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2019: A pivotal year for the NHS

Paul Midgley and Oli Hudson, of Wilmington Healthcare, explore some of the key changes in the NHS in 2019


At the start of 2019, the NHS set out its priorities in its highly anticipated ‘Long-term Plan’, which provides a blueprint for the design and delivery of NHS services over the next 10 years.

The plan, which reaffirmed the NHS’s commitment to integrated care, has prompted significant changes with regards to structure; finance; commissioning; outcomes and key performance indicators (KPIs).


The Long-term Plan stated that, by April 2021, all areas of England will be covered by an Integrated Care System (ICS), with typically just one Clinical Commissioning Group (CCG) per ICS area. In June, three further areas were designated as ICSs by NHS England. CCG mergers have continued in 2019 and it is possible that, ultimately, there could be a reduction from the current 191 CCGs to around 60-70.

The introduction of Primary Care Networks (PCNs) in July, which are the building blocks for Integrated Care Providers and Partnerships (ICPs), was another fundamental structural change.


Some ICSs have already dispensed with standard Payment by Results (PBR) contracts and are operating more integrated budgets or block contracts. These systems are trailblazers which all other health systems are under pressure to emulate within the next few years.

The move from PBR to variable, outcomes-based and block contracts is creating a more complicated landscape in terms of the relationship and money flow between commissioners and providers, and also from the perspective of understanding how PCNs and ICPs take on some of the lower level commissioning and contracting functions of CCGs.

A knock-on effect of outcomes-based and block contracts, and the integrated approach that underpins them, is that hospitals will no longer compete against each other.

Commissioning and hospitals

Although the NHS is committed to ICSs, in some parts of the country, such as London, which have large and long-established teaching hospitals, it is likely that these hospitals will drive the local care agenda. These hospitals will still have a fixed budget for providing local services and they will have to determine how to manage it.

Also on the hospital theme, in a bid to improve surgical services, the Long-term Plan promised to continue backing hospitals that wish to separate urgent and planned care into different sites which are known respectively as ‘hot’ and ‘cold’ sites, and this style of working has been increasing this year e.g. in North Tyneside.

Bringing care closer to home

Reducing hospital stays and bringing care closer to home are key objectives in the Long-term Plan and also its predecessor, the Five Year Forward View. Some innovative healthcare organisations have already successfully shown how it can be achieved. For example, Calderdale and Huddersfield NHS Foundation Trust has a day-case digital knee replacement surgery where some patients can have an operation and be discharged within 24 hours. Rehabilitation therapists can then remotely monitor the patient’s progress at home, via wearable technology in the form of a sensor worn by the patient.

System-Wide Key Performance Indicators (KPIs)

The NHS Oversight Framework (OF) for 2019/20 has replaced the provider Single Oversight Framework for hospitals and the CCG Improvement and Assessment Framework (IAF), which set annual targets for CCGs. It means that hospitals and CCGs must now work together to deliver on KPIs across their STP/ICS footprint.

Under the OF, KPIs are being set for individual disease areas. For example, indicators and targets have been set for around 20 different areas for cancer.

Market Access

Post-election, all health economies are due to publish new plans for their localities in response to the Long-term Plan. The deadline for these plans was originally set for mid-November but it has since been extended for at least another month.

The new plans are highly significant since they may impact on which drugs are used and how care pathways are provided. This means that, to a large extent, we are ending the year on a ‘wait and see’ basis.

It will be essential for pharma to conduct a locality by locality analysis of the new STP/ICS long term plans to define how clinicians fit into networks and who will be in the new decision-making units.  Pharma also needs to identify the clinical leaders who are tasked with managing transformation and who will be leading workstreams.

Pharma should also follow the specialist organisations that are working alongside ICSs and STPs on specific disease areas, such as Cancer Alliances.


There are golden opportunities for pharma to support local health economies in delivering key elements of the Long-term Plan. But the local NHS landscape is becoming increasingly complex and more change is on the horizon.

Pharma needs to take an increasingly tailored approach to customer engagement in 2020 and seek to understand the goals and aspirations of individual health economies as they continue to evolve in line with the NHS’s long-term vision.


Paul Midgley is Director of NHS Insight and Oli Hudson is Content Director, both at Wilmington Healthcare. For information on Wilmington Healthcare and to find out more about the latest developments in the NHS, including the role of PCNs, visit

19th December 2019


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