Dr Matthew Dolman, Somerset CCG chairman and newly appointed senior responsible officer (SRO) for the county’s STP ‘footprint’ told GPonline he accepted many GP colleagues would see the plans and new structures as yet another layer of bureaucracy.
But he argued that primary care would benefit from STP plans being developed by health and social care commissioners and providers in 44 regions across England.
Each of the 44 STP areas - or 'footprints' - brings together five CCGs on average, covering all of England, and will aim to set out how the local system will improve health and wellbeing for the population, improve service quality and deliver financial stability and balance.
STPs will set out local plans to deliver the NHS Five Year Forward View. Local health systems are specifically required to plan for sustainable general practice and improve primary care infrastructure.
The GP Forward View published last week said that the STP process would lead to additional local investment for general practice.
Dr Dolman, who is seconded from the CCG to lead the Somerset STP, acknowledged that cynics would see the new new level of co-ordination as recreating regional health authorities. But he said the STP is more ‘sophisticated’, reflecting the evolving complexity of the modern health and care system.
The requirement for a new level of co-ordination, he said, was recognition that things have to be done differently to meet current challenges. ‘That's frustrating and may come across as another bureaucratic change, but in fact things are having constantly to evolve. But as long as the clinical leadership that's really important plays through … then this change is necessary.’
In Somerset the STP will set out new outcomes-based payment mechanisms to ensure funding is shifted into the community. Somerset has spent 18 months developing a new whole-system outcomes framework that the STP will build into contracts. In future, Dr Dolman said, contracts will incentivise providers to invest in ‘person centered care’.
‘It will incentivise bone [health] rather than hip surgery. That's where we know we have to move the thinking, so we get more rheumatologists into the system, more support to primary care to think about [osteoporosis] prevention rather than thinking about surgical procedures once they have broken their hips.’
Somerset has developed a ‘sophisticated model broken into domains’, Dr Dolman added. ‘One of the big challenges is that you won't see outcomes maybe for 20 years. So if you incentivise [measures to avoid] diabetic amputations, you wouldn't see [benefits] for many years, so you have to have metrics to take you through the journey. So we have a sophisticated framework working with hospitals, GPs, public health, citizens, to try and do that completely differently.’
Somerset is unusual among the 44 STP footprints in covering only one CCG. Most of the new local health systems cover several CCGs and populations of 1m-2m people.
New models of care
Dr Dolman said that for Somerset the STP is a continuation of work already ongoing in the country to commision and provide services differently including a programme to join up health and social care and a PACs new care model vanguard lead by Yeovil District Hospital with south Somerset GP practices.
The PACs programme will be a ‘core component’ of the STP, Dr Dolman said, which will seek to spread the lessons from the vanguard across the country.
‘The thinking’ of the local health system, said Dr Dolman, is to roll out the PACs model across the whole of Somerset. ‘We want to change a whole system. And we are constrained by workforce, recruitment, the money we haven't got, overspending. And a whole community of health and care wants to do things differently. So that is our ambition, to deliver high quality care, joined up, that gives a satisfying professional career for anyone coming in to Somerset,' he said.
‘The vanguards were predicated on the brief the STPs have, but small scale. So the different ways of primary care, extended primary care; in South Somerset, complex care hubs, health connectors in the community, all the stuff we are learning we are looking to push out and model if we can across the rest of Somerset.’
Dr Dolman is one four GPs among the 44 STP SROs. Other SROs include NHS trust chief executives, council chief executives and social care directors.
The Somerset GP said it was important for GPs to engage with the STP process despite it seeming like another wave of bureaucracy. ‘What is implicit in the Five Year Forward View is the key role primary care has moving forward and we’ll try to ensure in Somerset is that the STP plan engages with primary care,' he said.
But he added that he understands GPs will struggle to find the time. ‘It's about the energy on the ground. We are trying to support them to give them the time and space but I don't underestimate how difficult this is.’