NHS to begin roll-out of federated data platform in spring 2024

By Integrated Care Journal

The supply contract has been awarded to software company Palantir Technologies UK and will see up to £330 million in investment over the seven-year contract period.

The NHS will introduce a new platform in spring 2024 to enhance patient care, reduce waiting times, and expedite hospital discharge procedures. The Federated Data Platform (FDP) will consolidate existing NHS data, enabling healthcare professionals to access critical information more readily, resulting in improved and timelier patient care.

This new platform will integrate key data currently held in disparate NHS systems, addressing some of the healthcare system’s post-pandemic challenges. By aggregating real-time data, such as hospital bed availability, elective waiting list sizes, staff schedules, medical supply inventories, and social care placements, healthcare professionals can optimise resource allocation, including operating theatre and outpatient clinic utilisation, to ensure patients receive timely care.

Palantir Technologies UK, supported by Accenture, PwC, NECS, and Carnall Farrar, was awarded the software supply contract following an open and competitive tender process. The contract will entail a seven-year investment period as more trusts adopt the platform. The initial contract year is expected to see an investment of at least £25.6 million, with total investment over the seven-year contract period reaching up to £330 million for the FDP and associated services. Following the award of the contract for the FDP this week, there will be a six-month implementation period where products supported by the current platform will be transitioned across.

Data access within the FDP is strictly controlled by the NHS, requiring explicit permission for any company involved in the platform. Data usage within the platform is solely for direct care and planning purposes. It will not be utilised for research purposes, and GP data will not be incorporated into the national version of the software platform.

Pilot projects utilising the new data-sharing approach have demonstrated reduced waiting times for planned care and discharge delays, as well as faster diagnosis and treatment times. Since implementing the system, North Tees and Hartlepool Trust has reduced long-term stays (21 days or more) by 36 per cent despite increased demand, with a 7.7 per cent increase in hospital admissions.

NHS National Director for Transformation, Dr Vin Diwakar, said: “Better use of data is essential for the NHS to tackle waiting times, join up patient care and make the health service sustainable for the future. Patients come to the NHS at some of the most vulnerable points in their lives, and they want to know that our healthcare teams have access to the best possible information when it comes to their treatment and care.

“This new tool provides a safe and secure environment to bring together data, which enables us to develop and deliver more responsive services for patients and will help the health service drive the recovery in elective care.”

Palantir CEO Alex Karp said: “This award is the culmination of 20 years of developing software that enables complex, sensitive data to be integrated in a way that protects security, respects privacy and puts the customer in full control.

“There is no more important institution in the UK than the NHS and we are humbled to have now been chosen to provide that software across England to help bring down waiting lists, improve patient care and reduce health inequalities.

“It builds on our role supporting the delivery of the COVID-19 vaccine and, more recently, helping individual NHS Trusts to schedule more operations.”

Matthew Taylor, Chief Executive of the NHS Confederation, commented: “Health leaders will welcome the introduction of the Federated Data Platform as an important tool to help organisations across the NHS more rapidly connect and access data, free up vital clinical time and deliver more efficient, faster and safe care for patients.

“For the platform to succeed, it will also be crucial that the public continue to be engaged with, and that any concerns they have on the sharing of their data are addressed meaningfully. Likewise, Government and the wider NHS will need to ensure that there are adequate numbers of staff working in digital and patient data roles.

“We hope the new platform will offer much needed capacity for many Integrated Care Systems and for those systems that have already built their own effective platforms, we welcome both the assurance that they will be able to decide if and when to opt into it, and that they will continue to be supported.”

Can allied health professions catch up with NHS digitisation?

By Andy Soluk

As the UK healthcare landscape undergoes a radical digital transformation, can the independent sector adapt or will it be left behind?

This article was kindly supported by FormDr.

Thousands of independent practices and health-adjacent businesses are being left behind as the NHS moves towards digitisation. The extensive report on June 30th 2023 from Parliament’s Health and Social Care Committee recommends a plethora of changes to the NHS and integrated care systems (ICSs), with barely a mention of the tens of thousands of health and wellness professionals who work outside of the NHS.

Yet, private practices and allied health professionals around the country are interacting with tens, if not hundreds, of thousands of people who would equally benefit from digitisation. Many of these practices are still using pen and paper for their basic functions.

This is a mistake, and these health professionals cannot be left behind.

The process of an osteopath

Let us step into the shoes of an osteopath to explore the process that thousands of people face. While the NHS might cover osteopathy in some areas, most people pay for private treatment and are decoupled from NHS systems.

Upon registration, a patient would fill out a litany of paperwork, from medical history forms to informed consent. Perhaps an osteopath can email a copy of these forms to a patient before the first appointment. However, in our increasingly digital age, only 52 per cent of people living in the UK own a printer, so about half the population will need to complete paperwork in the office.

