Why is the new NHS operational planning guidance so significant and what does it mean for pharmaceutical companies? Oli Hudson, Content Director at Wilmington Healthcare shares his thoughts.
In a year when so much has been thrown up in the air, it was no surprise to see the NHS planning guidance look and feel very different when it was finally published last month.
Gone is the usual flurry of outcomes-based incentives; in their place is arguably a more pragmatic, though no less challenging, set of arrangements focused on getting hospital performance back to some semblance of normality.
But what are the implications for pharma? Here, we’ll look at what this means in practice and how it will affect what NHS customers look for from industry over the crucial months ahead.
The planning guidance always deals with the short, rather than medium or long term aims of the NHS, and the most pressing issue now is to engage with resolving the crisis of the pandemic. Thus, in order, its first four priorities are:
- supporting the health and wellbeing of the workforce
- rolling out the vaccination programme and meeting the needs of patients with COVID-19
- accelerating the restoration of services (particularly elective, cancer and mental health care)
- expanding primary care to address access, outcomes and inequalities – many of which have been exacerbated in the light of the pandemic.
The headline aim of the new guidance is to get the NHS back on its feet by restoring, as quickly as possible, pre-COVID activity levels. To do so, it dangles the considerable carrot of a £1 billion recovery fund as an inducement for providers.
Under the block contracts running until October 2021, NHS trusts receive a set amount of core funding regardless of the levels of activity they achieve. However, from this month, trusts will be paid over and above this core funding for additional activity through the new fund. There is a target of reaching 70% of pre-COVID activity in April, increasing to 85% in July.
Harking back and looking forward
However, there are a number of caveats in place for providers if they want to access their share of this funding – for example, in order to qualify, Trusts must address health inequalities in their new activity and are also advised to perform at least 25% of out-patients services remotely.
The guidance, therefore, feels like it is both harking back and looking forward. Hospital customers will obviously be squarely focused on increasing activity and getting back to a level of previous performance that is more in line with public expectations. But Trusts are being primed to see the way forward rather differently, recognising that the last 12 months have stimulated changes that should be consolidated rather than abandoned.
So, for example, the guidance advises that remote working, remote consultation, monitoring and follow-up will be used as much as possible. And Trusts will be expected to amend pathways in order to help address inequalities and facilitate home-based care, opening up new opportunities to rethink the way care is delivered.
Collaboration and system-based planning
The document also puts as much emphasis on the how as the what, with collaboration as a deep-rooted principle.
Hence there are milestones for integrated care systems (ICSs) to meet, including formulating a plan and governance framework that will be signed off by NHSE by the end of the first quarter. System level financial arrangements will also be in place, organisational development will be required and there are milestones for digital transformation too.
Similarly, there’s a renewed focus on place (that is, areas of 250-500k population) as the base unit for decision-making. It will be at this level, instigated by provider collaboratives and alliances, where most transformation will take place, and organisations and networks at this place level will duly form the most important new stakeholder group for industry.
Partners in change
There are a number of implications in this. The first is the fact that pharma can play an important role in solving many of the quandaries presented by the planning guidance – from offering advice on medicines optimisation, to making better use of remote technology, to providing data and services to help reshape care pathways. Pharma has the means to become an important solution-giver during this critical period.
The second is that this guidance, along with the ongoing implementation of structural reforms, will create a new stakeholder environment that will require new approaches from pharma. Understanding the new landscape and being able to advise within a quite localised picture of structural and organisational change will be essential.
Third and finally, the guidance underlines the need for emotional intelligence in dealing with the NHS. While we expect a dying down of the pandemic over the summer as seasonality and vaccine roll-out dampen its embers, there will still be immense pressure on frontline staff to recover lost ground, many of whom will have been through an extremely turbulent and exhausting period.
It has, therefore, never been more important for commercial suppliers to understand the heightened emotional and psychological environment in which NHS decision-makers operate, and to invest in deep, empathetic relationships with these stakeholders, supporting them in delivering the changes and improvements they need to make.
Grasping the tenets of the planning guidance will give a good sense of the realities that frontline clinicians will face in the months ahead – important for framing your offer in a sensitive and informed way and positioning yourself as a genuine partner in change.