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Stevens reiterates call for fundamental primary care redesign in STPs

NHS England CEO Simon Stevens has emphasised the importance of the NHS to undergo a redesign of primary care under STPs, insisting that general practices are no longer like the ‘corner shops’ of our communities.

Stevens stressed the need for the NHS to achieve substantial ‘service redesign’ in order to deliver upon its £22bn efficiency target in his speech at the NHS Providers conference last week. He also called for the NHS to make sure that money is well spent on tackling the ‘big’ health conditions like cancer and mental health and giving itself more financial headroom.

“When you think about [STPs], the ‘P’ really means three things. In some cases it’s a … set of proposals. In other cases the proposals are evolving into clear plans. In the most advanced places the plans are evolving into governance partnerships, with a pooling of sovereignty and formal mechanisms for actually taking common shared decisions for the population,” Stevens said in his speech, outlining his ideal vision for STPs.

“Within those the subset will evolve into population systems. There are places in the country that are now firmly heading down that path.”

Stevens identified primary care as the NHS’s ‘blindspot’, pointing out that there are 300 million encounters a year in GP surgeries in comparison with around 23 million in hospital A&E departments. He emphasised that if the availability of general practice comes under pressure it has an inevitable impact on hospital services.  

He reiterated his call for a move away from traditional GP practices to Multispecialty Community Providers (MCPs) becoming the focal point for a far wider range of care needed by registered patients.

But Dr Maureen Baker, the immediate past chair of the RCGP, warned recently that general practice risks losing £33m this year and £760m by 2020 due to CCG underspends and the roll out of STPs.

Stevens also commented that hospitals must be more frugal in their planning to achieve their financial targets too, such as cracking down on the use of clinical locums and agency staff. But, according to the latest King’s Fund quarterly report, a third of NHS providers recently forecast they will not meet their control totals.

“There are too many places with completely unaffordable medical consultant locuming,” Stevens said. “One of the things we should be taking a hard look at is any service where we are spending more than [£150,000] on medical locums for more than six months.”

“You need to be coming to [NHS England] or [NHS Improvement] to say that and NHSE will have to be taking the difficult decisions to stop it. The clue is in the word ‘unsustainable’ as we cannot continue to sustain it in the current operating model.”

When asked about chancellor Phillip Hammond’s controversial decision not to announce more funding for health services in the recent Autumn Statement, Stevens stated his belief that any extra funding that becomes available should go first to the adult social care sector rather than the NHS.

“I’ve not given up on the possibility that that’s what will come about. It’s a work in progress. I don’t think we’ve heard the final word on the subject,” he commented.

The continuous tension in the health service for extra funding has come even more to the fore of late, with councils and NHS experts expressing their disappointment after Hammond’s statement last week, arguing that social care must be the priority over the coming months to relieve pressure on NHS services.

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