A patient likely arrives 20 minutes early to complete paperwork and review with the front desk staff. If his or her handwriting is illegible, then the process takes longer and creates additional delays.

Once this initial paperwork is sorted, staff must file it and ensure security. Practices have a false assumption that paper is safe, though we have seen fines under GDPR up to £275,000 for not handling paper health data properly. The Information Commissioner’s Office (ICO) is becoming more active and could strike at any time.

Returning patients might need to complete less paperwork, but the inefficiencies in paper still compound and take up valuable time and resources. One of our own surveys found that small practices saved an average of 21 minutes per patient when digitising.

This hypothetical osteopath is only one example, but it is not difficult to imagine how fitness centres, genetics testers, pharmacies, fertility clinics, anyone offering elective surgery, or small health-adjacent businesses are wasting hours each week on paperwork. For these practices, time spent on paperwork directly impacts client and patient care. These health and wellness professionals also need help digitising.

How practices are impeding their future progress

There is another, less obvious problem with paper processes. As the NHS moves towards digitisation and integration, practices and businesses without electronic records exclude themselves from future involvement. The NHS wants to streamline its processes and make data more accessible for GPs, but paper forms do not allow for this.

The foreseeable future of health care in the UK is built around ICSs. The wider NHS is also focusing more on preventative care, which, due to resource constraints, increasingly falls under the purview of the independent sector. The opportunities for growth in these practices and businesses will exponentially increase as they digitise and can more easily link with the NHS.

What can practices and small businesses do?

Fortunately, solutions to streamline paper processes exist and the rapid expansion of telehealth during Covid-19 shows that digitisation is possible and necessary. While the NHS is moving towards its goal, there are three steps that all practices and businesses, regardless of size, can take today to ensure they do not fall behind.

1) Examine your current process of sending and receiving paperwork.

Any good change management strategy starts with an assessment of current workflow. Do you only offer paper forms when a patient or client comes to the office? How many staff members are dedicated to intake? What do you do if someone is concerned about a Covid-19 resurgence and refuses to sit near strangers? Dive into your process.

2) Look for small, yet impactful changes you can make.

Perhaps you can put a copy of your forms on your website so that patients know what to expect. Emailing or text messaging forms can also be an easy step in streamlining your paperwork. Even a simple change such as highlighting required questions on your form could save hours each week.

3) Digitise where you can.

The more you can digitise your process, the easier it will be for everyone. While the goal should be to digitise everything, small steps are an improvement and worth celebrating. Building secure online forms and creating fillable documents might seem like a large hurdle to overcome, but the time and money savings will be astounding. Moving your paperwork online also allows you to keep electronic records and store information such as photographs in one place.

It is clear that the future of the health care sector will have digitisation at the heart. The unfortunate reality is that most of the focus is on the NHS. However, there are steps that small private practices and businesses can take to move towards a paperless existence and prepare for future benefits. Digitisation will soon be ubiquitous across health and care, so why not start saving time and money today?

Andy Soluk is the Director of European Operations for FormDr: a digital platform for health professionals to build, send, and receive custom forms. Get in touch to learn how we can help streamline and digitise your paper processes.

Acute Care, News November 17, 2023

NHS braced for “toughest winter” – NHS Providers report

By Integrated Care Journal

New state of the provider sector report finds trust leaders anticipating “toughest winter”, with low morale and high levels of burnout fuelling concerns.

More strikes, staff burnout and relentlessly rising demand for care amid a severe funding squeeze could put paid to further progress in cutting delays for patients, health leaders have warned, according to a new survey by NHS Providers.

The State of the provider sector survey, which provides a yearly snapshot of the hopes and fears of leaders of hospital, mental health, community and ambulance services across England, found that:

Eight in ten leaders (80 per cent) say this winter will be tougher than last year (66 per cent said last year was the most challenging they had ever seen).
95 per cent are concerned about the impact of winter pressures.
Most (78 per cent) are worried about having enough capacity to meet demand over the next 12 months – higher than before the pandemic in 2019 (61 per cent).
Most are concerned about the current level of burnout (84 per cent) and morale (83 per cent) in the workforce.
Almost nine in 10 (89 per cent) are worried that not enough national investment is being made in social care in their local area.
Fewer than one in three (30 per cent) think that the quality of health care they can provide in the next two years will be high.

The survey also found that without exception, trust leaders said more industrial action would harm their ability to hit targets for reducing backlogs and delays in planned and emergency care, with a knock-on effect for services right across the NHS.

Commenting on the release of this year’s State of the provider sector survey, Sir Julian Hartley, Chief Executive of NHS Providers, said: “These results paint a very concerning picture about the challenges the health and care sector faces. Patient care and safety are front and centre in everything that trusts do. But the stark reality is that NHS trusts are facing their toughest test yet.

