The new sustainability and transformation plans (STPs) — five-year plans for the future of health and care services in local areas — are going to reshape local health and social care in England.
With nearly 55 million people living in England, the 44 STPs aim to improve collaboration across local health and care organisations to help boost the health of the nation. For instance, from our reading of the plans, STPs could help reduce the incidence of stroke by ensuring patients with atrial fibrillation are prescribed anticoagulants, help reconfigure specialist cardiac services, improve asthma outcomes and lead to better management of long-term conditions.
Different way of working
The NHS has operated in a competitive environment since 1990 when the NHS and Community Care Act introduced the concept of the internal market. Now, STPs require NHS and local government leaders to collaborate to improve care based on local needs. This will dramatically change everyone’s way of thinking and working.
Some leaders are working together and talking through challenging issues, for instance, asking how they are going to integrate services for older people. But it will not be enough for leaders to hold business meetings. Frequent contacts, developing trust and looking at longer term change are required. The nature of the dialogue should be examined because, if it is an environment where leaders of organisations compete for a transaction, then they will not share useful information with others.
To address the financial challenges of the NHS, it is only right that there should be more collaboration between organisations. With the rise in chronic conditions, which cannot be treated with a single fix, patients will need care from a range of bodies, including pharmacy, which is also on the front line but often relegated to the margins of any large reshaping of the NHS landscape.
When leaders meet, they need to develop a shared purpose: a high-level vision where all people can live better and longer lives that can be cascaded back to their organisation to increase engagement among staff.
In health, with advances in technology, people are thinking through how they can shift resources to offer more care in the community to prevent hospital admissions.
It will be a challenge for the different organisations to collaborate in STPs. Many of the bodies with a healthcare function are already engaged with each other in the STPs, but not so with other groups such as local authorities, which are important because they provide services, too, such as rehabilitation for stroke sufferers.
STPs’ relationship with local councils has been patchy. In some areas, STP leads have been keen to share their plans with local councils, but this is not always the case.
Getting a foot in the door
Pharmacy owners, pharmacists and locums need to read the plans in their area, make frequent contact with the people and organisations involved in the STPs to ensure that pharmacy and pharmacists are on the radar. They need to make sure that any long-term plans firmly include the benefits to patients of pharmacy involvement. Sometimes it is going to be difficult to enter dialogue with STPs and it will be hard to identify the right people to engage with.
STPs will have different priorities in different regions, so it cannot be expected that they will treat pharmacy services the same. Some may want minor ailment services, others may not be interested in smoking cessation services, for instance. But not being involved means citizens with health challenges over the next five years may not reap the benefits of pharmacy services.