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Sustainability and Transformation Plans: transforming patient care through GP services – Dr Arvind Madan

The purpose of Sustainability and Transformation Plans (STPs) is to help ensure health and social care services in England are built around the needs of local populations. In this blog, NHS England’s Director of Primary Care, Dr Arvind Madan, explains how they have the potential to completely transform the care patients receive through GP services.

As a GP, I have the privilege of playing a part in the health of my community and get to see what matters most to people. From their health services, it’s usually simple – they want to be able to talk to a trusted health professional when they feel they need to. They also want to feel they are getting the best possible treatment and care, if they need it, and reassurance at what can be a stressful time.

With the NHS, I’m proud to be part of an institution that people hold in high regard and to be one of hundreds of thousands of people across the country all working with a common cause – to provide the best possible care for our patients.

But weaknesses in the system are revealed at times of serious pressure on health and social care services. We see it in news headlines about A&E waiting times, pressure on hospital beds or trying to get a GP appointment. More importantly, it has impact on the usually great experience our patients have of the NHS.

The reasons for pressures are well-known – including a greater number of people living longer, many with complicated health needs. The NHS has always responded and adapted and we have its staff and volunteers to thank for this. But we have to strive for a better system that not only responds to pressures but can also innovate and reduce them.

I’m talking about more care and a greater range of health services closer to people’s homes in primary care. This is not a new solution. It’s been grappled with in NHS circles for years and is already happening in parts of the country.

Most people don’t need emergency services for the majority of their health needs. They have illnesses or conditions that can be managed in primary care and with self-care. Not only is this more convenient for patients, but greater capacity in primary care helps patients to manage their health, reducing their chance of needing emergency services. This ensures the best emergency care is available when people need it and it is the right thing to do in how we use precious resources.

Increasingly, more services are based in the community. The General Practice Forward View committed to support this with millions of pounds of investment to modernise buildings and technology in primary care and to house diagnostic equipment enabling a greater range of treatments, including minor surgery. These things were once the sole domain of the hospital. But this is no longer true, as more patients benefit from an expanding range of services closer to their homes.

To support this, staff are specialising in more areas. The General Practice Forward View committed to an extra 10,000 people working in general practice by 2021. This included, for example, 1,500 additional clinical pharmacists.  These experts can help patients with complex medicinal issues, and oversee the transition when patients leave hospital, particularly when different medication is involved. Clinical pharmacists’ contribution helps people to live independent lives and reduces the chance of them needing to go back to hospital.

Patients also need to know their options and more must be done to steer them to the right services. That’s why an additional £45 million will be invested over five years to allow reception and clerical staff in every GP practice in England to play a greater role in care navigation and handling paperwork, freeing up more of GPs’ time to see patients.

Historically, the health and social care system were not set up in a way that supports collaboration across services. Patients have to tell their story multiple times, with staff from various organisations delivering different elements of their care. Individual organisations have had different priorities and separate ring-fenced budgets. This doesn’t lend itself to health and social care services working as a unit, giving a seamless care experience for patients. At its worst, it has led to unhelpful competition and fragmentation, as each organisation works towards different priorities.

The time has come for more collaboration. The push for services to be situated in primary care is part of this, dissolving boundaries between general practice, outpatient services, community services, mental health and social care. This conversation has begun with the 44 Sustainability and Transformation Plans – working towards one health and social care system.

The central thread that ties them together is providing care closer to home, where this is safe, appropriate and cost-effective, in a strengthened primary care setting. Making it work won’t be easy and will need real commitment. But, in over 20 years as a frontline GP, this is the first time I have seen such a concerted effort to bring services and teams together in a way that makes sense for patients.


Arvind Madan

Dr Arvind Madan was appointed as NHS England’s Director of Primary Care in October 2015 with view to him providing clinical leadership for the transformation of primary care provision.

Arvind is a practicing GP based at the Hurley Group, a large multi-site general practice and urgent care provider. He retains this regular clinical commitment looking after patients in East London.

Arvind has a strong track record of using new technology and redesigned ways of working across care boundaries to improve outcomes and deliver better value for money.

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