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31.08.16

STPs: A mile wide and an inch deep?

Mark Spencer New NHS AllianceDr Mark Spencer, co-chair of the New NHS Alliance, explains why sustainability and transformation plans (STPs) seem to be more about slash and burn rather than transformation at present. 

I recently heard a phrase that was used in the context of how to go about making sustained and meaningful change. The analogy was to look at an issue as if it was an inch wide and a mile deep; i.e, to really get into the detail. Unfortunately, the more I read about STPs the more it becomes clear to me that many are a mile wide and only an inch deep.  

Money will be saved by “rationalising” A&E services, by closing hospital wards, or even whole hospitals, and by a refreshed focus on prevention and self-care. However, there is sparse detail on the “how” or the “who”. The detail regarding the role of primary care in the new world appears to be missing. 

I believe the reason for this is an almost complete lack of primary care input into putting those plans together.  Some STPs have hospital trust ex-chief executives as their chairs who have little interest or respect for primary care. This means that we are battling against a culture of the old order.  

“GPs will do it” would seem to be a much-repeated mantra. Really? STPs should be closely examined to determine the extent to which primary care was included. 

Unchanging 

It is clear that far from being transformational, the “new” system is unchanging despite all the rhetoric. What has happened to clinical leadership, and specifically primary care leadership in the new NHS? It would appear to have been offered a back seat in the process, if any seat at all.  

The primary care workforce will be the ones who will need to deliver the transformation plans and yet, to date, there has been little, if any, involvement

New Models of Care require integrated provision across primary and community services, with Multi-disciplinary Community Providers (MCPs) being put forward as one of the solutions. Where are they going to come from? Where is the leadership? Where is the local ownership? Where is the buy-in from practices and frontline clinicians? A failure to take the local workforce along this journey will result in stagnation at best and a complete collapse at worst. 

It is imperative that not only existing primary care leaders be included in the planning process, but also emergent, young leaders who will take responsibility for ensuring that transformation then becomes sustainable in the long term.  

At present STPs seem to be more about slash and burn rather than transformation. In some areas they will do some good things, but in most places they are there to solve the hospital overspend questions. We’ve been here before; ground hog day revisited? 

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