UNDERSTANDING THE ROLE OF PLACE WITHIN THE NEW NHS: FIVE THINGS INDUSTRY NEEDS TO KNOW

The Health and Care Act encourages the NHS to think, plan and organise itself across three distinct tiers of management: system, place and neighbourhood. Of these, place tends to be the one we get most queries and questions about when discussing the new NHS landscape with pharma executives. So, to help, here are five things industry should bear in mind about place.

1. Place-Based Partnerships (PBPs) are increasingly important decision-making units at sub-system level, and are a crucial stakeholder group for pharma and med-tech
   
   

   PBPs are an alliance of organisations – including GP Federations, Primary Care Networks, Local Authorities, NHS Trusts, social enterprises, and charities – that work together on the planning and delivery of health and care services to support their populations.  Some are entirely new, others have grown out of existing partnerships across health and care, but all have an important role in the development and delivery of service plans across a given area.

   Integrated Care Boards (ICBs) are expected to invite the views of PBPs in the development of their five-year strategies, giving them considerable influence in the direction of travel within a given system. They also play a fundamental role in most to translating and operationalising these plans and priorities on the ground – in particular, it is through PBPs that many of the practical discussions about how to make pathway change a reality on the ground will happen.

   PBPs also help to join the dots at neighbourhood level, by helping to scale and integrate local activity. In particular, they are the main mechanism through which decision-makers within primary and community health networks connect with what is going on within the acute and tertiary providers – indeed, one of their main purposes is to improve join-up between primary, community and hospital care on behalf of their population.

2. The size and profile of PBPs varies considerably, and many are still finding their feet, with clear governance arrangements yet to be put in place.

   Place is a fluid and evolving concept within NHS management. There is no hard-and-fast boundary between what is PBP-led responsibility and what should be driven by the ICSs, creating a kaleidoscope of practices – while in many parts of the country the principles governing place-based decision-making and their relationship with the system are still taking shape.

   Indeed, analysis by the Health Service Journal shows there will be a total of 175 places within the 42 ICS areas in England. However, only 54% of these had governance arrangements in place and just 41% had appointed executive leaders. On top of this, as Georgia Butterworth of NHS Providers has shown, there are also significant differences in the size of the footprint covered by place. Some designated places in larger ICSs cover the same population size as a small ICS, for instance.

   An understanding of the scale and circumstance of each place will therefore need to be factored into the way industry engages across different territories.

3. There are some common principles emerging from the more established partnerships, which demonstrate the issues that PBPs are going to be most interested in.
   

   
   The Feel Good Barnsley Place Partnership is a typical example of what PBPs are tending to focus their attention on. It has developed a health and care plan based around four overarching aims: workforce growth; strengthening prevention; improving equity of access and joining up care and support for those with the greatest need.

   In practice, most of the plans coming out of PBPs translate into targeted action to support better population health, tackle health inequalities and improve the way health and care services work together to meet individual’s personalised needs and support the quality and sustainability of services.

   Of course, given the operational challenges facing providers, many PBPs will explore these through the prism of managing hospital demand and patient flow, with healthcare providers working with local authorities to improve discharge support and care, for example. They will also typically work ‘upstream’, often in partnership with charities, community groups and Primary Care Networks, to reduce the volume of preventable admissions through more assertive screening programmes and stronger community-based support.  

4. To cut-through, industry needs to engage PBPs on their own terms, framing their commercial offers in a way that supports their strategic goals of improving access, tackling inequalities and enabling flexible and joined up service delivery.
   
   

   Firstly, the clinicians and service leads who feed into place-level plans are fundamentally looking to improve pathways and population health outcomes on the basis of evidence and best practice – pharma and med tech organisations will need to consider what data and intelligence they can bring to the table.

   Secondly, high on the agenda of PBPs will be issues around workforce capacity – industry will therefore need to the resourcing benefits of innovation, by demonstrating how their propositions can take pressure off primary and secondary care services or provide greater clinical or operational efficiency.

   Thirdly, tackling health inequalities is also a paramount concern – so PBPs will be receptive to approaches that provide both an evidence base and new solutions to help local health and care organisations help a particular patient cohort or a set of unmet needs within a particular pathway.

5. In many cases, there will be a high degree of fluidity between System, Place and Neighbourhood organisations and their operational plans – understanding those relationships, and how they translate in terms of governance and delivery models, is extremely important.

To give an example, industry will need be aware of the role that Provider Collaboratives are playing within a particular place’s footprint, and how they work together with the PBP.

Though Provider Collaborative are largely a system-level construct, there will need to be connections drawn between the acute/tertiary part of pathway (typically organised at system level) and the post-discharge rehabilitation and care delivered at place level. As a result, many PBPs may work under contract with larger Provider Collaboratives to support these integrated care pathways.

Similarly, PBPs may work with neighbourhood-based organisations and networks (like PCNs) to provide scale across a wider footprint as well as connecting the priorities pursued by primary and community care organisation with the acute/tertiary providers within a town or district.

This underlines a fundamental point: that while we talk about system, place and neighbourhood as distinctive, compartmentalised terms, the reality on the ground will be more fluid, particularly as PBPs find their feet.

Understanding the individual dynamic across these levels, the supporting governance, and the way this translate into service delivery will remain crucial to the way industry engages with different place-based arrangements.

Wilmington Healthcare provides market leading data, insight and intelligence across the healthcare community. To find out more about how we can support your NHS partnerships, visit wilmingtonhealthcare.com.