• Elimination of the projected 2020/21 deficit of £726 million;
• Reduction in the number of acute sites;
• A transformation of primary care to local multidisciplinary teams at primary care access hubs;
• Greater emphasis on prevention and early intervention;
• To reduce the number of A&E visits, outpatient appointments, and non-elective admissions;
• The overall aim of the STP is to move care from the acute sector into the community sector.

The STP includes plans to review specialised services at hospitals including St George’s, Epsom, St Helier and the Royal Marsden, to tackle the rising cost of care and identify the “optimal configuration” of services. The most likely target for closure is considered to be St Helier Hospital.

The STP states:

"The evidence suggests that we could reduce the number of acute sites run by the four acute trusts from the current five and this could improve the quality of care. Through the development of this five year forward plan the system has tested two hypotheses:

• That four acute sites is an appropriate configuration to deliver clinically and financially sustainable care in south west London; and
• That three acute sites is an appropriate configuration to deliver clinically and financially sustainable care in south west London."

There have been reports that emergency and maternity care will be cut from one hospital and it is possible that cancer services at St George’s, Epsom and St Helier and the Royal Marsden hospitals in Sutton and Chelsea will be merged to one shared site.

In November 2017, the Epsom & St Helier Trust Board decided to proceed with its plan to remove acute services from one or both of Epsom hospital and St Helier hospitals. A member of KONP Croydon noted that “the plans are to close all acute, emergency and maternity services at both hospitals – with only the possibility that they might build, just one, new acute ‘facility’ at some future date, at an unspecified location."

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 and could involve a new type of contract and capitated (i.e., fixed budget) funding. For further details see our pages on New Models of Care and Accountable Care Organisations.

Plans for transforming primary care in south west London include new multidisciplinary locality teams, which will be aligned to GP localities and take a role in managing long-term conditions, well-being and early intervention to prevent admissions. Primary care access hubs will be established with social care, physiotherapy and mental health wraparound services and integrated with urgent care services.

The STP contains a proposal to roll out the Sutton care home vanguard across the STP area, covering six boroughs and a population of around 1.4 million. The Sutton scheme funded regular named-GP visits to local care homes to provide healthcare, health and wellbeing reviews and end-of-life planning.

The plan also says that practices will have access to social prescribing. Practice federations will be embedded from 2017/18 and able to bid for enhanced service contracts and an MCP-type organisation will be formed by 2018/19.

The South West London STP board had one of the highest spends on management consultants to help draw-up the plans.

The hospitals in the area are under considerable pressure: by March 2017 Kingston Hospital  had had to issue two warnings to residents to avoid using the service as it struggled to cope with increasing pressure. This has led to critics to note that the plans to close one hospital in the area would lead to major problems and to even go as far as to say that:

“If St Helier closes people will die. People will die because services will be cut, they will die because they will have to travel greater distances to hospitals. There is no way about it, closing more hospitals will be fatal.”

The planned extension of the Sutton vanguard - which ended when funding ran out - has raised concerns. For this primary care approach to be extended throughout the STP area, primary care would first have to be stabilized and funding increased, as at present there is no capacity or funding for such expansion.