“As we head into what’s expected to be another gruelling winter, the spectre of more strike action continues to loom large over the health service. Efforts to bear down on waiting lists – a government priority – have been hit hard by industrial action. With targets to tackle record waiting lists already being watered down, any further walkouts would compromise the NHS’ ability to deliver efforts to reduce care backlogs and lead to more delays in planned and emergency care.

Money worries continue to mount with more than three in four trust leaders (76 per cent) saying they are set to be in a worse financial position than last year. Funding pressures are fuelling concerns about future patient safety and the quality of care as well as threatening to hit trusts’ ability to ramp up services as they brace for winter.

Steps to date to curb costs have included shelving plans for more beds, having to put on hold recruitment to plug gaps in the workforce, and reducing investment in community and mental health facilities.

Healthcare leaders say that the toughest test yet for trusts is coming, as winter and budget pressures bite. More strikes would undermine efforts to cut waiting lists, and a sustained focus on the quality of patient care is essential, said respondents.

Despite the huge challenges, the survey showed an undiminished determination to keep improving patient care, giving them the right care in the right place. Trusts’ commitment to addressing race and health inequalities remains as strong as ever, the report finds, with 86 per cent of trusts surveyed prioritising race equality and tackling discrimination.

However, the survey also found that trust leaders are deeply concerned about the impact of winter pressures on their ability to meet demand and provide high-quality care. They are calling for urgent government action to address the funding squeeze and support the workforce, as well as to invest in social care.

Without this action, they warn that further progress in cutting delays for patients will be put at risk.

“Ultimately, it’s patients who will suffer”

Sir Julian Harley added: “The NHS can’t afford further strikes. Talks between the government and doctors’ union are promising and it’s absolutely vital that ministers pull every lever they can to break the deadlock.

“The major, systemic financial pressures providers continue to face are adding to trust leaders’ worries alongside widespread staff shortages with more than 125,000 vacancies in the NHS in England, and soaring demand for many NHS services.

“The direct costs of hiring temporary cover for striking staff and the indirect costs of rescheduled appointments and procedures are having major knock-on consequences for trusts, including weakening their ability to recover care backlogs for hospitals, community and mental health services.

“Trusts are having to tighten their belts to find unprecedented efficiency savings while inflation squeezes already strained budgets, leaving little in reserve to invest in the extra capacity they need to deal with winter demand. There is palpable frustration at the Treasury’s unwillingness to provide extra funding to tackle the fallout from nearly a year of industrial action.

“The consequences of forcing NHS England and the DHSC to raid their budgets to make up this funding shortfall will be felt far and wide, putting the core NHS budget under further strain and much needed projects, including digital transformation, on the back burner. Ultimately, it’s patients who pay the price.

“Despite these multiple challenges, credit must go to trust leaders and their staff who have reduced the longest waits for treatment and continue to work flat out to see patients as quickly as they can.

“Their determination to deliver timely, high-quality care for patients is unshakeable. Their desire to improve services and build on the achievements of the NHS is undimmed. They are doing great work, often in the most difficult circumstances, but it’s clear that they face their toughest test yet as winter and budgets bite.”

The full ‘State of the provider sector’ report can be accessed here.

All news

Pharmacy First service agreed as Recovery Plan set to launch

By Gabriel Blaazer

Negotiations have concluded around the implementation of the Pharmacy First scheme, which is now set to launch in full on 31st January 2024.

The government, NHS England, and Community Pharmacy England (CPE), which represents all community pharmacy owners in England, have reached agreement regarding the launch of the new national Pharmacy First service, set out in this year’s Delivery plan for recovering access to primary care.

CPE’s Committee unanimously accepted the proposed deal, which outlines how the £645 million investment pledged in the Delivery plan will be used to support the rollout of expanded community pharmacy services. The agreement was reached following months of negotiation between CPE, the Department of Health and Social Care and NHS England.

Public Policy Projects has recently advocated for an expansion of pharmacy services in England in its report, Driving true value from medicines and pharmacy, which was chaired by Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation at Frimley Health and Care Integrated Care System.

It is now confirmed that the Pharmacy First services will be launched on 31st January 2024 as an Advanced Service, subject to the required IT infrastructure being in place. Under the new service, pharmacists will be able to offer advice and prescribe treatment for seven minor ailments, including sore throats, insect bites and uncomplicated urinary tract infections for women. Patients will be able to access the service without an appointment, as well as via referrals from NHS 111 and GPs.

Following consultations with pharmacists, patients with symptoms indicative of the seven conditions covered will be offered advice and prescription-only treatments where necessary, under a Patient Group Direction (PGD). CPE hopes that in the future, independent prescribers will be empowered to complete episodes of care without requiring a PGD.

