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How does the government plan to reshape the NHS?

Oli Hudson, of Wilmington Healthcare, explores the government’s new white paper, which proposes key reforms for health and social care

Introduction

The Government’s new white paper solidifies and codifies much of what has been happening in health policy around integration over the past five years, as reflected in the NHS Long-term Plan and the Five Year Forward View.

Indeed the ‘Integration and Innovation: working together to improve health and social care for all’, white paper, which lays out legislative proposals for a Health and Care Bill, indicates a clear shift to collaborative working. 

In this article, we will explore key elements of the document, including its plans for integrated care, the potential impact of more central government intervention and the proposed introduction of national medicines registries.

Integrated care

The white paper confirms that NHS England (NHSE) is backing legislation to abolish Clinical Commissioning Groups (CCGs). This could see the core statutory functions of CCGs absorbed into Integrated Care Systems (ICSs), which will ultimately become statutory bodies. Alternatively, CCGs may merge to become ICS-sized structures.

These changes are likely to affect Area Prescribing Committees (APCs). For example, if two or three CCGs that currently have separate APCs merge to fit the size of an ICS, or are absorbed into the system, then the number of APCs could decline.

Other changes needed to facilitate joined-up working include integrated finances with ‘a single pot’ of money shared between ICSs or groups of providers.

Also of particular note in the white paper is the inclusion of NHSE’s recommendation for a reserve power to set a capital spending limit on Foundation Trusts – a move which underlines the system-level approach.

The structural changes needed to facilitate integrated care have major implications for territory and account planning for pharma. Key stakeholder maps will need to be constantly updated as the move towards ICSs continues apace, and CCGs are expected to merge at scale and pace.

In finance, industry will need to identify the payers in the new organisations that are emerging, including the people who control rebates, and track how APCs are operating and on whose behalf.

Government control

Under the proposals, the government would be able to get involved in decisions on local ‘reconfigurations’ – i.e. the work undertaken by each part of the system. In many areas, this may involve plans to close or downgrade hospitals as more services are moved out of secondary care – decisions that are, of course, likely to be highly contentious within the local communities these hospitals serve.

As some critics have pointed out, the new proposed central powers could, therefore, come at a price for the government since the public would be likely to blame it generally for unpopular decisions around services or setbacks rather than local healthcare system leaders.

On a national scale, the government also wants powers to intervene in, direct and oversee the work of NHSE itself, which threatens to remove its current independence in making decisions about the future of services.

Medicines Registries

One area mentioned in the white paper that is of particular significance for industry is the proposed introduction of national medicines registries. Under the scheme, the Medicines and Healthcare products Regulatory Agency (MHRA) would develop and maintain publicly funded and operated medicines registries, and work with the NHS to populate and maintain them where there is a clear patient safety or other important clinical interest.

The medicines registries would provide patients and their prescribers, as well as regulators and the NHS, with the information they need to make evidence-based decisions and would include an element of patient reported outcome measures.

Currently, the MHRA receives data from pharma companies when there is a knowledge gap, or when it is needed to make a decision on efficacy or safety, however, the new medicines registries would give a more joined up view.

Medicines registries could provide an opportunity for pharma to be proactive in gathering real-world data around patient experience. This could help back up clinical trial results and inform industry’s value propositions, particularly around high cost drugs.

Conclusion

While the prospect of more central government control places a question mark over the autonomy of decision-making at both local and NHSE levels, the white paper makes it clear that the Government is committed to delivering integrated care.

Consequently, this year, we expect to see the move towards population-based healthcare, joint accountability for patients in systems and shared local budgeting, continue to gather pace, prior to ICSs being given statutory powers.

This will bring major changes for pharma from the need to regularly review its key stakeholder maps to the ability to fully embrace the whole system approach and ensure that its value propositions help the NHS to improve patient outcomes and also deliver on wider priorities.

Ends

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

14th April 2021

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