24.08.16
STPs must not ‘starve services and force clinicians to do more with less’
The government must not use the new sustainability and transformation plans (STPs) as a vehicle to “starve services and force clinicians to do more with less”, the chair of the BMA’s GPs committee has said.
Dr Chaand Nagpaul noted that the much-anticipated STPs could provide an opportunity for health and social care providers to come together to develop a more integrated health service, with less duplication and bureaucracy, “but only if doctors are at the very heart of their growth and development to drive positive change”.
The NHS-led plans have come under criticism recently, and only this week local council leaders have called for an ‘equal role’ in chairing the footprints to deliver a common understanding of integration and redesigning services.
Dr Nagpaul noted that while the direction of travel is “potentially welcome” it is absolutely crucial that adequate funding, both in terms of up-front capital and long-term resource, is provided to ensure that any changes can make a difference.
“This will require ministers to address the overall woeful underfunding of the NHS and social care, in the face of the stark financial challenges already faced by the NHS and local authorities across the country,” he said.
The BMA noted that draft plans, which were submitted to NHS England at the end of June, aimed to identify gaps and duplications in health structures. NHSI last week also outlined the priority benchmark areas for STP consolidated business plans.
Recently NHS England’s CEO Simon Stevens, who has been reviewing the STPs with NHSI’s Jim Mackey, said plans are on track to be agreed by autumn, with “final sign off of most STPs by October”.
But a survey of NHS finance directors recently found that only 16% believe STPs will succeed in delivering sustainable care by 2021.
The BMA has now published guidance for doctors, which includes information about the plans, key priorities and an analysis of implications for members. It notes that the footprint-based nature of STPs means that the implications will vary depending on which area of the country doctors work in, as each footprint will have 3-5 priorities that they are focusing their time and resources on
It adds that STPs will bring together all previous transformation proposals under one umbrella and, therefore, should encourage more strategic planning across the footprint.
But the union said it is also possible that STPs will further complicate local decision-making, particularly if the STP footprint doesn’t match natural organisation/geographical alliances.
The guidance said: “STPs could result in decisions being made at different levels, making it unclear where ultimate accountability lies and the fact that different STPs will focus on different priorities could lead to increasing fragmentation. In addition, the accelerated timetable might mean decisions are made without a clear governance structure in place.
“In some cases, for example where STPs make changes to the way care in their area is delivered by introducing new models of care, STPs could also result in a shift in where you see and treat your patients or a change in which organisation employs you.”
The BMA said it is crucial that doctors and other key stakeholders engage in and influence the plans as they develop. While there is national direction and oversight of STPs, they are being developed locally. It advises doctors to contact their STP lead, LMC (local medical committee), LNC (local negotiating committee) or industrial relations officer to find out the best way to get involved.
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