As per CPE, the following stipulations have also been agreed:

The writing-off of previous funding over-delivery worth £112 million for CPCF Years 3, 4 and 5. If this money had been re-claimed from pharmacy owners over a year, it would have resulted in a reduction in the Single Activity Fee of around 10 pence per item.
Protecting baseline CPCF funding: the new money will be accessible as soon as possible rather than risk further over-delivery against Year 5 CPCF funding – the writing off of some Year 5 projected over-delivery supports this.
The inclusion of an upfront payment for of £2000 for Pharmacy First to support pharmacy owners to prepare and build capacity for the new service.
Increasing service fees to support ongoing capacity to deliver Pharmacy First, and for an uplift in fees across all services.
Reducing activity thresholds at the start of the scheme to “more achievable levels”.

The National Pharmacy Association (NPA) has welcomed the announcement, while also repeating calls for an increase in core funding for the community pharmacy contract to underpin sustainable future growth for the sector. NPA Chair, Nick Kaye, said: “We welcome this commitment to invest in a nationwide Pharmacy First service for common conditions. The new funding, whilst welcome, will not in itself solve the financial crisis in community pharmacy, but it is a substantial investment in a key service that could be a stepping stone to more.

“NHS England have put their faith in us, having seen community pharmacy successfully deliver other clinical services at scale. I’ve no doubt that pharmacies will once again deliver an impressive return on investment for the health service.

Highstreet pharmacist Boots has also welcomed the announcement pharmacy reforms. The chain announced today that it will roll out the NHS Pharmacy Contraception Service, allowing pharmacists to provide contraceptive advice and prescriptions, in the coming months. The service has already been successfully piloted in 22 stores in England.

The NHS Blood Pressure Check Service will also be expanded to most Boots stores in England, allowing pharmacists to check patients’ blood pressure and provide advice on reducing their risk of cardiovascular disease. Boots has said that the new and expanded NHS services will be good news for patients, pharmacy teams and GPs alike.

Seb James, Managing Director of Boots UK & Ireland, said: “We welcome the government’s announcement of plans to launch new contraception and minor ailments services in England, which will make life easier for patients to access the care and medicines they need quickly and help reduce GP wait lists.

“We have been working with our pharmacy teams in stores to roll out these new services to patients in England. We are already commissioned to deliver similar services for the NHS in Scotland and Wales and these are very popular with our patients and pharmacy team members.

“The free NHS blood pressure checks that we offer at most of our stores in England can save lives by spotting potential cardiovascular problems at an early stage, which also helps to reduce the burden on the NHS longer term.”

Not just for Christmas: Winter clinics a shining example of innovation we cannot overlook

By Dr Owain Rhys Hughes

Amid news that no funding is expected for community acute respiratory hubs this winter, Dr Owain Rhys Hughes explains why these are a shining beacon of innovation that the NHS cannot afford to overlook.

As winter fast approaches, the NHS is gearing up for another incredibly tough season. Waiting lists have hit a new record high of 7.8 million people and ongoing staff shortages continue to pile pressure on overstretched services. Innovation has a vital role to play in supporting the NHS to navigate these periods of intensified pressure. The winter clinics that provided lifeline support during last year’s winter months, which are yet to receive repeat funding for this year, are a shining example of the importance of such innovation – and the danger in overlooking it.

While primary care services deal with an existing backlog of appointments and referrals, the additional influx of patients expected to hit GP surgeries during the winter months – due to spikes in cold and flu complaints, for example – threatens to be overwhelming. Expanding the capacity and resources of primary, community and secondary care during this period is therefore essential. Winter clinics provided a crucial first line of defence for patients experiencing cold and flu symptoms last year. This deflected pressure from GPs and emergency services, boosting their capacity to see the patients they really needed to see.

Without initiatives like these, which facilitate the joined-up collaboration desperately needed to ease pressure on individual services and streamline patient triage, the NHS is facing a winter of unprecedented strain. A lack of capacity within primary care could leave many patients turning to A&E for support. In turn, this could place excessive pressure on secondary care, pushing up wait times for those in most urgent need of treatment.

We cannot afford to overlook the vital necessity of innovation that can unlock and support more collaborative care delivery and boost clinical capacity where it is needed most.

Winter clinics are just one example of the value and potential of such innovation during times of excessive pressure and need. There is a wealth of holistic and tech-powered solutions offering the tools for wider collaboration and more effective clinical communication. Harnessing these is essential to providing the infrastructure and support needed to ensure that the NHS can continue delivering exceptional levels of care amid growing strain.

Streamlining referrals into secondary care and introducing new sites for care delivery and diagnosis is a key way in which innovation is helping to do this. The rapid rollout of Community Diagnostic Centres (CDCs) across the health service is providing additional capacity and working to help reduce the number of patients being sent into secondary care for diagnostic tests and consultation. This is not only helping to diagnose illnesses such as cancer sooner, but is also allowing for triage to a wider range of services, ensuring only those who really need to be seen in urgent care are sent into hospital.

