NHS Long Term Plan Implementation Framework

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NHS Long Term PlanImplementationFrameworkJune 2019

Contents1.Introduction to the NHS Long Term Plan Implementation Framework . 32.Delivering a new service model for the 21st century . 7Transformed ‘out-of-hospital care’ and fully integrated community-based care . 7Reducing pressure on emergency hospital services . 9Giving people more control over their own health and more personalised care . 9Digitally-enabling primary care and outpatient care . 10Better care for major health conditions: Improving cancer outcomes . 10Better care for major health conditions: Improving mental health services . 11Better care for major health conditions: Shorter waits for planned care . 133.Increasing the focus on population health . 144.More NHS action on prevention . 155.Delivering Further progress on care quality and outcomes . 16A strong start in life for children and young people . 16Learning disabilities and autism . 17Better care for major health conditions . 19Cardiovascular disease . 19Stroke care . 19Diabetes . 20Respiratory disease . 20Research and innovation to drive future outcomes improvement . 21Genomics . 22Volunteering . 22Wider social impact . 226.Giving NHS staff the backing they need . 237.Delivering digitally-enabled care across the NHS . 258.Using taxpayers’ investment to maximum effect. 28Financial and planning assumptions for systems . 28Improving productivity . 29Reducing variation across the health system . 309.Next steps . 31Annex A Funding the Long Term Plan . 33Annex B: Financial assumptions for strategic plans . 36Annex C: LTP headline metrics . 40Annex D: Supporting wider social goals . 422 I NHS Long Term Plan Implementation Framework

Introduction to the NHS Long Term Plan ImplementationFramework1.1The NHS Long Term Plan, published in January 2019, set out a 10-year practicalprogramme of phased improvements to NHS services and outcomes, including anumber of specific commitments to invest the agreed NHS five-year revenuesettlement. This Implementation Framework sets out the approach Sustainabilityand Transformation Partnerships (STPs)/Integrated Care Systems (ICSs) areasked to take to create their five-year strategic plans by November 2019 coveringthe period 2019/20 to 2023/24. These plans should be based on realistic workforceassumptions and deliver all the commitments within the Long Term Plan. Thisdocument does not repeat the rationale and commitments set out in the Long TermPlan.1.2System plans will be aggregated, brought together with additional nationalactivity and published as part of a national implementation plan by the end ofthe year so that we can properly take account of the Government Spending Reviewdecisions on workforce education and training budgets, social care, councils’ publichealth service and NHS capital investment. The national implementation plan will setout initial performance trajectories and programme milestones to deliver Long TermPlan commitments.1.3Some of the commitments in the Plan are critical foundations to wider change. Allsystems must deliver on these foundational commitments for both servicetransformation (Chapter 2) and system development (Chapter 3) in line with nationallydefined timetables or trajectories, including the Government’s five financial tests whichare set out in Chapter 8, with proposed metrics included in Annex C.1.4Systems will also have substantial freedoms to respond to local need, prioritise,and define their pace of delivery for the majority of commitments (Chapters 4 and5), but will need to plan to meet the end points the Long Term Plan has set.1.5Plans should prioritise actions that will help improve the quality of, and access to, carefor their local populations, with a focus on reducing local health inequalities andunwarranted variation. Ensuring that we back our staff (Chapter 6) and develop adigitised NHS (Chapter 7) will also be at the heart of local plans.1.6The national and regional support that systems can draw on is signposted throughoutthis Implementation Framework alongside a number of nationally delivered activities tosupport local implementation. It aims to reflect our new national operating model. Ourambition is to better coordinate how national and regional teams are workingtogether to provide support to systems, based on local needs.1.7The Implementation Framework has been developed and tested with many of thestakeholders that were involved in developing the Long Term Plan. We havesought views from systems across the country to inform the development of theImplementation Framework. We have also engaged with stakeholders, including theNHS Assembly and partners from Local Government Association, NHS Providers, theNHS Confederation, Academy of Royal Medical Colleges, government and VCSEorganisations. Based on their feedback, we have focused this ImplementationFramework on setting out what the NHS needs to deliver from 2020/21 through to2023/24, including the national ‘must dos’, whilst leaving space for systems to set outNHS Long Term Plan Implementation Framework I 3

