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Hundreds of doctors debated the 5YFV (Five Year Forward View) — the vision for the NHS in England — at the BMA annual representative meeting in Liverpool last month. The meeting concluded that it would support the successful implementation of the new care models if five key criteria were met.
Implementation of the new models needs to involve full consultation with the relevant stakeholders in primary and secondary care.
Why? Without doctors and other clinicians on board, the transformation of the NHS into a more coordinated and integrated health system, as envisaged by the 5YFV, is unlikely to be achieved.
Effective and early consultation will be the first step to achieving staff engagement (which is linked to improved quality of care for patients).
Experience also tells us that it is the cultural and behavioural change in organisations that has the biggest impact when it comes to integration and other service change projects.
There’s not much chance of this happening without a wide sense of ownership.
In addition to the points already made about clinical engagement and ownership, the evidence also tells us that medical leadership can improve organisational performance.
The design and development of the new models also needs to be heavily informed by patients and the public: what problems they currently face; how these might be overcome; and what kinds of outcomes are meaningful to them.
The new models should involve primary, community and secondary care clinicians working in collaboration and not one group dominating another.
Public health must also be part of the conversation, bringing the development of the new models and prevention closer together.
The 5YFV aims to break down the barriers between different parts of the health service, and health and social care. This should not be undermined by the potential for the new care models to prove divisive.
A common perception around multi-specialty community providers and primary and acute care systems is that each model is being led by a particular sector, rather than genuine cross-sector collaboration.
Less focus on the particular model and more focus on the shared goals might help.
In a recent survey of BMA members, doctors told us that one of the main things of interest to them would be whether local plans — whomever was leading them — were going to result in more patient-centred and coordinated care.
Organisations should be supported to work together and not focus on creating a new single organisation which would employ all staff involved.
Prioritising ‘virtual’ over ‘structural’ integration makes sense. Evidence has shown structural integration — mergers between organisations — to be insufficient in achieving better coordination, integration of services and improved patient outcomes.
Common methods of virtual integration — partnerships and networks between organisations — include multidisciplinary teams, case management, managed clinical networks and joined-up care pathways.
Encouragingly, there is much overlap here with the emerging new models pilots (the ‘vanguard’ sites).
The virtual route will also be much less disruptive; an important point given the need for stability in the NHS and in order for stronger relationships to develop between service providers.
And less than half of the doctors we surveyed said they would be interested or very interested in working for a single, integrated organisation in the future (41.6 per cent).
As new models of care emerge across England, they should focus on delivering services in an area, and not seek to compete with other providers outside their locality.
The development of the new models should promote population-based, sustainable and joined-up services. They should reduce, not increase, service fragmentation and simplify, not complicate commissioner-provider relationships.
It’s time for integration, not competition, to take centre stage in England.
Whether the 5YFV new care models can make any kind of a dent in the looming £22bn funding gap — between what NHS England says the health service will need in five years and the real-terms increased promised — is another matter entirely.
Read more about the 5YFV in the BMA’s new briefings
Mark Porter is BMA council chair
Wholeheartedly agree with Mark.
It appears that the anatomy and physiology of the NHS is going to be changed in five years. This would blur the gap between primary and secondary care along with greater integration to social services and public health. Patient care be individualised and with more self control with engaing preventative measure in the community and more ownership of their own health.
MCPS and PACS is being piloted and so for encouraging reports and it appears that MCPS will be more favoured. Working in collaboration is key to success rather than domination.
My concerns remain as: further closure of secondary care hospitals? End of National TCS?? Creating an environment of apopotosis of NHS leading to total privatisation of the NHS???
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