GP Practices have a role to play as physical hubs, from which a range of demand-reducing and preventative voluntary sector services could be based. In my view, GP’s surgeries could asset share, or make proper space available to a range of local services, so that patients can access early intervention, or intervention pre-hospital at least. GPs who need new accommodation should work with local developing Housing Associations to identify hub spaces.
What are the policy levers that can deliver this change? As a starting point, a requirement for all Health and Wellbeing Boards and CCGs to include their largest local Housing Association plus another voluntary sector representative on their panel would pay dividends.
Policy should require GPs to host a minimum of five other representatives from community providers. Commissioned contracts across the NHS need to be for a minimum of three but on average five years. Much resource is wasted in procurement activity at small and medium providers.
Shared outcomes frameworks across the NHS could incentivise the hubs to have outcomes-based results based on patient experience.
Hospitals need to freeze beds and be incentivised to make savings channelled into community services that are non-nursing and non-residential.
Funding specifically for Housing Associations and health to build large scale transition-from-hospital units - like hotels with care - should be funded and staffed by support not NHS colleagues.
Significant funding could be ring-fenced in policy for community services that are not NHS/GP or nursing led, but which are commissioned to meet preventative and demand reduction outcomes. Services that have been funded via the ‘Supporting People’ fund have had a requirement to be person-centred for more than ten years. The voluntary sector is way ahead of the NHS in person-centred and individually tailored support and care planning. Health planning could be an extension of this as well as a connecting activity.
In order to ensure patients are able to make informed choices there needs to be one patient advice service at every GP hub that has access to shared information with patient permission. There needs to be nurse and community partnership work for each patient with an agreed diversion plan.
The National Evaluation of Partnerships for Older People provides sound evidence for the outcomes and cost savings achieved if services are community rather than hospital facing. There needs to be a policy approach that allows for a managed risk in making the step-change from ever- expanding hospital based care to services that are often co-designed with the people who use them. These services are effective and deliver real solutions to keep people living at home or in a community setting much longer and with great overall well-being.