NHS London has set out a five year strategy for overhauling healthcare in the capital that includes plans to move care out of hospitals, open more than 100 polyclinics, and make greater use of email and telephone consultations.
IT is at the heart of many of the plans outlined in the newly-published First Stage Report on the capital’s strategic plan for 2010-15, which aims to inject new pace into proposals first outlined in 2007 by Lord Ara Darzi.
The report warns that without change the NHS in London will have to cope with a funding shortfall of between £3 billion and £5.1 billion a year by 2016-17.
It also says there is a “compelling case for change” in the capital’s “poor quality primary care services”, wide health inequalities and failure to meet patient expectations.
It says poor GP access and long A&E waiting times contribute to an over-reliance on "hospitals as the answer".
The plan says the shape of London’s healthcare services will be changed by moving care out of hospitals, delivering 102 polyclinics – the vast majority by 2013 – improving care for people with chronic conditions and giving patients new routes into ‘polysystems’.
At the same time, it says there is a need for some hospitals to become local hospitals and to refocus major acute hospitals on delivering emergency care to patients with the most critical conditions.
The plan identifies ten strategies to support the implementation of its vision, including IT systems thatsupport the delivery of integrated care “including the patient care record and patient booking”.
It says that for polysystems to deliver to their maximum potential, “electronic patient records must be able to be shared between care settings and safely share information with social care services, linked to disease registries.
"It must also be possible to provide diagnostics in the polysystem setting and exchange diagnostics between care settings.”
Priorities for 2010-11 include setting up 30 polysystems and implementing changes to hospital delivery of healthcare for patients with stroke, trauma, cardiovascular disease and cancer.
Polysystems will have a polyclinic at their ‘hub’ but also deliver care in patients’ homes, in ‘spoke’ GP practices, and at other locations in the community.
Ruth Carnall, NHS London’s chief executive, said: “With ten polyclinics already up and running, some Londoners are already seeing the benefits of better care closer to home.
"With today’s report, all Londoners can be confident that the NHS is working together to get this high quality care rolled out as standard over the next ten years.”
Primary care trusts moving on the proposals have already encountered opposition where they involve changes in A&E services. Prominent campaigns have been set up to ‘save’ A&E at the Whittington and Chase Farm hospitals.
However, the report says providers will be hit by a falling tarrif and a rise in cost and demand. To cope, it suggests they will need to make 35% productivity improvements over the next five years.
The SHA has identified five areas where it says productivity improvements could be made.
In primary care, these include increasing the time GPs and nurses spend with patients from 18 hours to 25 hours a week, which it estimates could save £600m.
They also include reducing appointment lengths, partly by greater use of email and telephone consultations, producing an estimated saving of £570m.
The plan also envisages a single point of contact for urgent care with specialist advice provided over the telephone – described as “hear and treat” – or through an urgent care centre.
Other aspirations included in the report are that all patients nearing the end of life will have an electronic care plan, that there will be “transparent information” on GP performance in the public domain, and that there will be better use of e-health technologies to support home monitoring.
The SHA said London’s 31 PCTs, grouped into six clusters according to geographical area, are now preparing detailed plans on implementing the strategy. Later in the spring, the SHA will release its Integrated Strategic Plan to pull together those plans.