Another way in which diagnosis and referrals are being streamlined to free up capacity is through the introduction of digital advice and guidance. The use of digital tools to connect clinicians across different services can enable GPs and community clinicians to contact specialist consultants in real-time. This allows for advice and guidance to be easily and securely shared, and joint referral decisions to be made. As a result, the number of unnecessary referrals into secondary care can be reduced. Meanwhile, patients can be triaged to the most appropriate form of care sooner, avoiding repeat referrals and additional admin for GPs, boosting their capacity to spend with patients.

In my role at Cinapsis, I’ve seen this have an incredibly positive impact. Through our work in Norfolk and Waveney, for example, we’ve seen the use of digital advice and guidance reduce the wait time for specialist advice from 50 weeks to just 48 hours. This benefit has a knock-on effect by reducing the number of patients entering secondary care when they don’t need to. It also saves GPs time previously spent on copious admin and processing unnecessary referrals, freeing them up to see a higher number of patients.

As each new winter brings a fresh wave of increased pressure on our NHS, we must do everything we can to brace for and reduce the strain it puts services under. We cannot remove this pressure altogether; but we must embrace innovation wherever possible to facilitate the cross-service collaboration and vital communication needed to help clinicians unlock capacity and manage heightened patient demand.

Dr Owain Rhys Hughes, Founder and CEO, Cynapsis

Inclusive innovation: using community co-innovation to tackle health inequalities and digital exclusion

By Fran Ward and Dr Paulina Ramirez

By Fran Ward, Project Manager, NHS Arden & GEM CSU and Dr Paulina Ramirez, Academic, Birmingham Business School.

Digitalisation of the NHS has the potential to enable more personalised care and improve health outcomes. But it can also widen health inequalities. Some people in communities facing social and economic deprivation, which are also those experiencing the poorest health, find accessing care increasingly difficult as the NHS becomes more digital.

If those most in need of health services become less able to access them, health outcomes for these communities will worsen and the overall cost of healthcare will increase. Integrated care systems (ICSs), therefore, need to maximise the value of their investment in digitalisation by making it work for all their communities, not just the ones they know and understand well.

The ‘Building Inclusive Digital Health Innovation Ecosystems’ research programme, led by University of Birmingham’s Business School and supported by NHS Arden & GEM’s digital transformation team and Walsall Housing Group (whg), explores how community co-innovation could be used to develop digital healthcare that works for diverse communities and reduces the risk of exclusion.

Co-innovation is about understanding and framing problems and taking a bottom-up approach to generating new ideas in response. Specifically, this programme of community co-innovation is socially inclusive by design, creating an opportunity for disadvantaged communities to share their knowledge and lived experience. It gives these communities an equal share of voice alongside commissioners, clinicians and other stakeholders in the development of new digital health technologies or design of new online services.

Peer research

To genuinely hear what more deprived communities need, it is important to rethink how we in the NHS structure engagement to make it easier and more comfortable for those we most want to hear from. Training peer researchers from whg and local voluntary organisations enabled us to build on existing skills, connections and relationships. As trusted members of the community, peer researchers were better able to have relevant conversations within people’s homes, and elicit more honest and open responses on how people access technology and the barriers they face.

The resulting insights challenged some assumptions around barriers to adoption of digital technologies. The main source of inequality was found to be the lack of skills and confidence to engage with online services, with an individual’s type of work or family support structure often having a greater influence on digital proficiency than age, for example. Concerns around data privacy and information sharing were high, causing some not to access potentially valuable support. Despite positive attitudes towards digital in general, many felt digital services such as online GP appointments were not an adequate replacement for face-to-face health services due to a combination of trust, complexity and importance of healthcare in people’s lives.

Simply developing more digital services without addressing these fundamental barriers is inevitably going to limit success.

Changing the nature of engagement

Although good examples of user engagement in digital health services exist, there are constraints too. In particular, technology companies often have little or no engagement with deprived communities so can’t be sure their technology will work for those most likely to have the highest health needs. Alongside peer research, we need to create spaces for co-innovation to happen, bringing together these stakeholders to share information and work together to come up with new ideas.

A locally hosted co-innovation event enabled system partners in the Black Country ICS and health technology companies to hear from and engage with peer researchers and other local community organisations to start putting theory into action. Based on health priorities identified through the peer research, table group discussions addressed challenges such as how to ensure that a mental health app was used by those who most needed it, and how to increase numbers of patients from areas of high deprivation attending diabetes reviews. Peer researchers were able to articulate the day-to-day challenges people in their communities face and why, for example, simplicity and ease of use is often preferable to feature-packed, complex apps.

The event has already resulted in a dedicated task and finish group being set up at NHS Black Country Integrated Care Board to explore how community co-innovation can be applied to issues such as digital GP access. Whg is also keen to continue building a space for co-innovation within its community. More broadly, however, there is a wealth of learning from this approach which can be applied to digital transformation across the country.

