Election fever!

The campaign trail injects further uncertainty
into a period of significant change for the NHS

The General Election announced for July, with purdah pre-election and consequent changes in people and policy after, is a source of further uncertainty for the NHS.

This comes as the health service was already facing a period of significant change, and this rapidly shifting landscape creates major challenges for pharma.

There were already big challenges within the healthcare system in England and a likely change of government (if the polls are to be believed) will ramp up the pressure on an NHS already facing some significant difficulties.

Exacerbated by the pandemic and industrial action, waiting lists are now the longest they’ve ever been, with over six million patients awaiting critical treatments.

Keir Starmer has announced Labour’s six first steps if it wins an election and this included ‘Cutting NHS waiting lists by providing 40,000 more appointments each week’, but with no clear plan on how to achieve this, it currently doesn’t present a solution to an overwhelmed healthcare system.

Workforce shortages further strain the system, posing significant barriers to timely access to care, and currently 75% of people are waiting over the 62-day target to get cancer treatment, highlighting the need for systemic reforms to address underlying inefficiencies and shortfalls in healthcare provision.

This environment presents a significant challenge in ensuring equal access to treatment and medicines.

There is an opportunity for a deep dive NHS landscape analysis to really understand what the impact of changes to the health sector mean for the pharmaceutical markets and how pathways can be reviewed to ensure the best outcomes for patients.

GPs and practice teams are seeing more demand than they’ve ever seen before and patient satisfaction in general practice is at an all-time low.

There were over 30 million appointments last year, which is an increase of 11% since before the pandemic.

The current five-year framework that has introduced some positive changes to general practice over recent years, is due to end this year in England. It was expected that this framework would be rolled over in an election year, but now the election has been called this leads to more uncertainty.

A review of this framework could lead to amendments in how general practice is commissioned.

Looking back over the last four years, there has been a real drive to improve patient access in general practice through the Additional Roles Reimbursement Scheme (ARRS), which has bolstered the primary care workforce and new roles, for example enhanced nurse roles have been added to the scheme.

In recent conversation with Laura Norton, Chief Operating Officer, Northwest Leicestershire GP Federation she said: “A big risk associated with this uncertainty brought about by the late publication of the planning guidance and the expected rollover of the five-year framework, is that it’s much harder for organisations to take risks and innovate when they can’t plan, as it creates short termism, which doesn’t necessarily lead to the highest quality services.”

While the manifestos have yet to be published, it is likely that a change of government would bring a completely different primary care regime and the DHSC is also currently consulting on the ‘role of incentive schemes in general practice’, which includes schemes such as the quality and outcomes framework and investment and impact funding (IIF).

The IIF forms part of the Directed Enhanced Service (DES) contract and is an additional financial incentive scheme for primary care networks (PCNs).

These incentive schemes are used as a top up of funding where GP practices are required to meet certain targets to access these funds.

Some of them are linked to medicine safety, patient experience, or learning disabilities checks for example.

There is a new 2024/25 PCN contract DES that focuses on using a population health management data-driven approach for better outcomes for patients.

It contributes to the delivery of proactive care to prevent hospital admissions and the contract has a focus on collaboration and value for money.

Understanding that these incentivisation schemes in general practice are under review and could impact policy from 2025 onwards is important for industry partners.

The pharmaceutical industry has traditionally worked with primary care as part of these incentivisation schemes, so influencing through this consultation process is an opportunity.

PCNs are approaching current challenges in different ways depending on the needs of their populations and the maturity of the network. Some of them are focusing on health inequalities and some specifically on cancer referrals and improving patient access.

A field-based market access team needs to understand these challenges and make sure that a value proposition could be scaled to either PCN or integrated care board (ICB) level to drive change for the life sciences industry.

Laura Norton confirms that “The life sciences industry are getting better at understanding the different motivators for PCNs. It’s about developing relationships to understand the specifics of each network and what the opportunities might be for the short- and longer-term benefits.”

