As we all know, change is afoot. Last year’s Long Term Plan set out some pretty demanding targets, including the headline 30% reduction in face-to-face hospital appointments. Now, to help with this, NHSE has published its “Operational Planning and Contracting Guidance 2020/21”, setting out where its efforts will be focused.
We’ve summarised some key elements of the plan, but there’s some revolutionary change on the cards to start off with:
Change to the outpatient tariff system means non f2f is incentivised
A familiar refrain we’ve heard over the years is that hospitals are not incentivised to reduce patient visits as they are paid much larger tariffs for outpatient appointments compared to non f2f interactions. In short, why why would you opt for a £30 payment for advice that might keep the patient out of hospital when you can collect a much larger tariff for an outpatient appointment? That’s about to change, though.
The operational plan announces that the payment system is to be reformed so that providers do not lose income as a consequence of reducing face-to face contacts. Commissioners and providers are expected to agree “blended payments” that include Advice and Guidance and uptake of non—face to face consultations.
This means that, finally, the balance is going to change – for Trusts it is going to be far more lucrative to keep patients out of hospital using advice & guidance and to deliver consultations remotely if they get paid the same as they would for an in-person appointment. And that’s a good thing. It’s likely to prompt the same wholesale change that we’ve seen with Internet shopping – a huge shift to online and remote models of service delivery with a much smaller reliance on bricks and mortar.
This is, of course, at the heart of the Long Term Plan, and the knock on effects for all elements of the health economy will likely be positive. Patients get easier access to care with reduced costs of attending hospital, the NHS modernises whilst saving money and NHS sustainability improves through less travel to hospital. Is this the win-win-win we’ve all been hoping for?
Other key elements of the Operational Plan
– Primary Care and Community Health Services – “Investment and evolution” – Supporting the evolving PCNs, there are 3 main priorities: workforce redesign and development, improving patient access and waiting times (including the option of an online consultation), more integration with community providers (incl. pharmacies) to deliver improved services in the community.
– Urgent Care – deliver on performance targets – All providers should plan to deliver material improvements in A&E performance against a 2019/20 benchmark. To achieve this, all systems and organisations are expected to reduce general and acute bed occupancy to a maximum of 92%, improve admission avoidance and increase the number of patients that are seen and treated on the same day (SDEC). In addition, by September 2020 all providers are required to deliver acute frailty services for 70 hours per week and work to reduce avoidable conveyance to ED by ambulances (including exploring how more clinical assessment can be carried out by local Integrated Urgent Care CAS Services).
– Mental Health – more funding, more integration – All CCGs will receive additional baseline funding in 2020/21 to bolster community mental health provision for adults and older adults. By 2021, all providers of community mental health services for adults and older adults should have arrangements in place with their PCNs to organise and deliver services in an integrated manner. There will also be more support for learning disabilities and autism.
– Reduction in RTTs plus 26-week choice – shorter waiting lists – waiting lists to be lower on 31 Jan 2021 than on the 31 Jan 2020. This may be managed at the ICS level. Financial sanctions to remain in place for breaches of a 52 week wait.
– Cancer – more funding for Cancer Alliances – increased funding for rapid diagnostic centres, lung health check programmes, children’s hospices and end of life care.
– Prevention and Sustainability – more cash, more planning – more investment in keeping people healthy and reducing the carbon footprint of the NHS.