The Coffee Break No. 64; 21/01/2019

News updates this fortnight covers the future of the NHS, improvement and integrated care. The coffee break is split into sections so you can easily scroll through each area of interest.


Future of the NHS

Firstly this fortnight, with the recent publication of the NHS Long-Term Plan we look at 3 articles discussing the plan.

NHS England have published an article entitled ‘Local NHS allocated £570 billion to fund the NHS Long Term Plan’. The article explains that “every area in England will receive a cash increase of at least 17% over the next five years, including a minimum rise of 4.4% next year.” Simon Stevens quotes that “it will fund cutting edge treatments such as genome tests for every child with cancer, build up community services to provide more joined up care while taking pressure off hospitals and address the unmet need for mental health services.”

The NHS Confederation give their response to the publication of the NHS Long-Term Plan. Matthew Winn, Chair of the Community Network said: “A shift in focus towards prevention and community care will help ensure people can live healthier, longer lives, and receive care in or close to their homes, reducing admissions and demand on already over-stretched hospitals.”

The British Medical Journal has published an opinion piece regarding ambitions for new primary care networks. “Primary care networks (PCNs) are a key part of the NHS Long Term Plan. Based on the plan, all GP practices are required to be in a network of around 30-50,000 registered patients by June 2019, and clinical commissioning groups (CCGs) are required to commit recurrent funding to develop and maintain them. ”

The BMJ have reviewed the research on GP collaborations, and examine three areas which they believe policymakers should consider before more detailed guidance is developed on PCNs. The questions they discuss are: What can networks achieve, and when? Should they be geographically mandated? What’s the right size?



Moving on, Abraar Khan, an internal medicine resident at the Brigham and Women’s Hospital, authors a frank blog article in the British Medical Journal. He asks why doctors do things and answers because “that’s the way we’ve always done it”. He goes on to discuss “The reality of medicine is that there are many things we as doctors do for absolutely no reason. That is to say, there is no evidence (randomised controlled trial or otherwise) for doing them, other than – that’s the way we’ve always done it.” Abraar Khan gives an example of a patient on his ward rounds who had been relatively stable for a few days. The patient complained of a disturbed night’s sleep due to his vital signs being checked overnight. Abraar questions were the checks truly necessary and could they be discontinued to give him more comfort, but also, from a clinical perspective, he no longer needed them.


Integrated Care

With community services central to the plans for the future of the health and care system and the NHS’s new long term plans ambitions to support “out of hospital care” the Kings Fund have published a concise and detailed article explaining what Community Services are. The Kings Fund reasons that despite their vital contribution, community services are poorly understood. In their explainer they set out what these services are, the challenges they are facing and how they are changing.

Lastly, NHS England have published an article examining Somerset’s pioneering ‘Homefirst’ scheme which offers patients who are healthy enough, help to finish their therapy at home. Homefirst is delivered by specialist teams of staff who are able to help patients, once they are home, regain their independence faster. “Instead of waiting to complete assessments, such as walking the ward, in a busy unfamiliar place, people for whom it’s safe to do so can be discharged home at the right time and get support for important tasks, based on their home and enabling a quicker and happier recovery.”