Developing best practice

It is clear from this work that input from communities facing social and economic deprivation is essential in finding solutions to some of the nation’s most complex health challenges – and that how we do that is as important as why.

Findings from the ‘Building Inclusive Digital Health Innovation Ecosystems’ research have been used to develop a What good looks like for our communities report to support the NHS Digitalisation Framework. This highlights the need for affordable, simple, safe and inclusive technology that is well integrated with in-person services, guarantees data privacy and is supported with local skills training and support.

We have also developed a playbook to guide ICSs in using community co-innovation to develop digital health services, drawing on the learning from this programme to encourage greater use of this approach across the NHS. After all, there is no point in developing digital services that aren’t going to work for the communities we most need to help.

Photo caption: Peer researchers interviewing community members in their own homes in Walsall.

To find out more about digital inclusion and health inequalities, see: The digital divide: Reducing inequalities for better, prepared by Public Policy Projects.

Recognising the value and impact of AHP support workers within healthcare

By Integrated Care Journal

This week the Chartered Society of Physiotherapy, along with a coalition of 13 other allied health professional (AHP) bodies, is celebrating Support Worker Awareness Week.

AHP support workers are an integral part of multidisciplinary teams. They are relied upon for the transformative role they have to play across many different services, including physiotherapy. They work within their scope of practice to carry out a wide range of tasks and are supervised by a registered healthcare professional who retains responsibility for patient care.

The value of support workers cannot be underestimated. The contribution to services by support workers, both in the NHS and the independent sector, enhances patient outcomes, improves patient experience and increases service efficiency. They also provide immeasurable guidance and support to the wider health and care team.

Currently, we see increasing numbers of support workers playing a vital role in facilitating education by supporting physiotherapy students with their learning. By supporting physiotherapy students with practice-based learning during their placements, support workers offer a safe and supportive space, and contribute to the growth of the profession.

During the pandemic, support workers demonstrated great flexibility and brought new skills to the role. Their responsibilities increased and elements of their practice developed to meet the extraordinary pressures on the system.

Need for more support workers

More physiotherapy support workers are needed within the NHS, but this demand can’t be met by increasing the registered workforce alone. With ever-increasing physiotherapy waiting lists, an ageing population and more patients living with multiple conditions, more support workers are needed to fulfil population, patient and service delivery needs in safe, effective ways.

The CSP has recently conducted a physiotherapy workforce review in England and is calling for 6,500 additional non-registered physio posts in the NHS over the next five years. Additionally, the recent NHSE intermediate care framework recommends maximising the use of skilled support workers. If utilised at the right points in intermediate care pathways, their skills and expertise will improve access to high quality rehab that is timely, safe and person-centred.

In Northern Ireland, we want to see the implementation of the recommendations outlined in the Physiotherapy Workforce Review Report published in 2020, including the establishment of apprenticeships for physiotherapy support workers. In Scotland, we are calling for funded ‘earn and learn’ routes to be established and in Wales, the expansion of the level 4 apprenticeship scheme for support workers.

The support worker role is evolving, with increased opportunity to carry out additional responsibilities in practice. Higher-level support workers have additional responsibilities across the four pillars of practice. These roles are important to provide a positive impact on patient flow, quality of patient care and to meet new national policy developments.

What support workers need

Support workers need clear opportunities and pathways to develop capabilities and pursue career development. Each UK country should have a programme of work to develop support worker roles including those at higher level. This should both develop CPD opportunities, a greater consistency in levels of practice, capabilities and governance arrangements.

Higher-level support worker roles are one example of career development and provide opportunity for managers to think creatively about the skills mix within their teams.

With the right systems and support in place, support workers can do so much more.

Looking to the future

With the opening of the National Rehabilitation Centre (NRC) in East Midlands planned in early 2025, there is a new pioneering role.

The centre will offer a foundation degree apprenticeship for a rehab assistant practitioner role (band 4 equivalent). The rehab assistant practitioner will work across OT, physio and nursing with an evidence and training base behind them.

The NRC plans to offer around three to four hours a day of rehab as opposed to the 30-40 mins per day rehab normally offered in the NHS. Rehab Assistant Practitioners will be key in meeting these ambitious targets.

It is clearly time to recognise and shine a spotlight on the vital role of support workers but also most crucially to invest in their pathway and career opportunities.

Pioneering diabetes prehab service launches in Wirral

By Integrated Care Journal

Service uses population health data to identify those most at risk of having surgery postponed

One Wirral CIC, a non-profit community interest company that proactively helps to bridge gaps in health services and support for local communities, has launched a ground-breaking diabetes prehabilitation service to reduce surgery postponements, tackle waiting lists, and improve postoperative outcomes for patients. The service uses population health tools and analysis of hospital waiting lists to identify and support those most at risk of having surgery postponed.