One of the big changes on the horizon for 2024 has been the devolution of the specialised commissioning budget. Over the past 18 months NHS England (NHSE) issued plans to delegate the commissioning of 59 out of 154 specialist services to ICBs.

Moving the decision-making and commissioning of these specialised services closer to the vulnerable patients and the communities who need them, will have a positive impact on patient care.

So, although this brings more uncertainty, there’s also opportunity to drive meaningful change for patients.

From 1st April just over 50% of ICBs have taken responsibility for the service delivery and the commissioning of those 59 services, and the other half of the ICBs will maintain a joint commissioning arrangement with NHSE to ensure the safety of that transition.

There will be regulatory governance from NHSE in this transition to mitigate potential risks.

This will be interesting from a field market access perspective as there could be over 1,000 different services involved where ICBs may wish to change provision configuration.

Those ICBs that will become responsible for these services, are being given a ring-fenced specialised commissioning budget as they try to streamline services and work better with local communities.

There may also be opportunities to make cost efficiencies by selecting one provider within an integrated care system and potentially use the ring-fenced budget to invest in other areas within the community.

The ring-fencing of this funding arrangement is important for the healthcare industry.

Meanwhile, NHSE has confirmed that the commercial and funding approaches for both high-cost drugs and devices will be controlled nationally, with a strong national clinical leadership through the foundation of 42 Clinical Reference Groups across the specialised services.

The review of the financial arrangements over the next year could provide the healthcare industry with an exciting opportunity to partner with ICBs and be involved in that review while they move from a provider-led arrangement to being a population needs-based service.

The aim is for this to lead to a more sustainable healthcare system, as currently 70% of the NHS budget is spent on secondary care, which has increased by 7% since 2015, so spending more efficiently on out-of-hospital care focused on population health needs is essential.

Specialised cancer services for adults are included in the 59 services within this new arrangement. Cancer services are complex to navigate so this could be quite a significant change.

Previously some of these pathways have been high cost and low volume so this brings an opportunity to integrate using the same providers across the whole pathway to deliver better outcomes.

The NHS has a wealth of data and the level of sophistication and intelligence on those data sets has increased enormously in the last ten years.

This supports the health service to move from being reactive to being much more proactive, which can only be done through the use of sophisticated and intelligent data sets.

The DHSC has commissioned the federated data platform to manage hospital data to improve patient care and tackle waiting lists. Wes Streeting, the shadow health secretary and potentially the next Secretary of State for Health and Social Care, has recently said that Labour would like to extend this to include primary care.

How healthcare data is articulated and presented is key to show where change is needed. Data can have a powerful message if it’s delivered correctly and industry should be using data to demonstrate impact and to address the big challenges for the NHS.

There is a huge workforce issue at the moment and lots of Trusts are in financial deficit – can this data demonstrate a clinical impact of innovative products within the pathway to support this narrative.

There are 30% less commercial clinical trials taking place in the UK than five years ago. Currently finding people to take part in clinical trials is an additional burden for the NHS as it holds the data and identifies patients.

A new system of patient self-selection would remove this additional workload, while making sure the UK stays competitive in the innovative landscape of developing and launching new treatments and technologies.

The Tony Blair Institute recently published the third in a series of papers that highlighted the current global revolution in science and technology.

The third paper highlighted that the role and use of data in the NHS is vital to reach both research potential and its function in directly improving patient, treatment and public health.

The paper suggests the creationof a ‘health passport’ that holds individuals’ medical health records that individuals have control of and can authorise sharing.

This would increase patient activation, improve consistency of care and increase the opportunities for clinical trials through sharing data and volunteering to take part.

Data and technology can be used to support patient activation, self-management and encourage people to stay healthy, which will reduce the pressure on a health service that continues to face huge financial challenges and increasing demand.

Steve How is Market Access and Patient Activation at IQVIA UK.
Go to iqvia.com