How funding flows in the NHS
The NHS: how providers are regulated and commissioned
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NHS England and NHS Improvement is responsible for providing national direction on service improvement and transformation, governance and accountability, standards of best practice, and quality of data and information. NHS England and NHS Improvement came together in 2019 to act as a single organisation (maintaining separate boards). The aim of the merger is to work more effectively with commissioners and providers, making more efficient use of resources, and removing duplication.
The Care Quality Commission’s (CQC) role is to register care providers and monitor, inspect and rate their services in order to protect users. CQC publishes independent views on major quality issues in health and social care.
Regional NHS England and NHS Improvement teams are responsible for the quality, financial and operational performance of all NHS organisations in their region. Increasingly, they are working with local systems (ICSs/STPs) to oversee performance, support their development and make interventions when necessary.
Sustainability and transformation partnerships (STPs) bring together NHS providers and commissioners, local authorities and other local partners to plan services around the long-term needs of local communities. STPs cover populations of 1-3 million people.
In some areas, integrated care systems (ICSs) have evolved from STPs. ICSs are a closer collaboration in which organisations take on greater responsibility for managing local resources and improving health and care for their populations. According to the NHS long term plan, every part of England will be covered by an ICS by 2021.
Integrated care partnerships (ICPs) are alliances of providers that work together to deliver care by agreeing to collaborate rather than compete. These providers include hospitals, community services, mental health services and GPs. Social care, independent and third sector providers may also be involved. NHS England and NHS Improvement is developing an ‘integrated care provider contract’ as an option for formalising these partnerships. ICPs cover populations of 250–500,000 people.
Primary care networks (PCNs) bring general practices together to work at scale with other local providers from community services, social care and the voluntary sector. Together they provide primary care by using a wide range of professional skills and community services. Since 1 July 2019, all except a handful of GP practices in England have come together in around 1,300 geographical networks. PCNs cover populations of 30–50,000 people.
A couple of concerns:
* No mention of the role of the Secretary of State for Health. What is his role now following the Health and Social Care Act 2012? Is he still ultimately accountable for the NHS to Parliament?
* The unwritten rules of the game are changing and maybe these need to be aired because clearly there is a lack of transparency about what they could mean. I'm referring to the role of the private sector in healthcare. Yes, it has been embedded in the NHS since 1948. However, what we've seen since 1990, but with an increasing escalation since the 2012 Act, is the marketization of the system. Look no further than what's happening with the estate function, private finance projects, Prop-co let alone the range of clinical and non clinical services being privatised. Accountable Care Organisations are modelled on the US private healthcare system.
Readers may wish to refer to Allyson Pollock's work ahttps://www.allysonpollock.com/ and indeed consider lobbying their MP to support the NHS Reinstatement Bill 2017 http://www.nhsbillnow.org/
I work both in the NHS in dementia services as well as independently where I collaborate with systemic thinkers and practitioners to develop much needed systemic capabilities. In the NHS I work as a front line practitioner and innovator of new ways of understanding and treating complex health conditions like dementia, depression and other chronic inflammatory conditions . Our present linear mental models are limiting us in what we perceive, identify, prioritize and decide to treat. This falls far short of what else is possible and would be much cheaper and less wasteful in the longterm. I offer to help develop communities of practice where people share practices and develop them also know as communities of learners. What is missing for me in traditional communities of practice is paying attention to 'the community itself and how it learns'. When the 2 aspects of CoPs come together, we have what I would call powerful incubators for real transformation and improvement, both of people as well as organisations. I have just published an interview with Dr.Margaret Hannah who models such change in Scotland as director/leader of Public Health. http://www.enliveningedge.org/organizations/humanising-healthcare-part-…