Serious questions have been raised about the ‘rushed’, under-resourced and poorly publicised NHS plans that ministers expect to rescue the NHS from falling into the red.
GPs have told the BMA they have been excluded from discussions on STPs (sustainability and transformation plans) until the last few weeks, despite some first drafts being handed to NHS England in June.
The BMA sent letters to every MP in England on 11 November to find out whether they were consulted about the plans, many of which propose significant reshaping of NHS services.
Camden local medical committee chair and GPC member Farah Jameel, who has seen the STP for north central London, said it included ‘unrealistic’ targets including one to cut all healthcare demand by some 30 per cent.
‘It’s all been rushed through at such an escalated pace,’ she added. ‘Only in the last few weeks were we asked to send a representative to the STP board. The reality is that you can’t really influence things if you’re not really around the table.’
Sutton LMC chair Rebekah Dowdy said the south-west London STP had engaged with GPs but its plan failed to address serious problems in primary care.
‘As identified in the STP, our premises are at breaking point – we can’t fit any more surgeries in. My practice is a good representative of that,’ she added. ‘Nothing in the plan is about the nitty-gritty of how to do it, it doesn’t address these problems.’
The concerns from GPs come after weeks of unrest about the STPs, which are being drawn up by local health leaders, commissioners and councils in 44 areas across England.
Social care in crisis
Birmingham council chief executive Mark Rogers sparked a ministerial intervention last month after criticising NHS England for directing a ‘let’s sort the NHS out first’ approach to STPs without properly addressing the financial crisis in social care.
‘Adult social care is not going into crisis – it is in crisis,’ Mr Rogers is reported as saying.
‘You can’t just sort it out on its own, you have to look at how you transform all of the services but the tendency of the NHS can be to sort itself out first when the going is really tough.’
In Nottinghamshire, the STP is expected to meet a forecasted deficit of £500m – causing great concern among healthcare staff and local experts.
Martin Gawith, chair of Healthwatch Nottingham, which represents patients in the area said: ‘It’s going to be very difficult and at the end of the day I do genuinely believe we need to find more resources as well as making greater efficiencies. I believe there will have to be more funding.’
The King’s Fund has warned that all but £300m of the £2.1bn had been drained from the NHS budget to fund changes proposed by STPs.
BMA council chair Mark Porter said the NHS was at breaking point. ‘Investment in health simply isn’t keeping up with demand. We’re still seeing hospitals without beds, waiting times too high, crushing pressure on mental health services and cuts to the public health budget.
'The majority of trusts are in the red and the NHS doesn’t have enough staff or resources to meet demands.
‘If the Government is serious about tackling health inequality, then we need to see a long-term strategy for the NHS that addresses the fundamental workload and funding challenges that are overwhelming our health service.’
Find out more about STPs and read the letter
Read more from Peter Blackburn and Keith Cooper.