned to enable more cases to be handled remotely and electronically, avoiding up to a third of face-to-face outpatient visits (up to 30 million appointments a year). All acute, community, and mental health providers will be “fully digitised” across all locations and departments by 2024. In 2019-20 100 000 women will be able to access their maternity record digitally, with coverage extended to the whole country by 2023-24. Decision support and artificial intelligence will help eliminate variation across the country and help patients to managing their conditions themselves.
Mental health will receive a growing share of the NHS budget, worth at least a further £2.3bn a year by 2023-24, and extra money will be targeted at mental health services for children and young adults. By 2023-24, an additional 345 000 or more people aged up to 25 will be able to access support though NHS funded mental health services or support teams in schools or colleges. By the end of 10 years all young people who need specialist care should have access to it, the plan pledges. After 2020-21 95% of people with urgent cases of eating disorder will receive treatment within one week, while non-urgent cases will be seen within four weeks. More support will be available for adults and children in a mental health crisis.
The proportion of cancers diagnosed at stages I and II will increase from around 50% now to 75% by 2028, achieved through raising awareness of symptoms, lowering the threshold for referral by GPs, improving access to diagnosis and treatment, and identifying more cancers through screening. The faecal immunochemical test for haemoglobin will be introduced for bowel cancer screening, HPV screening for cervical cancer, and computed tomography for people at high risk of lung cancer. By 2023 more than 100 000 people a year will have access to extensive genomic testing.
The plan aims to prevent 150 000 heart attacks, strokes, and dementia cases over the next decade. Defibrillator networks will improve survival after out-of-hospital cardiac arrest, and access to cardiac and stroke rehabilitation will be widened. For eligible patients with stroke, use of medical thrombectomy (from 1% of eligible patients to 10%) and thrombolysis (from 50% to 100%) will be widened.
A single multidisciplinary clinical assessment service will be embedded in NHS 111, ambulance dispatch, and GP out-of-hours services from 2019-20 to help patients, carers, and staff ensure patients receive the most appropriate service, and by late 2020 all areas in England will have an urgent treatment centre as an alternative to hospital emergency departments. A greater proportion of patients (from a fifth to a third) who are admitted to hospital from the emergency department will be discharged on the same day.
Smokers will get more help to quit, especially hospital inpatients, expectant mothers and their partners, and long term users of specialist mental health and learning disability services. Access to weight management services in primary care will be targeted at people with type 2 diabetes or hypertension and obesity, and an extra 1000 children a year will get support for severe complications related to obesity. The NHS diabetes prevention programme will be doubled, and hospitals with the highest rates of admissions related to alcohol dependence will get specialist alcohol care teams.
More funding will go to areas with the highest health inequalities, worth over £1bn by 2023-24. During 2019 these areas will have to set out how they will reduce health inequalities by 2023-24 and by 2028-29, and they will have targets, including ones relating to poverty. An extra £30m is earmarked for meeting the needs of rough sleepers and for more support for problem gamblers.
Children’s and maternity care
Action will be accelerated to achieve 50% reductions in stillbirths, maternal mortality, neonatal mortality, and serious brain injuries by 2025. By spring 2019 every trust with a maternity and neonatal service will be part of the National Maternal and Neonatal Health Safety Collaborative, and every NHS maternity and neonatal organisation will have a named maternity safety champion. Maternity services will be expected to deliver an evidence based infant feeding programme in 2019, and more physiotherapy will be available to women who experience incontinence after childbirth.