how they will deliver and phase progress in line with local priorities. It does not repeatthe asks of the 2019/20 Operational Planning and Contracting Guidance.An integrated approach to strategic and operational planning1.8STPs/ICSs are expected to bring together members organisations and wider partners,adopting a common set of principles and leadership behaviours as they develop anddeliver plans. In doing this, systems will be expected to ensure that their plans alignwith the following principles: Clinically-led: In practice this means that systems will need to identify andsupport senior clinicians to lead on the development of implementationproposals for all Long Term Plan commitments that have clinical implicationsand on the totality of their plan.Locally owned: Build on existing engagement with local communities toensure they can meaningfully input into the development of local plans. Localgovernment will be key partners to developing system plans and are asked toengage throughout the process. Similarly, the voluntary sector and other localpartners, including representatives from the most marginalised communitieswho often experience the poorest health and greatest inequalities, should beinvolved. Support for this is available through the NHS Involvement Hub, thenational resource pack and the nationally commissioned Healthwatch contract.Realistic workforce planning: The interim NHS People Plan sets out thenational context. Systems should set out realistic workforce assumptions,matched to activity and their financial envelope. Plans should also show thesteps to be taken locally to improve retention and recruitment.Financially balanced: The outline business rules for planning are set out inChapter 8 of this Implementation Framework, with supporting assumptions andfinancial allocations set out in Annexes A and B. Systems need to show howthey will deliver the commitments in the plans within the resources available.Local plans will need to include the financial recovery plans for individualorganisations in deficit against specified deficit recovery trajectories (test 1),with actions to achieve cash releasing savings (test 2) including through thereduction of unwarranted variation (test 4) and how they will moderate growthdemand (test 3). Plans should set out capital investment priorities for capitalbudgets being agreed through the forthcoming Spending Review (test 5).Delivery of all commitments in the Long Term Plan and national accessstandards: The Long Term Plan was based on an inclusive and thoroughprocess that identified prioritised, costed interventions based on clinicalevidence and patient and public views. The Long Term Plan will beimplemented comprehensively, with system plans setting out what theircontribution to this will be. Plans which will cover the four-year period April2020 to March 2024 will also need to set out how systems will continue tomaintain and improve performance for cancer treatment, mental health andA&E, to the point at which any new standards proposed by the Clinical Reviewand accepted by Government are implemented. They should also set out howelective care activity will be increased to reduce elective waiting lists andeliminate 52 week waits.Phased based on local need: Whilst the Long Term Plan must be delivered infull, this does not mean that all initiatives should be implementedsimultaneously everywhere. National requirements for some foundationalrequirements have been set out in Chapters 2 and 3. Beyond this, the scaleand pace of local implementation should be based on local need and priorities.4 I NHS Long Term Plan Implementation Framework

1.9Reducing local health inequalities and unwarranted variation: Systemplans should set out how they will use their allocated funding to deliver tangibleimprovements in health outcomes and patient experience and help reduce localhealth inequalities. System plans should also use available data to understandhow their outcomes compare with their peers, identify and reduce unwarrantedvariation.Focussed on prevention: System plans must consider not just how to deliverhealth services but how to prevent ill health.Engaged with Local Authorities: System plans should expect to bedeveloped in conjunction with Local Authorities and with consideration of theneed to integrate with relevant Local Authority services.Driving innovation: All system plans must consider how to harness innovationlocally.All systems will be expected to agree their plans by mid-November 2019 and publishthem shortly thereafter. These strategic plans will form the foundation of service andsystem change over the next five years. Whilst they will continue to evolve over thatperiod, it is important that systems are transparent about their plans and ambitions.Annex C sets out the initial proposed headline measures against which the success ofthe NHS will be assessed. Views on the appropriateness of these measures areinvited. These will then be finalised as part of the national Implementation Plan in theAutumn and used as the cornerstone of the mandate and planning guidance for theNHS for the next 5 years. Systems should therefore show how they plan to makeprogress against them. Further details on these measures will be published shortly.1.10 As part of our new shared operating model, NHS England and NHS Improvement willwork through our integrated regions with local systems as they develop and finalisedtheir plans. For foundational elements as set out in Chapters 2 and 3 of this document,and for other Long Term Plan commitments where local need means rapid progress isrequired in the early years of implementation. Regions will seek greater levels of detail,including trajectories. National teams will work with regions to ensure that credibleplans and trajectories (where applicable) exist to deliver Long Term Plan commitmentsand the five financial tests over the next five years. Further details on how national andregional teams will work together and support systems is set out in the Chapter 9.A proactive approach to prevention and reducing health inequalities1.11 Over the next five and ten years the NHS will progressively increase its focus onprevention and ensure that inequalities reduction is at the centre of all our plans. AGovernment’s forthcoming Prevention Green Paper should provide furtheropportunities for the NHS and Government to go further, faster, in prevention andinequality reduction and will feed into future iterations to system plans.1.12 System plans should demonstrate the key areas of inequality they will tackle and howadditional funding is targeted, for example actions that will address the healthinequalities experienced by disadvantaged or vulnerable groups, such as people withdisabilities, LGBT , BME communities as well as others. Systems can draw on PublicHealth England’s (PHE) Place Based Approaches to Reducing Health Inequalities andthe Menu of Evidence Based Interventions for reducing Health Inequalities beingpublished in the summer as they develop their plans. Systems should complete anEquality Impact Assessment for their plans.NHS Long Term Plan Implementation Framework I 5