Since April 2023, the service has supported two Primary Care Networks – Moreton and Meols PCN and North Coast Alliance PCN, funded by the North West Coast Clinical Networks. However, the service will now be extended across Wirral to all Primary Care Networks. The goal is for the approach to be adopted nationally.

The diabetes prehabilitation service uses the Cheshire & Merseyside Combined Intelligence for Population Health Action (CIPHA) population health management system, on Graphnet Health’s CareCentric platform. CIPHA surgical waiting lists at Wirral’s Arrowe Park Hospital are used to identify diabetic patients who are awaiting surgery and have a HbA1C (hemoglobin A1C – a test commonly used to diagnose diabetes and prediabetes) over 69mmol/mol or a BMI above 40.

The early identification of patients at risk of having their surgery postponed removes the need for GP surgeries to make referrals. The service also receives referrals directly from secondary care, for people that have had their surgery postponed, and have diabetic risk factors.

Once identified, patients are contacted within 48 hours and booked in for an appointment with a diabetes prehabilitation health coach, in a local community setting, such as a library. If a person’s HbA1c is over 69, they are automatically booked in for an appointment with a diabetes specialist nurse, who will look at medicines management and optimisation. Once they have seen the health coach and nurse, they commence a personalised prehabilitation lifestyle plan, which they follow up until surgery, whether that is a matter of weeks or months.

Lucy Holmes, Wellbeing Lead at One Wirral CIC, explained: “The population health and data-driven approach means we are able to contact the right people at the right time and give them the best intervention before their procedure, without anyone slipping through the net. We look at their lifestyle and they’re encouraged to participate in activities, including the free diabetes exercise sessions that are held in the community each week. Their medications are also assessed. It means we’re looking at a person from a holistic point of view, not just clinically and not just non-clinically. It’s a true community-based, multi-disciplinary team approach.

“We’re so pleased to be able to roll this out across Wirral, but it’s an approach that could easily be lifted and shifted. We would love to see it adopted nationally, because we have seen the many benefits of getting people fit before surgery.”

Dr Dave Thomas, Wirral Diabetes GP Lead, added: “With diabetes, we know that if someone is living with excess weight or their sugar levels are very high, then that comes with additional surgical risks, higher complication rates, they’re more likely to have a longer hospital stay, and they’re more likely to generally have a poorer outcome. So, a service where we’re getting people fit and healthy, and optimising their diabetes care prior to their operation can only benefit the patients. From a Wirral-wide point of view, it’s going to help reduce surgical waiting times, reduce complication rates, and it will allow us to reduce hospital stays.

“This really is a fantastic service. We haven’t seen anything like it anywhere else, which is really exciting and hugely positive for the patients that we’re supporting.”

To hear more about the benefits of the diabetes prehabilitation service, please click the video link: Wirral Diabetes Prehabilitation Service | How It’s Changing Lives.

New report from PPP calls for a pharmacy-led transformation of health and care

By David Duffy

PPP’s report stresses the need to support and empower the pharmacy sector and align its priorities with system-level health and care objectives.

A new report from PPP calls on integrated care systems (ICSs) to harness the unique capabilities of the pharmacy sector and implement a pharmacy-led transformation of health and care delivery. The report was launched at PPP’s ICS Delivery Forum event in London on Wednesday 1st of November 2023.

The report, Driving true value from medicines and pharmacy, is chaired by Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation at Frimley Health and Care Integrated Care System, and is the culmination of three roundtable events attended by key stakeholders from across the pharmacy sector and ICS leadership. Insight from these roundtables has also been accepted as evidence in the Health and Care Select Committee’s recent inquiry into the future of the pharmacy sector.

Emphasising the connectedness of pharmacy and local communities, the report calls for the value of pharmacy to be recognised beyond its potential to produce financial savings, and emphasises the need to leverage its diverse workforce, locally situated premises and unique patient knowledge in the delivery of system-level priorities.

It also concludes that the pharmacy profession must better articulate its value to constituent parts of ICSs, and that they require support to develop their voice, vision and leadership to meaningfully contribute to the delivery of integrated care. The report suggests that to enable this, primary care network (PCN) leadership must become more diverse to include the representation of pharmacy, and that pharmacy ambassadors should be expanded upon to provide inspiration to new recruits.

The report recommends that the NHS undertake regular regional reviews of the impact of the Additional Roles Reimbursement Scheme, so as to ensure that the local pharmacy workforce is not unnecessarily depleted while ensuring effective support for general practice. The report also calls for ICSs to establish more effective pharmacy leadership development programmes to enhance the sector’s influence at system level.

The report outlines major barriers to the progression of the pharmacy sector, including workforce pressures, outdated IT infrastructure and contractual mechanisms that hamper efforts at major reform. Although noting that the government has set out to address issues around workforce and digital maturity via the NHS Long Term Plan and the Delivery Plan for Recovering Access to Primary Care, it argues that ICSs have the power to go further by shifting to integrated, outcomes-focused contractual models. These, the report says, would enable the community pharmacy sector to focus on improving health outcomes and addressing health inequalities in partnership with wider primary care service provision.

