With the launch of the NHS 10-year plan, a new operating model will rollout single and multi neighbourhood providers, establish the much-discussed neighbourhood health centres, and ensure all NHS providers become Foundation Trusts with the freedom to decide how to organise their services to best meet local needs.
Work had previously begun on the new operating model with the plans to abolish NHS England and cut integrated care boards (ICBs) announced in March and the axing of more than 200 NHS organisations in June, but the new NHS 10-year plan takes this further.
Commissioning support units are also to be abolished, along with Integrated Care Partnerships. Instead, neighbourhood health plans will be drawn up by local government, the NHS and its partners led by Health and Wellbeing Boards. ICBs must be coterminous with strategic authorities wherever possible by 2035.
A new contract for ‘single neighbourhood providers’ will be rolled out early next year, according to the plan.
It will deliver enhanced services for groups with similar needs over a single neighbourhood of around 50,000 people and GPs will be encouraged to lead these neighbourhood providers as an alternative to working in general practice, it states.
A second contract will create ‘multi-neighbourhood providers’, covering 250,000 or more people, for care that requires a scaled-up approach across several different neighbourhoods in areas such as end-of-life care.
Multi-neighbourhood providers are to work with GP practices and smaller neighbourhood providers in their footprint to create new commercial opportunities including clinical trials and they can also support or take over struggling GP practices.
They will cover functions already being provided in some areas by GP Federations, such as shared back-office functions, overseeing digital transformation and estate strategy, and will provide data analytics and quality improvement.
Smaller neighbourhood teams will bring staff together from primary, community and acute sectors and include other staff such as those working in hospice outreach services.
Neighbourhood Health Centres and NHS Foundation Trusts
The plan states that Neighbourhood Health Centres will be in every community starting with places with the lowest healthy life expectancy and where possible by repurposing poorly used, existing NHS and public sector estate.
Staffed by NHS, local authority and the voluntary sector, these centres will be open 12 hours a day, six days a week, and aim to remove ‘the need to go to hospital for urgent care’.
The will provide diagnostics, post-operative care, rehabilitation into the community, as well as debt advice, employment support, smoking cessation and weight management services.
With the focus on best meeting local needs, by 2035 the Government aims for all NHS providers to be Foundation Trusts (FTs) by reinvigorating and modernising this model, with each having the ability to retain surpluses and reinvest them as well as borrow for capital investment.
‘FTs will use these freedoms and flexibilities to improve population health, not just increase activity’. The best of these will hold the whole health budget for a defined local population as a new integrated health organisations (IHOs). A small number will be designated next year with a view to becoming operational in 2027.
IHOs will align investments and savings so the cost benefits of innovation are realised and ‘never blocked’ the plan explains.
Financial incentives
The Government aims to ‘reinvent the NHS’ financial model’ as it has ‘developed an addiction to deficits’ the plan states.
‘To restore financial discipline, we will end the practice of providing additional funding to cover commissioner and provider deficits. This year, the £2.2bn in deficit support funding will not go to systems that fail to meet their agreed financial plans. Deficit support funding will be phased out from financial year 2026 to 2027,’ it states.
Instead, this year there will be a ‘transparent financial regime which holds leaders to account’ and by 2029/30 most providers will be expected to deliver a surplus.
All organisations are asked to provide five-year plans to help a shift to long term financial planning. And ICBs will withhold funding for poor quality care and pay bonuses for high-quality care. This will put an end to block contracts that are paid irrespective of how many patients are seen or how good care is.
To support the shift of care out of hospital, ‘year of care’ payments (YCP) will be developed and tested to allocate a capitated budget for a patients’ care over a year rather than a fee for a service.
It will be calculated based on the health need of the population being served. It could cover primary care, community health services, mental health, specialist outpatient care, emergency department attendances and admissions in one consolidated single payment.
These will be an ‘important feature’ of the neighbourhood provider contracts for specified populations or services.
The plan states: ‘The YCP will provide a sharp incentive to keep patients healthy and out of hospital because local NHS organisations will benefit from reducing emergency visits and reinvesting in community services.’
From April next year, ‘intensive’ work will begin with ‘pioneer’ systems which are already more advanced in designing their new care model to implement notional YCPs.
A version of this article was originally published by our sister publication Healthcare Leader.
