Land of the giants
Let’s talk about the entities we currently refer to as ‘hospitals’. There are 151 acute hospital trusts in England, most of which have more than one hospital site. So, what will that look like in a few years’ time? I’m guessing they’ll be fewer than 50 trust groups, all running a network of services across a defined patch.
Thirty years ago the idea was to have district general hospitals (DGH) serving populations of 250-300,000. Each DGH had A&E, theatres, maternity, pathology, radiology and so on, but that is already changing with the hub and spoke model, best represented by the Northumberland model*.
Then there are the chains, foundation groups and franchise models led by the Royal Free, Salford Royal and others. Salford now leads the Northern Care Alliance, a group of five former trusts amalgamated at scale. It is all about vertical and horizontal integration; tertiary, secondary, community and primary care in one single system that links key aspects like mental health and social care. Boundaries, roles, premises and terminology are changing so much that phrases like ‘secondary care’ and ‘community’ are becoming redundant.
Did you notice the restructure of pathology announced in early September? The plan is to have just 29 super-lab hub sites with all others being spokes operating a smaller range of services. What does this signal for imaging, A&E, maternity, oncology or any other specialism?
Let’s imagine 50 or so trust groups managing all NHS provider services across populations of 1.5 million, with integrated control of everything apart from ambulances. Impossible? Well, it is remarkably similar to the NHS I worked in for the first 10 years of my career. It is also an NHS that people in Glasgow, Cardiff and Belfast recognise, but with a harder drive on cost, workforce and premises. Now imagine local GPs coming in as salaried consultants engaged through their own consolidated groups.
Pharma must drop anachronistic thinking around hospitals. ‘Place’ and ‘integration’ are more important than buildings. Having one prescribing budget across an integrated health economy changes much of conventional sales activity. Moving from tariff transactions to programme budgets will significantly change value propositions.
The geographies of these integrated providers will develop from the catchment areas of tertiary centres and the best-performing trusts. Those boundaries will then set the map of sustainable transformation plans (STPs) or whatever replaces them.
Key account status will be defined by who leads change and who receives it – you need to identify the winners. For every Salford, there is an organisation about to be absorbed, but do you know who the carnivores are in this emerging landscape or are you simply relying on the herbivores?
*Ever-spinning wheel: The neo-healthcare vision
The transformation from a traditional NHS healthcare model is already being pioneered in Northumberland, whose transatlantic style ‘hub and spoke’ system refers to a series of alternative secondary sites, which are centrally connected to the main anchor site. Furthermore, all separate departments run the same operating system and software, providing access to the same information as the central hub. Put simply, it is an example of ‘reinventing the wheel’, but making a much better wheel than we had before.
David Thorne is Chair, Washington Community Healthcare and Non-Executive Director, City and Vale GP Alliance. Go to blueriverconsulting.co.uk