First community services spec will tie it to primary care

This intention was set out in papers on primary care and community services at a joint meeting of NHSE and NHS Improvement today.

NHS England will also develop a new community services programme, called “ageing well”, with four main priorities, the board paper said.

Two of the four match up to service specifications required in the five-year primary care network contract. These are better NHS support for people living in care homes – where PCNs will have responsibility for delivery – and implementing ”anticipatory care for complex patients at risk of unwarranted health outcomes”. The latter requires both primary and community care clinicians together in multidisciplinary teams.

Nikki Kanani, NHSE’s acting clinical director of primary care, said this week that these services would go towards NHSE’s ambitions for PCNs to help “get rid of that historical divide between primary medical services and community health services”.

She said: “We want the primary care networks to think about actually what does this whole population need as opposed to what does general practice need for this population.”

A third of the four programme priorities, set out in the board paper today, is for improving the response time of community health crisis services to two hours, and providing reablement care within two days of referral, in line with NICE guidelines. It wants these targets met across England by 2023-24.

The fourth is addressing workforce problems, including “a big workforce expansion”, and seeking efficiencies by implementing the Carter review for community services, which found considerable savings could be made in clinical and workforce productivity.

Integrating primary and community care services will be helped by a requirement in the NHS standard contract from 1 July this year for community services to configure their teams around PCN footprints.

“Obviously given the fact that this is about primary care working with community services to deliver this… we need to find the right way of articulating in those service specs the totality of the service, not just the primary care bit because, otherwise, it won’t work,” Ian Dodge, NHSE national director for strategy and innovation, said at a press briefing on Wednesday.

The new services specifications will be phased in line with growth funding for community health services over the next four years, which was also set out nationally at the board meeting today.

The long-term plan promised a ring-fenced uplift of £4.5bn for primary and community services from this year to 2023-24.

Under rules set out today, from April 2020, each NHS region will be obliged to spend a minimum amount of cash on top of their current allocations on these sectors. This requirement will then fall on each ICS from April 2023.

This model is meant to give regions “some flexibility in the three years between 2020 and 2023” while “avoid[ing] unrealistic backloading”, according to the board paper. 

Mr Dodge said: “There are systems that may be much more stretched than others and it may be harder to deliver that guarantee in that system, say, in the first year. If that is the case, that region makes sure that another part of their system overdelivers against the guarantee so that each region hits a hard number.”

They must honour the primary care network entitlements, as defined in the five-year network contract, as well as spend their agreed share of the remaining cash each year.

The baseline spending will be 2018-19’s planned spend which means, Mr Dodge said: “If a system now is disinvesting from some of the things that were in their baseline spend for 2018-19, then the risk is they’ll have to execute a bit of a [U-turn] in order to then make it up again come 2020-21.

“All CCGs have been funded fully for their share of the [primary and community growth] guarantee, it’s in their allocations already, so it’s kind of like a ring fence within the budgets that they’ve already been allocated.”