October 2022 • PharmaTimes Magazine • 26-27
// NHS //
Right time, right place?
Oli Hudson grapples with the role of ‘place’ in the new ICS landscape
With a geographical footprint roughly the same as a local authority, ‘place’ is emerging as an increasingly important unit of organisation within the NHS.
But how will it affect the way pharma companies engage and work with the NHS in future?
“Everything will ultimately fall into place, but place will not be everything. Over the last few years, you have been part of a CCG, but these have now been replaced, since a better way of organising everything is now in place, or rather in Place.” Dr Julius Parker, Chief Executive of Surrey and Sussex Local Medical Committees.
Over the summer, a tongue-in-cheek briefing shared with GPs across Surrey and Sussex about local reorganisations went viral. It took particular aim at the mysteries of what NHS policymakers call “place”, while poking fun at the jargon-ridden language of reform more generally.
If the piece reflects a bit of the cynicism felt by many clinicians about the latest reforms, it also more poignantly highlights the confusion we are picking up among NHS and industry practitioners about what place fundamentally is and why it matters.
So, in this article, we will try to ‘lift the veil’ a little on the idea of place: what is it, why does it matter and how should pharma best engage with it?
Sense of place
The basic units of organisation within the new NHS integrated care systems (ICS) landscape are now fairly well defined. The Health and Care Act encourages the NHS to think, plan and organise itself across three distinct levels of management:
Decision-making at place level is driven by entities known as Place-Based Partnerships (PBPs). These are an alliance of organisations – including GP Federations, Primary Care Networks, Local Authorities, NHS Trusts, social enterprises and charities – that are now working together on the planning and delivery of health and care services to support their populations.
Some PBPs are entirely new, others have grown out of existing partnerships across health and care. However, they are becoming an increasingly important stakeholder group for industry to consider in its brand planning, for several reasons:
Shared principles
So, what are PBPs focusing on today? This isn’t as straightforward a question as it may seem, not least because in many parts of the country the principles governing place-based decision-making and their relationship with the system are still taking shape. There are also significant differences in the size of the footprint covered by place – some designated places in larger ICSs cover the same population size as a small ICS, for instance, which affects their profile and focus.
‘Over the summer, a tongue-in-cheek briefing shared with GPs across Surrey and Sussex about local reorganisations went viral’
That said, there are some common principles emerging from the more established partnerships. The Feel Good Barnsley PBP is a typical example. It has developed a health and care plan based around four overarching aims: workforce growth, strengthening prevention, improving equity of access and joining up care and support for those with the greatest need.
Sixty miles to the east, the East Riding Place Partnership projects a similar set of goals in more direct way. Its vision statement (which is part of a five-year, place-based plan) pledges to create ‘an East Riding that is free from avoidable disease and injury, where all residents enjoy their maximum potential for health, wellbeing and participation, throughout their lives.’
In practice, most of the plans coming out of PBPs translate into targeted action to support better population health, tackle health inequalities and improve the way health and care services work together, both in order to meet individual’s personalised needs and to support the quality and sustainability of services.
Of course, many PBPs will be looking at these specifically through the harder-edged challenge of managing hospital demand and patient flow, with healthcare providers working with local authorities to improve discharge support and care. They will also typically work ‘upstream’, often in partnership with charities, community groups and Primary Care Networks, to reduce the volume of preventable admissions through more assertive screening programmes and stronger community-based support.
Place setters
First and foremost, it cannot be a conversation purely about product. Pharma needs to engage place based partnerships on their terms, framing propositions in a way that shows how they can support their strategic goals of improving access, tackling inequalities and supporting flexible and joined-up service delivery.
The clinicians and service leads who feed into place-level plans are fundamentally looking to improve pathways and population health outcomes on the basis of evidence and best practice – so can you offer them the data and intelligence that will help them meet these goals?
High on their agenda will also be issues around workforce capacity – so can you demonstrate that your offering can take pressure off primary and secondary care services, or provide greater clinical or operational efficiency?
Tackling health inequalities is also a paramount concern – so can you provide an evidence base and new solutions to help local health and care organisations to support a particular patient cohort within a pathway?
Industry should also be aware of the role that Provider Collaboratives often play within Place-Based Partnerships. Though Provider Collaboratives are largely a system-level construct, there is an important interplay between the acute/tertiary part of pathway (typically organised at system level) and the post-discharge rehabilitation and care delivered at place level.
As a result, many PBPs may work under contract with larger Provider Collaboratives to support more integrated care pathways. Understanding the different configurations and relationships between provider networks and place-based arrangements is therefore an increasingly crucial aspect of stakeholder mapping for pharma executives.
Final analysis
This underlines a crucial, final point: that while system, place and neighbourhood may appear as distinctive, compartmentalised terms on a page, the reality on the ground will be more fluid, particularly as PBPs find their feet. An acute understanding of local dynamics and circumstance is therefore crucial to the way industry engages with different place-based arrangements.
Enigmatic and evolving though they may be, there is real momentum behind PBPs. Often billed as “the engine rooms of transformation and change”, they are fast becoming a critical part of the new NHS architecture. To operate effectively, industry must now embrace the idea of place and learn how to engage with its agenda and priorities.
Oli Hudson is a consultant at Wilmington Healthcare.
Go to wilmingtonhealthcare.com
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