7. Greater Manchester
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.
Services cut for patients with serious congenital heart conditions at Manchester Royal Infirmary due to a lack of staffing. Those awaiting operations will need to travel up to 150 miles.
A reconfiguration of urgent and emergency care could lead to the closure of some urgent care centres. Two walk-in centres will shut in Bury and Prestwich and resources moved to NHS 111, GP surgeries and A&E departments.
Changes in who organises our care
A partnership between Manchester City Council and a newly formed CCG advertised a ten year contract worth £6 billion to run out-of hospital care in the entire Greater Manchester devolution region. The organisation will be known as a Local Care Organisation. The only bidder for the contract was the Manchester Provider Board, a consortium of NHS organisations in the city.
What are the proposed aims of the STP?
- Elimination of a projected 2020/21 deficit of £897 million;
- Strengthening of primary care to manage patients in the community more proactively;
- Increased integration of primary, community, social and secondary care;
- Increase in prevention services;
- Overall, the STP aims to move care from the acute sector to the community/primary care sector, reducing hospital visits and admissions.
Like other areas, the major aims are to transfer services out of hospital and into the community. The concern is that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.
Greater Manchester had already compiled a five-year plan by 2016 and this was put forward and accepted as the STP. This means that the changes in Manchester are further ahead than in most other areas.
Primary and community care:
There are now a number of primary care hubs offering seven day additional access across Greater Manchester.
NHS England and the 12 CCGs of Greater Manchester have collaborated to develop nine Greater Manchester primary care medical standards, which will be implemented by December 2017.
Programmes are in development to improve the population's health incorporating dentists, optometrists and pharmacists, as well as primary care.
The plans include the development of fully integrated Locality Care Organisations (LCOs), which include all health and social care providers in a locality who will work together to provide care to a defined population with primary care at the centre. The establishment of LCOs should enable conditions to be managed at home and in the community.
In March 2017, a partnership between Manchester City Council and a newly formed CCG that incorporates much of Manchester advertised a contract seeking a provider for “out of hospital” health and care services across the city. The 10 year contract is worth nearly £6bn. The winner of the contract will be known as a local care organisation.
The LCO will provide services for a population of around 600,000 across the city – but not the entire Greater Manchester devolution region. A single bid was made for the contract in June 2017 by the Manchester Provider Board, which is a consortium made up of Manchester City Council, local GP federations, the city’s three acute trusts, community service providers and Greater Manchester Mental Health Trust.
Eight clinical areas have been identified - paediatrics, maternity and obstetrics, respiratory and cardiology, MSK and Orthopaedics, breast, urology, neuro-rehabilitation and vascular - and service redesign is being investigated.
In August 2017, the Competition and Markets Authority cleared the planned merger of two major teaching trusts in Manchester - Central Manchester University Hospitals Foundation Trust and University Hospital of South Manchester FT.
A reconfiguration of urgent and emergency care is underway, which could lead to closures of some urgent care centres.
Two walk-in centres in Bury and Prestwich are due to shut. This decision has prompted widespread condemnation from local citizens: 2,000 people signed a petition to save Moorgate Primary Care Centre and Prestwich Walk In Centre. 83% of people disagreed with the plans in the CCG's survey on the closures.
Greater Manchester is one of four sustainability and transformation plan areas which will lead plans for regional back office mergers across the NHS.
Trafford CCG is considering plans to introduce a minimum waiting time for certain elective surgery in order to save money, according to a report in the HSJ and The Guardian in November 2017. The minimum wait time is likely to be three months for conditions such as cataract surgery and joint replacements.