• Elimination of a projected 2020/21 deficit of £854 million;
• Development of local care networks (LCNs) to establish multi-disciplinary networks;
• To increase in focus on prevention to improve the health of the population;
• Reduction in pressure on A&E by using alternatives;
• Increased collaboration across the footprint.

Overall, the STP aims to avoid the need for new hospital beds by reducing A&E visits and hospital admissions and by moving care away from the acute sector 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. This STP is also short on details of how the deficit will be eliminated at the same time as maintaining levels of care.

Under NHS England plans all STP areas will develop into Integrated Care Systems (ICS), previously known as Accountable Care Systems (ACS). This is a new model of care that aims to integrate hospital, community and social care. For further details see our pages on New Models of Care and Accountable Care Organisations.

As part of a move to new models of care, the STP includes the development of 23 Local Care Networks (LCNs), which will incorporate all 246 GP practices. LCNs are similar to multispecialty community providers (MCP) and bring primary, community, specialist teams working in the community, mental health and social care colleagues together to manage the health and care of local populations of between 50,000-100,000.

The STP also aims for an increase in births at home and reduce the number in labour wards.

According to the STP, by 2018 an integrated urgent care system will be established, bringing together the whole system, including a new 111 service. This will include a single out of hours number and access to a clinical hub, and will promote the use of alternative services in the community, including district nurses and community pharmacy.

The last walk-in centre in South London, in New Cross, was to be closed in December 2017, but will now remain open until the end of March 2018. An overwhelming 82.2% of people in the consultation opposed the closure.

The STP contains plans change the number of hospitals performing elective orthopaedic surgery, reducing the number from eight to two. However, following consultation and a campaign, Our Healthier South East London STP wrote to councillors in July 2017 saying the plans for a two site model had been dropped. The STP will now pursue a three site model – however, trusts failing to hit standards in 18 months could still have work sent elsewhere.

Lewisham and Greenwich Trust looked the most likely to lose work, according to an early assessment by commissioners of where the centres would be best located.

The STP outlines the increased use of digital technology. It is proposing the introduction of “algorithmic decision support tools” to aid its 1.67 million population and to have “universally deployed digital alternatives to face-to-face care in primary care and outpatient services.”

In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what the CCG areas with the highest over-spends will be required to do to enable them to spend less money and remain within a budget known as a 'control total' for 2017/18; the capped expenditure process (CEP).  The 14 CEP target areas include South East London. The measures under discussion include the following:

• Limiting the number of operations carried out by non-NHS providers so the funding stays within the NHS. Considerations differ between areas but include both limiting patients’ choice of providers, and reducing work which is outsourced by NHS trusts. In some cases it would require the NHS to find the capacity to carry out more operations;
• Systematically drawing out waiting times for planned care, including explicit consideration of breaching NHS constitution standards. Some plan to target delays at specialties/areas where waits are currently lower than average;
• Stopping NHS funding for some treatments, including extending limits on IVF, adding to lists of “low value” treatments, and seeking to delay or avoid funding some treatments newly approved by the National Institute of Health and Care Excellence;
• Closing wards and theatres and reducing staffing, while seeking to maintain enough emergency care capacity to deal with winter pressures;
• Closing or downgrading services, with some considering changes to flagship departments like emergency and maternity - though these would normally take too long to deliver savings this year;
• Selling estate and other “property related transactions”;
• Stopping prescriptions for some items, as suggested by NHS Clinical Commissioners earlier this year.

The commissioners in the area told the HSJ that they have been told to examine “difficult decisions” and “think the unthinkable”, including modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial.