38. Somerset

What concerns have been raised about your STP?

Health planners are trying to reduce NHS deficits and think about ways to re-organise care. However getting the large deficit under control could prevent facilities being developed that can cope with the health and care social needs of local people.

Proposed changes

Weston General Hospital A&E department has been closed overnight due to staffing shortages, hospital bosses made their decision following severe criticism about substandard patient care from the CQC that noted that some patients were being treated in corridors. This has led to fears that the hospital will be downgraded and lose its A&E and critical care service.

There are concerns over the future of the maternity unit at Bridgwater Hospital.

Changes in who organises our care

Somerset is to develop as an accountable care system that the STP indicates will save money and help eliminate the deficit. Budgets for NHS and social care will be combined and a provider/s will deliver services through an outcome-based contract.

What are the proposed aims of the STP?

  • Elimination of the projected 2020/21 deficit of £596 million;
  • A focus on prevention to lead to a sustainable system;
  • Redesign of clinical and financially unsustainable hospital services;
  • A shift of services from a hospital to a community setting;
  • To create an accountable care organisation by 2019.

Like other areas this STP aims to transfer services out of hospital and into the community. The concern is that financial pressure will mean that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.

Further information   

The STP is short on details of how exactly the deficit is going to be eliminated.

Primary care

The total primary care workforce in Somerset is set to rise by 43% between 2017 and 2021 under the plans, with new pharmacists, paramedics, counsellors, nurses and health coaches. This is part of a system of workforce skills downgrading as the number of GPs will fall.

Analysis by GPonline of the Somerset STP has found that it would lead to an 18% drop in GP numbers by 2021.

Hospitals

In acute services, the plan says “alternative models of delivery” will be developed for “vulnerable services”, including consolidation and introduction of “single site, single workforce solutions” if appropriate. This could mean the closure of hospitals or the withdrawal of certain services.

Several services are listed for redesign, including paediatrics, maternity, dermatology, oral maxillofacial surgery, urology and oncology.

After press reports that many departments at Yeovil Hospital and Musgrove Park Hospital would merge, in November 2016 a spokesman, speaking on behalf of both hospitals, said: "There are no plans to merge departments at Yeovil Hospital and Musgrove Park Hospital."

The STP includes the development of a Hospital at Home service.

New models of care

The major focus of the STP is to eliminate the deficit by consolidating services across the area's two acute providers and the formation of an "accountable care system" by April 2019.

According to analysis of the STP by the HSJ, the accountable care system will be in two parts: a “strategic commissioning function” will be created with NHS and social care working together “under a single commissioning arrangement to secure outcomes and pool budgets” and an “accountable provider organisation”, where services are “delivered by a provider, or group of providers” through a single governance structure to the Somerset population through an outcome based contract.

The analysis concluded that it was not clear whether the accountable provider organisation could result in providers merging.