New analysis published today by Future Health (Future Health Report – ICS FINAL) and supported by healthcare management consultancy Acumentice identifies 16 of 42 regions – including a number in traditional Conservative heartlands – where primary and secondary care services are under high levels of pressure going into this winter.

Report author Richard Sloggett spoke to LBC News about the findings:

The research finds widespread variation in access to services including a nearly four-fold variation in the proportion of patients waiting three weeks or more for a GP appointment.

Analysis from 9 different NHS data sources including appointment access, waiting times and ratios of staff to patients is used to look at relative pressures between new Integrated Care Systems (ICSs), established in July 2022 and now responsible for regionally managing health services.

Key findings include:

• 16 of the 42 new ICSs are under relatively high levels of pressure across both primary and secondary care
• Of these 16, the 5 health systems under the most pressure are Bedfordshire Luton & Milton Keynes; Kent & Medway; Leicester, Leicestershire & Rutland; South Yorkshire; and Sussex
• Also included are areas with higher levels of deprivation in the Midlands and the North: Cumbria and Northeast, Lincolnshire, Nottingham and South Yorkshire and Bassetlaw

By contrast a similar number of systems are classified as under lower relative pressure. These include Bristol, North Somerset and Gloucestershire; Buckinghamshire, Oxfordshire and Berkshire West; Coventry and Warwickshire; Hertfordshire and West Essex; Staffordshire and Stoke on Trent; Suffolk and North East Essex.

The report also uncovers widespread variation in access to services, including:

• The number of primary care appointments per head of population is 58% greater in Cornwall ICS than in North Central London ICS
• A nearly threefold variation in the number of patients unable to get a GP appointment so attending A&E. Black Country ICS in the Midlands with 16% has the highest rate, Herefordshire and Worcestershire with just 6% has the lowest rate
• Herefordshire and Worcestershire has the lowest GP to patient ratio, below 1500. Kent and Medway has the highest, which is 50% higher (over 2000)
• Birmingham and Solihull and Black Country ICS both have 20% of patients noting a fairly or very poor experience of primary care. This is more than double Gloucestershire ICS with just 8% of patients

The report makes a series of recommendations aimed at national Government and the NHS leadership which it argues would help tackle the challenges being faced.

1. Pensions – The Government should bring forward an urgent pension reform package to support improvements in doctor retention
2. Workforce – The Government and NHS England should agree longer term, more secure contracts for primary care pharmacists, social prescribers and care co-ordinators to support increased GP capacity
3. Data – New health systems need to prioritise an integrated data strategy to effectively assess service pressures. This needs to cover primary, secondary and social care data and include data at local place and neighbourhood level to understand the differences within regions
4. Accountability – Ministers must put tackling service variation as a central objective of their winter and long term service plan. To deliver this:

• NHS England should ensure that Ministers and the Department of Health and Social Care have access to the most up to date and granular data on pressures in the system
• A small team of data analysts should be employed in Ministerial private office with full access to the data and use it to brief Ministers weekly on current trends and challenges relating to health service pressures

If enacted the recommendations would help support the delivery of the ambitions set out within the recent report from Dr Claire Fuller on how these new systems can work effectively to improve population health[1].

Richard Sloggett, former Special Adviser at the Department of Health and Social Care and the report author said:

“This research highlights the different relative pressures new Integrated Care Systems are under heading into the winter and shows that not all systems are being created equally. Worryingly for the Government they include parts of the country both with marginal seats and in more traditional Conservative heartlands in the South East. The new Secretary of State is right to put tackling such variation in access and pressure as a priority. Whilst recent proposals are a start, far more assertive national action is needed urgently to match up to the scale of the challenge.”

Karina Malhotra, Managing Director, Acumentice who commissioned the research said:

“As Claire Fuller’s report set out, the development of ICSs is an opportunity for closer working between primary and secondary care that really delivers for patients. Our work across the NHS shows that sharing and integrating data along with granular data analysis is critical for system success. By building integrated data strategies across primary and secondary care which consider local context and population health needs, ICSs will be best placed to effectively tackle the pressures they face.”

Stephen Hammond MP, former Minister of State at the Department of Health and Social Care said: “This report shows the scale of the challenge facing many parts of the NHS this winter. It is absolutely critical that Government and NHS leaders work closely together to tackle the pressures and variation that has built up across the country. To do this Ministers must have access to timely, detailed data from the NHS to improve decision making, accountability and performance. The public and patients expect nothing less than full transparency and collaboration from those in charge of the nation’s health.”

ENDS

NOTES TO EDITORS

Summary of report recommendations

The Fuller stocktake[2] saw widespread and extensive engagement across the primary and secondary care system on how the new NHS structures should work effectively together.

But Dr Fuller’s report was also open that without national Government and NHS leadership the reports ambitions would struggle to be delivered.

This report, Under pressure: an analysis of primary care pressures facing Integrated Care Systems at launch, argues that the introduction of the following would all support the ambitions within the Fuller report to be realised:

• Accountability – Ministers must put tackling service variation as a central objective of their winter and long term service plan. To deliver this NHS England should ensure that Ministers and the Department of Health and Social Care have access to the most up to date and granular data on pressures in the system. A small team of data analysts should be employed in Ministerial private office with full access to the data and use it to brief Ministers weekly on current trends and challenges relating to health service pressures. NHS England should include measures within the new national oversight frameworks for ICSs, such as the NHS Oversight Framework, that properly assess the role of primary care in ICS decision making. It will be important that system oversight is both proportionate and takes into account the different healthcare needs of ICS populations and the impact of the pandemic
• Funding – A new funding formula for primary care that properly takes into account levels of deprivation and a review of primary and secondary care financial flows to ensure that payment mechanisms are flexible and support integrated working arrangements
• Workforce – Tackling issues with NHS pensions to support workforce retention and providing greater flexibility to local teams regarding recruitment through the Additional Roles Reimbursement Scheme (ARRS)
• Capital – Re-prioritising healthcare capital spending to ensure capital funding is available for primary and community care and to support more integrated service transformation. This could include a proposed Community Health Infrastructure Fund[3]
• Data – Utilise the Digital Health and Care Plan[4] and the efforts during the pandemic to reduce bureaucracy in data sharing and enforce action on suppliers who do not conform to minimum standards. Streamline national health technology funding into a health data infrastructure accelerator that enables systems to join up health data more quickly and easily
• Regulation – Ensuring that new system level service regulation through the CQC Single Assessment Framework clearly engages with primary care leaders, particularly Primary Care Networks

These actions from national bodies will provide an enabling environment for regional and local systems to deliver the changes and improvements in care needed.

[1] https://www.england.nhs.uk/publication/next-steps-for-integrating-primary-care-fuller-stocktake-report/

[2] https://www.england.nhs.uk/publication/next-steps-for-integrating-primary-care-fuller-stocktake-report/

[3] https://policyexchange.org.uk/publication/health-and-social-care-what-do-we-want-from-the-next-prime-minister/

[4] https://www.gov.uk/government/publications/a-plan-for-digital-health-and-social-care/a-plan-for-digital-health-and-social-care#appendix-a-our-action-plan-for-delivering-a-digital-future