Watch your step

8th November 2016

When the dog is outside the house he barks

When the dog is inside the house he bites

                                                Chinese Proverb

Many of you will be aware of the sustainability and transformation plans being developed nationally. More worryingly many of you are not aware. A recent survey by Neil Macey showed that locally 42% of respondents had little or no understanding.

NHS England has identified 44 footprints, each requiring a sustainability and transformation plan (STP). Locally that involves 3 hospitals (Colchester, West Suffolk, and Ipswich) and 3 CCGs, 2 GP Federations and Community Mental Health and Social Services across this area.  The secret nature of these plans has been a concern commented on by David Nicholson, previous Head of NHS England, as being unhelpful. The explanation that this is to allow the STP Planning Board to consider difficult decisions e.g. closure or merger of services without being under the public spotlight does not tie in very well with the Federations approach to openness and transparency. It also would seem that these very difficult decisions are ones that are best held in public and there needs to be honesty about the financial pressures that are driving them.

Writing in the BMJ this week Amber Davenport, Head of Policy at NHS Providers, says that the triple focus (improved health and wellbeing, transformed quality of care delivery, sustainable finances) of the original aims has morphed into “money, money, money”.

GP representation of the board is via the LMC (statutory), GP Federation and CCG colleagues. There is also an RCGP ambassador overseeing the SDPs. There is an expectation that 15-20% of transformation funding, £760 million nationally, will be spent on primary care.

Primary care has does have   concerns about the plans. Locally, due to financial problems the most significant impact is likely to be on secondary care to address their deficit. The worry is that areas not in deficit, e.g. primary care, will be plundered to support them and that they may try and move work into primary care unfunded. Though from what we have seen from the plan so far that does not appear to be the case.

There is an opportunity here for primary care to use this to provide more services and take the pressure of the acute trusts, with appropriate transfer of resource. . Without our presence around the STP table we will be unable to influence this and end up with decisions being made about primary care without our input. We need to be involved.