NHS planning guidance sets out plans for next two financial years

National NHS leaders have set out steps to strengthen collaboration across the NHS and ensure that local health and care areas are successful in delivering their blueprints for the future.

Published by NHS England and NHS Improvement, Delivering the Forward View: NHS Operational Planning Guidance for 2017/18 and 2018/19 provides NHS trusts and commissioners with tools they need to plan for the years ahead. For the first time, the guidance covers two financial years, to provide greater stability, underpinned by a two-year tariff for NHS patients and a two-year NHS Standard Contract.

A range of additional measures to help the NHS deliver on the commitments of the Five Year Forward View have also been announced, including:

• New incentives worth more than £100m to help tackle unnecessary delays in discharging patients from hospital;
• Incentives to reduce the number of people attending A&E with mental health problems;
• Further steps to ensure the sustainability of general practice.

The guidance is also published three months earlier than normal, to allow local leaders more time to plan their work in line with national priorities. These will include the actions agreed for priority areas such as cancer, mental health, learning disabilities, primary care and Urgent and Emergency Care.

To help local NHS organisations to work together effectively, Sustainability and Transformation (STP) areas will be able to apply for their own system-wide financial control totals. This will enable them to pool resources across organisations and make it easier to shift money to support care improvement and redesign.

The guidance provides further updates on longer-term financial challenges for local systems, retains nine national ‘must dos’ from 2016/17 and outlines a range of new Commissioning for Quality and Innovation (CQUIN) national indicators.

The updates include more than £100m of financial incentives for local health systems to take concerted, effective and sustainable action to help prevent unnecessary delays to patients leaving hospital. For older people in particular, longer stays can lead to poorer health and can increase their long-term care needs.

There are two new financial incentives to encourage providers to work with partners to improve mental health care for children and young people and for people with mental health needs attending A&E. People with mental ill health are three times more likely to present to A&E than the general population so the incentive will allow mental health and acute trusts to access funding aimed at improving support for the top 0.25% or 150-200 people per A&E who use it most frequently through improved recognition and coding of mental health needs and proactive care planning.

The planning guidance also gives more details on how the extra funding announced by NHS England in the General Practice Forward View will be used to help transform services. On top of planned increases to primary medical care allocations for general practice, the guidance confirms that there will be further local recurrent funding to improve and increase capacity in general practice, totalling £138m by 2017/18 and increasing to £258m in 2018/19. This means that from April 2019 every CCG can expect a minimum additional £6 per head to improve access to general practice.

For the first time, the new planning guidance places a requirement on CCGs to develop local action plans detailing how they will deliver on the aims set out in the General Practice Forward View. This will be a crucial part of delivering the overall vision for the local area, being developed as part of their Sustainability and Transformation Plans.

'We’re taking action to support collaborative action across the health service with fresh funding and practical measures to enable the NHS and our partners to deliver improvement in services including cancer, mental health, learning disabilities, primary care and urgent and emergency care,' said Simon Stevens, Chief Executive of NHS England.

Jim Mackey, Chief Executive of NHS Improvement added: 'The NHS has a real challenge on its hands, but the action we’re setting out will help the service pull together to make sure it can meet the needs of patients well into the future.

'Two-year operational plans, based on the Sustainability and Transformation Plans already being developed in each local health system, will create much greater stability and certainty for providers and the local communities they serve. Making sure that providers and commissioners can work together to provide high-quality care, within the resources available to the NHS, is central to getting the most out of the opportunities set out in this joint planning guidance.'

Paul Briddock, Director of Policy, Healthcare Financial Management Association (HFMA), welcomed the publication of the Operational Planning Guidance and described it as a step in the right direction. 'It supports the need for the NHS to work more widely as a system but with clear visibility of organisational control totals and requirements within that,' he said.

'Our members have been calling for longer term funding settlements, more realistic efficiency requirements and an earlier timescale for agreement on financial plans for the year ahead. We must not underestimate the scale of the challenge ahead or the strain that this will put on NHS finance staff, partially given the planning timescales outlined. They need to be supported in difficult times. But in overall terms we support the direction of travel outlined in the guidance.'