Left to right: Ursula Montgomery, Michael Lennox, David Tamby Rajah, Yousaf Ahmad.

Driving true value from medicines and pharmacy has been published in the week after the government published its response to the Health and Social Care Committee’s expert panel on the evaluation of the government’s commitments to pharmacy in England. In its response, the government didn’t recognise the expert panel’s overall rating of ‘requires improvement’ as being reflective of progress to date, but stressed its commitment to enabling pharmacy to maintain a central role in the NHS.

Report chair Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation, Frimley Health and Care Integrated Care System, said: “This report underscores the critical linkage between medicines optimisation and integrated care. While cost savings are a compelling aspect of effective medicines optimisation and of pharmacy, the true value of medicines and the pharmacy team encompasses the entirety of health and care delivery.”

The National Pharmacy Association’s (NPA) Local Integration Lead, Michael Lennox, said: “As one of the stakeholders involved in the development of this report, the NPA welcomes its publication.

“You can draw a straight line from key NHS reports like Fuller and Hewitt to this excellent new document about engaging community pharmacy in integrated care systems,” Mr Lennox said. “The NPA has been involved in all of these strategically significant reports and our recently published prospectus for future services features prominently in this latest document.

“This report has some useful recommendations for NHS England, including that the impact of the Additional Roles Reimbursement Scheme is placed under constant review for each region, ensuring that the local community pharmacy workforce is not unnecessarily depleted. There are challenges for pharmacy leaders too, for example, the need to focus on improving health outcomes in partnership with the wider primary care team.”

David Tamby Rajah, Pharmacy Consultant, Community Pharmacy South West London, said: “This report reiterates the key role pharmacy can play in the newly introduced ICSs, the importance of successfully integrating community pharmacy, and the value of pharmacy to the NHS Primary care recovery plan, medicines optimisation, and their connection to local communities.

“The importance of population health management to pharmacy is highlighted as we plan for the future. This is the right time for all pharmacy sectors to have a joined-up conversation and seek further collaboration to support the challenges the NHS now faces.”

The full report can be downloaded here.

Spirit Health’s innovative solutions in wound care: A path to improved patient outcomes and NHS savings

By Clare Leek

Wound care is an often complex therapy area with thousands of product options. Spirit Health’s wound care range focuses on simplicity, and could help deliver millions in saved costs for ICBs.

This article is sponsored by Spirit Health.

For more than 14 years, Spirit Health has proudly served as an independent service provider to the NHS. Specialising in close collaboration with NHS Medicines Optimisation teams, Spirit Health offers a wide range of products and clinical services that deliver cost efficiencies and improvements in patient outcomes. Spirit Health has many examples of lasting partnerships which support the NHS to achieve its priorities.

Active Implementation is the service that lies at the heart of Spirit Health’s commitment. This involves providing the resource needed to carry out the prescribing changes desired at primary care level. This ensures that the hard-pressed general practice and pharmacy workforces aren’t distracted or burdened further while integrated care boards (ICBs) benefit from quickly realising the outcomes of their review services.

While Spirit Health offers Active Implementation across most therapy areas, it also has its own product portfolios that are available for ICBs to take advantage of. These products are of high quality but also provided at a cost-effective price to enable the NHS to save money. At the centre of this offering is Spirit Health’s Simple^TM wound care range. By prescribing the wound care range, it could result in annual prescribing savings of over £18m across the NHS.*

Wound care is an often complex therapy area with thousands of product options. Spirit Health’s wound care range focuses on simplicity. Its Simple^TM Wound Care range is designed specifically for non-complex wound care needs and when utilised, produces significant savings in prescribing expenditure.

The range offers a variety of dressings from foams to hydrogels to alginates. Each product has unique features to ensure an optimal healing environment and enhanced patient comfort. Spirit wound care includes dressings across these categories:

Alginate Dressing
Hydrocolloid dressings
Amorphous hydrogel
Hydrogel dressings
Non-woven absorbent
Super absorbent dressings
Vapour-permeable dressings
Breathable, absorbent island dressings

Furthermore, the Spirit portfolio is accompanied by a programme of support and training for healthcare professional teams, ensuring changes are managed optimally. Through its team of clinical pharmacists and nurse educators, Spirit Health provides bespoke and flexible training, tailored to meet local needs. Spirit Health also work with primary care and community nursing teams to ensure they are supported through changes and the appropriate patient benefits are realised.

Contact Spirit Health to find out how they could help your organisation to achieve savings and efficient implementation.

Meds-op@spirit-health.com

0800 881 5423

Spirit-health.com/medicines-optimisation

* Savings based on ICB prescribing data from Sept 2022-Aug 2023 with a 70 per cent switch from current prescribing to comparable products from Spirit Health. 