Healthcare transformation?

It is sometimes very difficult keeping up with changes to health and social care arrangements. The NHS seems to delight in moving from one structure to another with a storm of new acronyms. But they have surpassed themselves this time and kept the same acronym (STP) and changed the meaning of it! STPs were originally Sustainable Transformation Plans, then Projects and now are Sustainable Transformation Partnerships!

What's in a 'P'?! I am really not sure that I know or indeed whether I am much clearer after last night.

And now this has all be overwritten with the agreement that Buckinghamshire should become an Accountable Care System.

NHS moves to end “fractured” care system

The head of NHS England will today (Thursday 15 June) pledge to end the “fractured” health and social care system that leaves too many patients “passed from pillar to post” by giving local leaders and communities more control over how they improve health and social care.

Addressing the NHS Confederation in Liverpool, Simon Stevens said: “As the NHS approaches its 70th Birthday, we are now embarked on the biggest national move to integrating care of any major western country. For patients this means better joined up services in place of what has often been a fragmented system that passes people from pillar to post.”

He announced nine areas in England – covering some seven million people – which will be the forefront of nationwide action to provide joined up, better coordinated care breaking down the barriers between GPs and hospitals, physical and mental healthcare, social care and the NHS.

Eight ‘accountable care systems’ (ACSs) will bring together local NHS organisations, often in partnership with social care services and the voluntary sector. They build on the learning from and early results of NHS England’s new care model ‘vanguards’, which are slowing emergency hospitalisations growth by up to two thirds compared with other less integrated parts of the country.

Bucks is one of these eight. And so in an effort to keep local people informed, Buckingham Town Council asked the local Clinical Commissioning Group to come to a public meeting and explain what changes were in train. The CCG set the date as last night (20 July) and I understand the only available space was the sports hall up at the new Lace Hill Sports and Community Centre. About 120 people turned up despite some saying it was not well advertised.

Before this meeting happened, it became clear that the proposal to build a new medical centre on the available ground on Lace Hill could (and I stress could) mean all the doctors' surgeries closing in the centre of town. Unsurprisingly many people have taken to social media to express their concerns about this change and many of them them turned up to the meeting yesterday. As this was known to be an issue, two GPs (Dr Jonathan Pryse and Dr George Gavriel) from the Swan Practice were late entrants to the panel. Details of all the panel below

The speakers also included: Nicola Lester, Director of Transformation from the CCGs.

So what did we learn?

With regard to the ACS, plans are afoot but how exactly this is going to transform local care, is still very difficult to say. Ms Lester presented this slide by way of an explanation of the aimed for new system:

I think this all pivots on having "community hubs" akin to what is being developed in Thame and Marlow at the moment. If you have the time, read this document for more explanation. I think there is also planned to be a more comprehensive triage done over the phone so that patients / clients are directed to the part of the health system that they need to access.

But in all honesty it is still a bit of mystery to me, as I do not live and breathe 'NHSspeak'. We were shown a video from Dorset which is apparently providing the template for services in our neck of the woods...

Dr Graham Jackson explained that the CCG would be putting up more information on their website soon as a start of further consultation and explanation. Here is a starter for ten for those who want to keep themselves appraised of these changes. Once I hear of anything more, I will add the links here.

Ms Lester went on to explain the "magnificent seven" core features of the new health care system that she is directing transformation towards:

The seventh is now dignity of care which has just been added to this list.

Dr Tina Kenny explained the role of the NHS Trust in all this with much enthusiasm and a helpful palpable case study but...

I think my overall view, at this point, is watch this space for something that makes more sense beyond all the jargon and elaborate diagrams. The direction of travel appears to be towards what I thought health and social care should always have been about: seamless & multi-disciplinary care than meets the needs / requirements of patients and communities. But what do I know...?! (If you think I have missed things, then do please tell me. I would love to understand this better...!)

So then we came to questions and pretty soon, the discussion got into the future developments of the surgeries in town and the planned creation of a medical centre at Lace Hill (details here). The Design and Access statement can be accessed via this FaceBook post by me a couple of weeks ago.

It was left to Dr Pryse & Dr Gavriel to explain the challenges they have with managing a multiple site practice, difficulties in recruiting staff (including GPs), the access the challenges they face and shear shortage of space. The new medical centre is designed to overcome most of these problems. I think their earnest ambitions to provide better healthcare for all was evident to see. Dr Pryse admitted that their original intent was to keep open some GP facilities in the town centre but it was now proving difficult to make all the figures add up. But, he explained, nothing is fixed as yet and certainly he was given plenty of guidance from his patients present at the meeting that having a town centre location was essential. There is much more water to flow under the bridge on this, clearly.

And I would encourage people to write with their concerns not only to the Swan Practice but also critically to the Clinical Commissioning Group (CCG). They, after all, hold the purse strings on all this. What was not evident last night was much sense of partnership between the CCG and the Swan Practice. It would have been helpful to hear the CCG Clinical Chair express his backing for the moves and a commitment to working with the GPs to find a workable solution... that did not happen in my earshot. Some more public statements on this would be welcome, I feel.

And moreover, I did not get the sense of any great partnership between the NHS services and County's social care ones. We all know that health and social care need to work together hand in glove and while there are plans afoot to do some more 'joining up' through the 'Better Care Fund', more explanation could have been provided. And moreover, a public and clear commitment by the Buckinghamshire officers and councillors present to be active and diligent participants with all the system, to make it work and find ways to sort the doctors' surgery issue was somewhat absent from last night's meeting.

More needs to be done to really join things up, it seems to me...

And so good that the meeting happened, but there is a long way to go yet! Meanwhile, here I am opening the meeting up (thanks for the pic Cllr Robin Stuchbury).