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5 insights from England's move to integrated care: What we can learn from the NHS Long Term Plan

January 24, 2019

    Last week, in its first major health policy release since 2014, England's National Health Service (NHS) unveiled its Long Term Plan. The much-anticipated document outlines the key strategic priorities for the health system over the next ten years. It focuses on how to bring care closer to the patient, reduce barriers to coordination, and deliver the care of tomorrow.

    What’s driving A&E and urgent care use in England?

    We read and analysed the document to understand the key policy changes and what they mean not just for England, but for health care leaders around the world.

    Here are our five biggest insights from the plan:

    1. England is doubling down on 'out-of-hospital' care

    In the next ten years, the NHS is committed to prioritising community-based care and will provide an additional £4.5 billion in funding over the next five years. From an operational standpoint, this means removing the divide between primary care and community health services by redesigning contracts, expanding investments, and keeping patients healthy in the community. One of the most significant changes is the introduction of Primary Care Networks, which will bring together geographically similar GP practices to provide enhanced, multidisciplinary community-based care.

    This shift also signals that the NHS has changed the way it thinks about care management. Under the plan, non-clinical providers are expected to play a central role in supporting patients, reducing inequality, and expanding access to care.

    And underpinning all of this is a commitment to ensure care reflects the individual needs and desires of patients—social prescribing, personal health budgets, and enhanced support for managing health conditions will all be available to millions more patients across the country.

    2. NHS is expanding access points to reduce demand for emergency care

    Like in many health systems, the demand for acute care in the NHS is on a long-term upward trajectory. Efforts to reduce wait times and introduce new urgent care pathways have slowed demand, but demographic trends mean that emergency hospital services will continue to be strained. New models of care delivery, including the expansion of Urgent Treatment Centers and the ability to book appointments through the NHS 111 service, are intended to help patients access appropriate care faster.

    3. Care management is at the heart of new efforts to improve patient outcomes

    Managing demand by providing services where most appropriate and working to prevent the emergence and exacerbation of illness is a sizeable undertaking and one that cannot be borne fully by acute care. Disease-specific support programmes will be introduced to help patients access meaningful care and appropriately manage long-term conditions. While common conditions, such as heart disease and diabetes, remain a core focus, a significant portion of funding will go to mental and behavioural health programmes. The NHS estimates that efforts to prevent and manage common conditions could save more than 500,000 lives over the next decade.  

    4. New investment in technology seeks to bring patients closer to care

    The NHS has made progress in moving towards a more digitally enabled health service. The new NHS app is being rolled out across the country, allowing patients to access NHS 111 online, view their GP record, and book appointments. And yet, care delivery remains analog despite the rapid digital transformations taking place in the world.

    By embracing digitally enabled care, the NHS hopes to take capitalise on technological advancements—deploy more clinical technology, reduce bureaucracy, stimulate research, and enable a digital-first service transformation. Investments in AI and new clinical technology will allow the health system to provide cutting edge care to patients.

    5. Population health management continues to shape the structure of England’s care delivery

    Delivering on all of these priorities will require a significant change in the organisational structure of the NHS, with an emphasis on enhanced collaboration and shared decision making. Integrated Care Systems (ICSs), previously introduced in progressive localities across England, will be expanded, covering the entirety of England by 2021. This new structure will bring commissioning and care delivery under one umbrella to redesign care and improve population health. Details of exactly how ICSs will be designed and function remain scarce, but bringing together decision-making, funding, and oversight is expected to help the NHS drive integration across acute, community, and primary care, and local government.

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