43. Gloucestershire

What does the STP mean for your area?

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

Proposed cuts

82 GP surgeries in the county will be merged into 16 GP hubs.

By 2021, the aim is that there will be an approximate reduction of 3,900 emergency admissions, 3,900 elective admissions, 125,000 fewer outpatient appointments and 6,700 fewer A&E attendances.

Lack of investment

In Gloucestershire alone, it is estimated a £150 million capital is needed to deliver the STP projects, but campaigners have noted that the STP contains no mention of where the money is coming from.

The financial problems facing the area was highlighted in May 2017, with the latest figures of the Gloucestershire Hospitals NHS Foundation Trust showing that the deficit increased almost fourfold from £11 million in September 2016 to £42 million in April 2017.

Changes in who organises our care

New ‘models of care’ are being investigated focused on redesigning community based care.

What are the proposed aims of the STP?

  • Elimination of a projected 2020/21 deficit of £226 million;
  • Development of urgent care hubs to act as a single point of access to health and social care;
  • Redesign of primary and community services;
  • Increased focus on prevention and self-care.

Like other areas they plan 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 does not include details of how the deficit is going to be eliminated and services maintained. Campaigners have been highly critical about the lack of figures in the STP document.

The STP includes the following:

  • Implementation of a new MSK model with clear pathways across primary and secondary care;
  • Changes to cancer pathways with a new community based survivorship model;
  • Implementation of an eye health clinical programme including delivery of new community eye health services;
  • Development and implementation of new pathways for respiratory and dementia care;
  • Development of an integrated specialist perinatal health service;
  • Systematic review of key programmes of care.
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Urgent Care

In urgent care, the STP plans a major redevelopment including urgent care hubs around the area, providing a focus for urgent care within geographical localities to include GP, community hospital and other community services.

Primary care and community care

The STP discusses the design of new models of care that will increase integration between primary and community care but with few precise details. The STP does note, however:

  • The increased collaboration of GP practices to cover 30,000 plus population areas;
  • An increase in patients able to access primary care online or via apps, with a target of 10% by the end of 2017 and 95% by 2021;
  • That by 2021 the STP's aims is to have  35 additional pharmacists qualified as prescribers working in practices, 65 additional GPs and 45 whole time equivalent advanced/specialist nurses.

Criticism

Stroud Against the Cuts has written to all councillors, arguing the plan’s budgets are “riven with holes” and provide no information on projected changes to staffing levels, number of beds, asset sell-offs, or deficits of the NHS Trusts."

They fear that behind closed doors the full plans hold details on “further cuts and sell-offs” to the county’s “much loved and vital hospitals”.

Liberal Democrat councillors have expressed concerns about cuts to beds in hospitals around the county: Councillor Iain Dobie, the Lib Dems' spokesman for public health and communities, said “From what we have heard there will probably be cuts in the number of hospital beds around the county. This is deeply alarming in light of increasing demand."

In May 2017 the councillor reiterated his concerns about the effect of the STP:  “I predict the upcoming rollout of the government’s Sustainability and Transformation Plans (STP) may well lead to the complete closure of at least one local hospital service in the county.”