The publication date represents a significant shift from previous annual guidance, coming three months earlier than normal, and covering two financial years (2017/18 and 2018/19) to enable more strategic planning. The guidance sets out detailed requirements for commissioner and provider plans, which will need to be agreed by both NHS England and NHS Improvement and must be submitted on 24 November.
The guidance sets out plans to make more sustainability and transformation funding available to providers in 2017/18 and 2018/19. This will be focused on emergency care, and is expected to deliver at least a pound for pound improvement in the financial positions. Transformation funding will be increasingly targeted to those Sustainability and Transformation Plans making most progress.
Sustainability and Transformation Plans (STPs)
The guidance re-emphasises the central role of Sustainability and Transformation Plans in delivering the Five Year Forward View, stating ‘Each STP becomes the route map for how the local NHS and its partners make a reality of the Five Year Forward View, within the Spending Review envelope. It provides the basis for operational planning and contracting.’
The guidance underlines the importance of working across organisations: ‘Good organisations cannot implement the Five Year Forward View and deliver the required productivity savings and care redesign in silos.’ Core baseline metrics for assessing STP performance will be published in November, focusing on finance, quality, and health outcomes and care redesign.
From April 2017, each STP area will have a financial control total that is the sum of the individual control totals. There will be some flexibility for organisational totals within the overall total, with permission from NHS England and NHS Improvement, but all local organisations will be accountable for staying within their own total and the overall STP total.
The latest guidance to STP leads is included in the annexe. Revised plans must be submitted by October 21 and leads are asked about the extent to which they have engaged stakeholders and the public to date, and how they plan to carry out further engagement with patients, communities and other partners, as well as clinicians and staff.
Support for patients and person centred care
The Planning guidance makes clear that system-wide changes are needed to deliver the Five Year Forward View, including improving preventative, primary and community based care, and “creating new relationships with patients and communities…The solutions will not come solely from within the NHS, but from patients and communities, and wider partnership including local government and the third sector; and effective public engagement will be essential to their success.
The nine ‘must do’ priorities set out in the 2015- 2020 shared planning guidance remain in place. Actions to meet these priorities include supporting self care and prevention, implementing the General Practice and Mental Health Forward Views, Cancer Taskforce report
The planning guidance also includes as an annexe the General Practice Forward View planning requirements, including:
- CCGs should plan to spend £3 a head as a one off investment for practice transformational support to implement changes aimed at freeing up GP time
- Funding to train care navigators and medical assistants for all practices
- An expectation for how CCGs will implement plans for care redesign for improved outcomes including how they will make better use of self care and technology
- £6 a head recurrent funding for extending GP opening hours; these can be provided on a hub basis.
It also states that ‘for people living with long term conditions, self care is usual care. STP footprints should ensure that people living with long term conditions with low levels of support, confidence to self care or activation, should undertake regular personalised care and support planning and are signposted to tailored support.” The single care plan this should create will be owned by the patient and shared with the system.’
Sarah Hutchinson is policy adviser at National Voices. You can contact Sarah via firstname.lastname@example.org.