Predictions for the NHS in 2019

As 2018 comes to a close, we reflect on the year and all the changes witnessed in the NHS.  There’s been tremendous progress with the Five Year Forward View, from working at scale to providing extended access across the country.

As Matt Hancock took the reins as Secretary of State for Health and Social Care in July, he’s shared his vision of a digital NHS. So what’s to come in 2019?

We’ve asked our network of industry leaders on how they anticipate the NHS landscape will change in the year ahead.

DIGITAL HEALTHCARE IS THE FUTURE

Sultan Mahmud - Director of Integration at The Royal Wolverhampton NHS Trust

Providers (GPs, Community and Acute Trusts) will need to work together more than ever for more joined-up care. Commissioning is going to be progressively about convening, and it’s the providers who will need to show place and system level leadership.

• We need to create spaces for the intelligent conversation, and GP/Consultant job plans need to be looked at to allow this.
• Workforce challenges require a paradigm shift in thinking in care delivery, from one-to-one to one-to-many.
• Data will become even more important – multi-morbidity requires intelligent datasets, electronic tripwires and proactive co-ordinated action with GPs, Consultants and Community staff working from the same platform.
• Digital healthcare is the future, let's plan better for it now and seize the opportunity.

JOINED-UP CARE

Dr Farzana Hussain MRCGP - GP, Trainer, Appraiser and Coach at The Project Surgery
@fhussain73

At Newham Health Collaborative, our local GP Federation, we aim to see a more joined-up NHS where patients do not have duplication of services. We aim to achieve this by working with our partners in the community trust and public health, and of course our hard working GP practices. We already have a good foundation with our MDT meetings that occur regularly and include social workers, district nurses and care navigators. We aim to build on this. We would like to see truly integrated care across the borough.

The Project Surgery wants to continue to deliver patient-centred, family-friendly continuity of care to its patients, but also enjoy the benefits of working at scale and would like to be the lead in collaborating with other practices to build a primary care home.

I am a GP, working in Newham for 17 years, and would like to see not only the health of my own practice's patients improve, but also the health of the local population improve. Despite being economically deprived, Newham has one of the richest cultural mixes anywhere in the UK, and I would like to see all groups get equal access to healthcare.

IMPROVED ACCESS TO PRIMARY CARE

Melissa Morris - Founder & CEO, Lantum
@meliss_morris

Behind Matt Hancock's vision for a digital NHS, access to primary care is going to get better, as patients are going to have increasingly more options to self-book into appointments and have greater opportunity to access a doctor with Telehealth.

We can definitely anticipate a big increase in integrated working, as primary and secondary care share resources and develop a more cohesive way of partnering together. New technology will be the key to speeding this collaboration up, and integrated care will accelerate when shared patient records become realised and the workforce is mobilised.

There will be greater pressure than ever on the workforce and more burnout before it gets better, as things are still complex, demand is spiralling and Brexit will have an impact. Hopefully we'll see a rise in support for clinicians and their mental health, which is something we really care about. We would gladly support a charity that supports this - come forward!

MORE COLLABORATION

Dr Mayur Vibhuti - GP Partner at The Churchill Clinic 
@MayurVibhuti

In 2019, I hope to see a shift in NHS culture to be more open and collaborative, and less about ownership and hierarchy.

Ownership of contracts, businesses and titles, combined with egos that are concerned with protecting the few rather than the many, are key blockers for the spread and adoption of innovation and therefore change within the NHS.

SUSTAINABLE GENERAL PRACTICE

Dr Ishani Patel - Co-Founder at Lantum and Innovation Mentorship Programme at RCGP
@drishanipatel

For 2019, I predict a less fragmented NHS, and more joined up ways of working across primary, secondary, community and social care. Practices will be more willing to collaborate and innovate together, understanding they have more that unites them than divides them. This will establish a shared purpose and vision, renewing the excitement in the profession and delivering better care for patients.

Online consultations within the NHS is a rapidly growing sector and I look forward to seeing robust evaluation on how it relieves GP workload, improves access and patient experience and creates capacity in the system with safety at its core.

I hope more junior doctors apply for general practice as a speciality, bringing a much needed and valued sustainable energy to our profession.

BETTER ROTA SOLUTIONS

Sue Turner - Neighbourhood Operations Manager at Salford Primary Care Together

I believe the flexibility of the rota and service solutions will evolve to enable modelling and availability for the Urgent Treatment Centre model of care. This builds upon the successful coverage for the streaming service since Oct 2017. This new approach to rota and service solutions includes:

• trialling the rota visual solution to enable ease of access and ability to view a large set of service delivery areas in Salford.
• developing a worked up model of locum coverage that serves neighbourhood presenting needs at scale.

PRIMARY CARE NETWORKS

Dr Mark Spencer - GP at The Mount View Practice 
@markspen9999

2019 will see the increasing emergence of a new leadership culture right across the NHS; a culture that is based on compassion and understanding, rather than top-down hierarchy and bullying. I also think that Primary Care Networks will flourish, with groups of GP Practices and the full range of community based Primary Care services coming together to work in an integrated way and in a true equal partnership with the residents of that community.

I would also envisage Primary Care Networks taking clinical and financial control for addressing the health needs of their communities and also starting to turn around the recruitment/retention crisis that Primary Care currently faces.

NHS 10 YEAR PLAN

Antony Nelson - Managing Director at Conexus Healthcare Limited 
@antonydnelson

Much of what will happen in the NHS in 2019 will be tempered by, or viewed through the lens of, the current substitute for NHS political football; Brexit. In addition, the looming end of parliament 2020 election deadline will skew all sorts of projects; assuming of course that we don’t end up with an election in the middle of the year.

The 10 year NHS plan will finally be published; there will be a rush of organisations saying they know exactly what it means and here’s their tool that can enable you to respond to the long list of asks contained within.

The promised billions in extra funding will go into select capital projects, underwriting acute care overspends and additional money into Primary Care, although only those bits of Primary Care operating at scale and looking after population health.

Further consolidation of CCGs, the emergence of the STP/ICS as a force to be reckoned with along with the obligatory comments on HSJ pages about payments linked to the next round of NHSE & I redundancies.

COLLABORATION AND INNOVATION ACROSS HEALTHCARE

Dr Will Dawson - Chief Medical Officer at One Medical Group
@drwilld

As an organisation, we believe in improving lives in every sense. We hope to see a greater emphasis on population health management and the shift toward outcome based service provision and commissioning. Part of this is the continued shift ‘upstream’ toward proactive care and prevention that starts in and delivers long term benefits to local communities. There is a real opportunity to make significant inroads in challenging health inequalities through patient centred services that are co-produced by local people; created by communities for communities.

There will be a continued movement towards delivering services at scale through greater system collaboration. Innovation through new care service models, contracts and workforce development and not just technology platforms will be essential. In particular, a focus on aligning workforce to the needs of local populations and delivering improvements in health, rather than traditional thinking.

With the ongoing partnership review, we hope to see a greater understanding and openness to alternative career pathways for GPs and other primary care clinicians that promote an enjoyable and sustainable workplace. We believe that ‘resilience’ should be seen not as the ability to ‘survive’ rising workloads and stress, instead we should be creating workplaces that feel safe, not stressful, promote joy and wellbeing, and offer the right work/life balance for everyone.