Oli Hudson, Content Director at Wilmington Healthcare, looks at the year ahead for the NHS and what it means for pharma in 2020.
Place-based care – which requires organisations to work together to improve health and care for a geographically defined population and manage common resources – will become increasingly widespread in 2020.
A third of the country is already covered by an Integrated Care System (ICS) and a further two ICSs – Cornwall and the Isles of Scilly; and Humber, Coast and Vale – are expected to form early in 2020.
It is also anticipated that a third of clinical commissioning groups (CCGs) will merge by April 2020. This is being driven by ICS borders and the need to achieve a 20% operational cost reduction.
Aligned Incentive Contracts (AICs), which require commissioners and providers to work towards the same key performance indicators (KPIs) are set to become increasingly prevalent in 2020. We also expect to see more Risk Share contracts, which encourage partners to work collaboratively across organisational boundaries and collectively manage risk across the system.
These types of contracts provide a clear indication that integration is happening swiftly and successfully.
“Pharma needs to take a tailored approach to customer engagement that is built on a clear understanding of the individual needs of NHS England’s diverse health economies”
Integrated care organisations
Integrated Care Providers and Partnerships (ICPs) have been springing up across the country to aid collaborative working. An ICP standard contract was launched in 2019 by NHS England and we expect this to be widely used between CCGs and ICPs in 2020.
Meanwhile, it is clear that Primary Care Networks (PCNs) will be very pertinent to industry in 2020. In addition to providing core GP services, PCNs have been tasked with delivering a number of new services that are all linked to NHS Long Term Plan priorities.
Five of the new services will start by April 2020, namely: structured medication reviews, enhanced health in care homes, anticipatory care (with community services), personalised care, and supporting early cancer diagnosis.
Medicines under scrutiny
With regards to structured medications reviews and optimisation, Network Contract Directed Enhanced Service (DES) Guidance for 2019/20 says that PCN members will support ‘direct tackling of the over-medication of patients’. This will include looking at inappropriate use of antibiotics, withdrawing medicines that are no longer needed and supporting medicines optimisation more widely. There will also be a focus on particular types of patients, with asthma and COPD patients; the frail elderly and care home residents listed among other priority groups.
These reviews are aligned with the new enhanced health in care homes service, where the NHS wants to help to reduce avoidable emergency admissions and ambulance conveyances, as well as tackle sub-optimal medication regimes. To achieve this, GPs and nurses will be brought into care homes by PCNs to assist with work that was previously the responsibility of social services.
To deliver on anticipatory care, PCNs must also be proactive about identifying and managing high risk patients generally to try to prevent conditions from worsening and keep people out of hospital. GPs will be required to look at big data that stratifies high risk patients, so they can take a population health management approach to allocating resources and budgets.
This kind of insight and proactivity is central to how PCNs operate and how they are going to be incentivised. Indeed, additional funding will be available to PCNs that go further and faster on delivering the national service specifications.
Early cancer diagnosis
Early cancer diagnosis is a key tenet of the Long Term Plan, and we expect to see multi-disciplinary teams working within PCNs to deliver cancer services. Screening and diagnostic services will also be increasingly provided in the community.
Personalised care is among the new service specifications for PCNs and it is particularly relevant to cancer care, where the NHS wants to use personalised and risk stratified screening and begin to test family members of cancer patients if they have an increased risk of the disease. It is likely that PCNs will be tasked with quizzing patients about their family history in order to gather data that will support this proactive approach.
Role for pharma
As we start 2020, the direction of travel for the NHS is much clearer than when the Long Term Plan was first published. Integrated care is happening, underpinned by new style contracts, with providers and commissioners working together.
But progress towards integrated care is varied, even within ICSs; hence pharma needs to take a tailored approach to customer engagement that is built on a clear understanding of the individual needs of NHS England’s diverse health economies.
Evidence-based propositions will be essential to prove why a particular drug should be used for a particular patient cohort. Pharma also needs to be thinking more widely about how its products can deliver cost savings across whole integrated care pathways, particularly with regards to reducing demand on hospital beds and outpatients’ services.
In essence, there are golden opportunities for pharma to help deliver integrated care and, led by insights from data, 2020 will be another year in which industry can play a major role in supporting the NHS through a period of rapid structural change.
Top 5 Takeaways
- Place-based care will become more common.
- 1/3 of CCGs will merge by April 2020.
- Primary Care Networks will be significant to industry in 2020.
- Do your products deliver cost savings across whole integrated care pathways?
- Evidence-based propositions will be essential.
Oli Hudson is Content Director at Wilmington Healthcare. Go to www.wilmingtonhealthcare.com