Investment to support transformation1.13 Systems already have five-year CCG allocations. This Implementation Framework alsosets out where additional funding will be made available to support specificcommitments and where activity will be paid for or commissioned nationally. Largely,additional funding will be provided in two ways: 1.14Where activity is expected to happen across the country and in every system,funding will generally be made available on a ‘fair share’ basis. Each systemwill be given an indicative additional allocation to reflect in their plans.Access to this service development funding will be conditional upon systemsagreeing their strategic plans with NHS England/Improvement’s regional teams,who will be advised by the National Service Transformation Directors. Moremature systems will have greater autonomy over how additional resources aredeployed. Detail of the indicative additional allocation for each system will becommunicated alongside this Implementation Framework.Some commitments within the Long Term Plan will of necessity have to befunded in a targeted way either because the whole country is not coveredby the service based on specific needs, or to test implementationapproaches as evidence is developed and service specificationsfinalised. The Implementation Framework identifies the commitments that willbe funded in this way, and when funding will be available. Where there is alocal ambition to act as a testing site for new approaches or interventions, andreceive a share of the associated funding, systems should discuss and agreethis with their region through the summer planning process. Individual nationalprogramme teams will also be able to share more information on how targetedfunding can be accessed.National aggregates for both the ‘fair share’ and targeted funding are set out atAnnex A.6 I NHS Long Term Plan Implementation Framework

Delivering a new service model for the 21st century2.1Delivering the fundamental service changes, set out in this chapter, along with theproductivity ambitions set out in Chapter 8, are a prerequisite for being able to developand improve other services based on local population health needs. Plans should setout how these foundational commitments within the Long Term Plan will bedelivered and their five-year trajectories for doing so.Transformed ‘out-of-hospital care’ and fully integrated community-based care2.2By July 2019 all of England will be covered by PCNs supported by significantinvestment (almost 1.8 billion by 2023/24) as set out in the five-year framework forGP contract reform. This investment is linked to a clear set of deliverables, laid out inthe contract documents.2.3PCNs are encouraged to make early progress in the service specifications thatcommence from 2020/21 including the anticipatory care requirement (with communityservices); Enhanced Health in Care Homes; structured medication reviewrequirements for priority groups; personalised care and early cancer diagnosis support.PCNs should also develop their partnerships with other health and care providers,particularly community and mental health services.2.4The GP contract guarantees funding to develop these multidisciplinary teams and willsupport the recruitment of 20,000 additional staff to work alongside doctors and nursesin PCNs over the next five years. The scheme will meet a recurrent 70% ofemployment costs for additional clinical pharmacists, physician associates,physiotherapists and community paramedics; and 100% of the costs of additionalsocial prescribing link workers. Growth has been phased over the five-year period toalign with supply and the developing maturity of PCNs. To effectively meet theirdiverse population’s needs, these staff will need to work alongside those from NHS,local authority and other organisations to provide integrated community care.2.5The Long Term Plan reconfirmed the commitment to ensure an increase of 5,000 fulltime equivalent doctors working in general practice as soon as possible. In addition toplans to recruit and retain more doctors and nurses – including additional fair sharesfunding for a two-year fellowship scheme for the newly qualified – growth in these roleswill be supported through increased GP contract funding, which rises by 978 million ayear by 2023/24 as a result of investment under the new contract. 12 million is alsobeing invested in GP retention in 2019/20 and 2020/21 and will be allocated on a fairshares basis to STPs.2.6This workforce will be supported through a network of primary care and communitytraining hubs that will deliver a set of core functions to educate, train and support thecurrent and future workforce working as part of multidisciplinary teams. All STPs andICSs will have access to the functions of a training hub by March 2020 and will receivea fair shares funding allocation from 2019/20 to 2023/24 to support this.2.7The framework for GP contract reform committed to the introduction of a newInvestment and Impact fund for PCNs, which will start in 2020 and will support deliveryof the Long Term Plan. Funding is expected to rise to 300 million in 2023/24.2.8The national PCN Development Programme will provide fair shares funding andsupport to local systems as they develop their PCNs including ensuring that each PCNNHS Long Term Plan Implementation Framework I 7

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NHS Long Term Plan Implementation Framework I 3 Introduction to the NHS Long Term Plan Implementation Framework 1.1 The NHS Long Term Plan, published in January 2019, set out a 10-year practical programme of phased improvements to NHS services and outcomes, including a

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