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How has the pandemic reshaped the NHS in 2020?

Oli Hudson, of Wilmington Healthcare, explores the major changes that have occurred across the NHS as key aspects of the Long Term Plan are rolled out at speed.

Introduction

At the start of 2020, the NHS was working on the next stage of its Long Term Plan defining how key aspects, such as integrated systems and moving more care out of hospitals, would work in practice.

However, day-to-day working in the NHS dramatically changed when Covid-19 presented the system with what its leaders have described as ‘arguably the greatest challenge it has faced since its creation.’

Funding

One of the most significant financial changes was the suspension of payment by results (PbR), and the announcement that all NHS trusts and foundation trusts would move to block contract payments for an initial period from 1 April to 31 July 2020.

This was followed, in September, by a new ‘system-level’ funding arrangement that supports integrated working by enabling large sums of money to be released to healthcare systems for distribution, rather than to individual providers.

System-level funding, combined with other joined-up finance approaches already in operation, such as blended payments, will support the holistic approach advocated by the NHS Long Term Plan.

Digital services

Covid-19 has expedited digital patient engagement, which was a fundamental aspect of the Long Term Plan. The plan also advocated a similar expansion of online consultations in secondary care and this style of working has begun to be adopted.

Some services will still need to be delivered in hospitals although service locations are changing as part of the acute care reconfiguration that has been happening this year in terms of hot/cold, and general/specialist sites.

Homecare

Covid-19 has created an urgent need to keep patients out of hospital where possible. This issue, which was another key Long Term Plan aspiration, has led to the creation of new pathways to enable treatment to be provided in the community or at home.

Patient safety, with regard to how a particular drug fits into the new Covid-friendly pathways, continues to be a critical factor for immunocompromised patients and this has been having a big impact on the pharma industry.

The changes needed to support care in the community in terms of NHS structure had already begun to take shape in 2019 with the introduction of Primary Care Networks (PCNs).  Care homes are a key area that will come under the aegis of GPs, who in their PCN contract have responsibility for managing these patients in-situ and reducing referrals. This is just one area in which they will play a critical role in delivering key aspects of the Long Term Plan, managing the pandemic and implementing the Reset.

The NHS Reset

In July, the NHS entered the Covid-19 recovery phase, where it set about tackling the elective care waiting list and restoring capacity while continuing to work towards key Long Term Plan ambitions.  However, the onset of a second wave of covid-19 in the autumn has hampered progress.

The NHS Reset, which aims to build on the positive changes that Covid-19 has brought to the NHS and to ensure that all pathways and services are reformed with a focus on innovation and system-wide change, will be critical in helping the NHS to tackle the challenges that lie ahead.

Many of the primary objectives of the Reset align with the NHS Long Term Plan, particularly around keeping patients out of hospital, where possible, and treating them at home or in the community.

Managing early discharge and risk monitoring will be essential to prevent hospital admissions.  More patients will be triaged remotely, and the Reset will find ways to make this as efficient and safe as possible while reducing hand-offs and appointments to maximise capacity. Technology will be key to driving these changes.

Market access 

Digital channels have become the primary method of customer engagement for pharma this year and this is expected to continue post-pandemic. Pharma needs to think creatively about how it can utilise digital channels in various forms and tailor content to different stakeholder groups, while allowing for face-to-face engagement, if required.

All pathways are being reviewed and pharma needs to work in partnership with the NHS to develop them. To achieve this, industry needs to understand how money flows through the NHS in the new funding structures and determine how it can deliver wider benefits to the system.

Industry also needs to understand where blockages are occurring in the system, including those related to the pandemic such as the elective care backlog and undiagnosed long-term conditions. To achieve this, it will need granular data to risk stratify cohorts of patients, determine how they can be managed, who will be responsible for them and whether additional training and resources may be required.

Conclusion

As 2020 draws to a close, the NHS continues to face unprecedented challenges.

The NHS Reset will be critical in enabling the NHS to capitalise on the progress that has been made in 2020 and to navigate the way ahead next year in line with key Long Term Plan aspirations.

Pharma has already shown how it can work in true partnership with the NHS during the pandemic and there is now a real opportunity for industry to get involved in the changes that are now occurring across patient pathways.

Ends

Oli Hudson is Content Director at Wilmington Healthcare. For information on Wilmington Healthcare, visit www.wilmingtonhealthcare.com

15th December 2020

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Wilmington Healthcare

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