Two-year planning guidance offers flexible STP financial control totals

NHS England’s first two-year operational planning guidance has set out strict new requirements for providers to meet the challenges facing the NHS in 2017-18 and 2018-19.

To help NHS trusts meet the new performance and financial challenges, the guidance covers two financial years and has been published three months earlier than usual.

It says that trusts are still required to deliver the Five Year Forward View, but warns: “Good organisations cannot implement the Five Year Forward View and deliver the required productivity savings and care redesign in silos.”

It then added: “We need new care models that break down the boundaries between different types of provider, and foster stronger collaboration across services.”

The report said that there is a need to “settle the numbers earlier” in order to end “adversarial and transactional relationships” as NHS organisations compete for resources.

The guidance is underpinned by the first two-year tariff and two-year NHS Standard Contract.

It said that two-year contracts will now become “the default” and the planning and contracting process will be “streamlined significantly”, including by cutting production costs and promoting partnership between organisations.

Simon Stevens, chief executive of NHS England, commented: “Today we’re taking action to support collaborative action across the health service with fresh funding and practical measures to enable the NHS and our partners to deliver improvement, including in cancer, mental health, learning disabilities, primary care and urgent & emergency care.”

However, Dr Graham Jackson, co-chair of NHS Clinical Commissioners and chair of NHS Aylesbury Vale CCG, argued: “The timescales that the planning guidance sets out for delivery will be challenging to achieve.

“This is a matter of particular concern this year given that contracts will be signed over a two year period rather than one – something that if we get it right will lead to increased stability and certainty for the system and better patient outcomes, but if rushed could lead to unsatisfactory results for commissioners, providers and most importantly our local patients.  

“While increased efficiency is essential, we must not lose sight of the need to maintain clinical and quality standards in the drive to achieve this.”

Flexible STP financial control totals

The guidance noted that local health areas are still required to implement their sustainability and transformation plan (STP) milestones as planned and deliver the STPs by 2020-21.

To help organisations to work more effectively on their STPs, the 44 footprint areas will now be able to apply for their own system-wide financial control totals, enabling them to “pool resources across organisations and make it easier to shift money to support care improvement and redesign”.

“To ensure that organisational boundaries and perverse financial incentives do not get in the way of transformation, from April 2017 each STP (or agreed population/geographical area) will have a financial control total that is also the summation of the individual organisational control totals,” the guidance said.

“All organisations will be held accountable for delivering both their individual control total and the overall system control total. It will be possible to flex individual organisational control totals within that system control total, by application and with the agreement of NHS England and NHS Improvement.”

Dr Amanda Doyle, NHSCC’s co-chair, said the organisation welcomed the commitment to support STP delivery “along with the increased focus it sets for planning at local level and the measures to encourage a more collaborative approach with risk-sharing across the system”.

Specialist services

Local areas will also be required to set out plans on how to implement the GP Forward View, and deliver planned reforms in emergency, cancer, mental health and learning disability care.

For example, by November 2017 urgent network specialist services are required to meet the four priority standards for the seven-day NHS.

Similarly, targets for mental health include ensuring at least 19% of people with anxiety and depression access treatment; that community crisis resolution services are available 24/7; and that out-of-area placements for acute care are eliminated by 2021.

NHS England also announced it will offer financial incentives for trusts to provide mental health care to the 0.25% of most frequent patients in their A&E.

Jim Mackey, chief executive of NHS Improvement, said: “The NHS has a real challenge on its hands, but the action we’re setting out today will help the service pull together to make sure it can meet the needs of patients well into the future.

“Two-year operational plans, based on the STPs already being developed in each local health system, will create much greater stability and certainty for providers and the local communities they serve.

“Making sure that providers and commissioners can work together to provide high-quality care, within the resources available to the NHS, is central to getting the most out of the opportunities set out in this joint planning guidance.”

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