Since the NHS Long Term Plan (LTP) was published on 7 January 2019, the NHS Operational Planning and Contracting Guidance 2019/20 has been released. It gives guidance on how the additional funding settlement for the NHS should be used.

Key points of interest are:

 It is the start of the process of producing the local plans that will be the implementation of the NHS LTP. For 2019/20, every NHS trust, NHS foundation trust and clinical commissioning group (CCG), will need to agree organisation-level operational plans which combine to form a coherent system-level operating plan. This will provide the start point for every Sustainability and Transformation Partnership (STP) and Integrated Care System (ICS) to develop five-year Long-Term Plan implementation plans, covering the period to 2023/24.

The document covers:

  • System planning
  • Financial settlement
  • Operational plan
  • Process and Timescale

System planning

Every STP/ICS must produce a system operating plan for 2019/20. This must include an overview of how the system will use its resources to meet population health need, including specialised commissioning and direct commissioning as well as CCG plans. It must also include a system aggregation showing how individual plans align to form a system plan.

All NHS providers and CCGs must be part of a plan. The focus should be on how to work together to provide efficiency savings, not cost shunting from one organisation to another.

Financial settlement

The focus of this section is on CCG funding settlements and tariff payments. It then addresses efficiency savings and steps that systems need to focus on to become more efficient. This includes working to make outpatients and community services more efficient through use of digital technology.

There is a list of ongoing opportunities which includes medicines value – e-prescribing; removal of low value prescribing; and greater use of biosimilars.

There is a list of specialist commissioning which includes reference to long term conditions, but specifically mentions hepatitis C and neurosciences. Also reference to rapid diagnosis of rare diseases, but in relation to genomics. Integrating specialist commissioning into locally commissioned services is also seen as an opportunity, including the move to a pathway approach to planning care for populations.

Operational plan requirements

This section lists the priorities seen as fundamental to transforming urgent and emergency and elective care. The nine deliverables are:

  • Emergency care – reducing the time for which patients are hospitalised.
  • Referral to treatment times – The expectation is that over 5 years the volume of elective care will go up, and waiting lists will come down, starting in 2019/20. However, waiting times commitments relate to 6 month and 52 week waits. The clinical standards review will look at waiting time standards (this is where we have a concern that the 18-week target may be changed/scrapped). There is also reference here to First Contact Practitioners for MSK patients.
  • Cancer treatment
  • Mental health – a series of deliverables for mental health includes a target that 50% of those on IAPT should recover. Depending how you define recover, this might be a barrier for MSK patients with long term conditions for whom managing their mental health is more realistic than recovery.
  • Learning disability and autism
  • Primary and community care – The focus of this is on primary care networks. STPs/ICSs must set out how they will achieve sustainability and transformation of primary care. Additional funding to primary care must deliver investment in transformation. A local workforce plan including multi-disciplinary teams and a primary care network development plan.
  • Workforce
  • Data and Technology
  • Personal health budgets – by March 2021 50,000 – 100,000 people must have a personal health budget.

The longer-term deliverables are those in the LTP.

Timeline

Draft organisation/operational plans submitted by 19 Feb with 5-year plans by Autumn 2019.

For more detail see the full document.

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