Last reviewed 4 May 2021

In this feature Thoreya Swage, Healthcare Consultant, describes the planning guidance that NHS England has published for the NHS for 2021 to 2022.

Background

The year 2020–2021 was unusual in that there was no planning guidance published for the NHS as the country was in the midst of the Covid-19 pandemic. The majority of services were focussed on treating patients with Covid-19 and extra resources were directed at training and supporting the workforce, facilities and equipment to deal with the pandemic.

Elective care was delayed and the non-Covid work concentrated on the urgent and cancer presentations during this time.

During this time, the NHS treated over 380,000 people with Covid-19 in hospitals in England and many more in primary, community and mental health services. The NHS was also able to treat over 275,000 people with cancer.

The Covid-19 vaccination programme was initiated with staff from healthcare and the over 80s receiving their first vaccinations in December 2020 and as of April 2021 — according to the government’s coronavirus dashboard — over 33.5 million people had received their first Covid-19 vaccination (with over 12 million having their second dose) in the UK, bringing the total to 45.6 million — half of the UK population. For England, as of April 2021, 28.4 million received their first dose while 11.3 million had their second dose — a total of 39.7 million. See Vaccinations and Immunisations.

During this time, services across primary and secondary care, and mental health have been developing and accommodating changes required in the delivery of care to ensure the safety of patients and the public. Innovations such as remote working and consultations using digital technologies, the streamlining of clinical and administrative pathways and other alternative ways of working have become a routine.

Planning guidance for 2021–2022

As the country started to emerge from the third lockdown, NHS England published the 2021–2022 Priorities and Operational and Planning Guidance in March 2021. The document sets out how the NHS will recover activity, and start to build on the changes and innovations that occurred during the time of the pandemic. This feature focuses on the actions required of primary care services.

The priority areas

The NHS is facing a large backlog of patients who are waiting for various elective procedures and diagnostics which has built up during the past year, as well as dealing with staff across all sectors who are exhausted by the demands of looking after people with Covid-19.

The pandemic has also thrown into sharp focus the gap in health inequalities that exist across the country.

Given this backdrop, NHS England has identified six key areas for focus during 2021–2022.

  • The health and well-being of staff, including recruitment and retention.

  • Continuing the Covid-19 vaccination programme and treating patients with the virus.

  • Transforming the delivery of services building on what has been learnt during the pandemic, accelerating the restoration of elective and cancer care and managing the increasing demand on mental health care.

  • Enhancing primary care capacity to improve access, health outcomes and health inequalities.

  • Continuing the transformation of urgent and emergency care to ensure appropriate attendance at A&E, streamlining admission to hospital from the emergency department and reducing the length of stay for inpatients.

  • Working with Integrated Care Systems (ICSs) to ensure the delivery of the priority areas.

Health inequalities

The issue of health inequalities was highlighted through the differential infection and survival rates of people from ethnic minority groups and people with disabilities, both in the NHS workforce and the general population. The pandemic also had an effect on people’s health and well-being, including mental health.

The Priorities and Operational and Planning Guidance encourages employers to allow staff to have an opportunity to recover from the past year through various means, including taking unused annual leave, flexible working (eg remote working) and access to occupational health support.

With the greater emphasis on working within systems, population health management will be essential in targeting recovery strategies, ensuring equitable access to care, leading to better health outcomes.

Primary Care Networks (PCNs) will be supported by their ICSs to work closely with their communities to tackle health inequalities. This includes the continuing action to deal with the backlog of management reviews of people with long-term conditions, for example medication reviews. Routine vaccinations will be supported through the resumption of QoF (Quality and Outcomes Framework) indicators from April 2021.

Meeting the needs of patients with Covid-19

The NHS Covid-19 vaccination programme will continue through 2021–2022 with vaccinations centres, hospital hubs, general practice and community pharmacy playing their parts. General practice is expected to retain a key role in the Covid-19 vaccination programme, specifically in vaccinating 18–49 year olds, if they can also fulfil their GMS contract requirements.

PCNs will continue to support the home oximetry and hospital-led “virtual wards” services in their area, the latter being an important aspect of care for Covid-19 patients who would otherwise be admitted to hospital. These services would be vital in any potential surges in Covid-19 patients.

Primary care

PCNs have shown their value during the past year in co-ordinating the response to the pandemic across their constituent practices through implementing the vaccination programme. This has been strengthened by working closely with community services.

PCNs are critical in enabling the expansion of the workforce in primary care and they are expected to play a key role in recruiting more GPs (an extra 6000) and to make progress in delivering 50 million more appointments by 2024.

Practices will be expected to continue the transformation work that was developed during the pandemic and make use of more online consultations. GPs will be required to reach out to clinically vulnerable patients, eg people with cancer (through the QoF Quality Improvement module on early cancer diagnosis), provide physical health checks for people with Serious Mental Illness (SMI) via strengthened QoF indicators; and enhance the accuracy of GP Learning Disability Registers to ensure that the identification of patients is complete, specifically for under-represented groups such as children and young people from minority groups.

In order to enable practices to implement these actions, ICSs will be required to support their PCNs to increase to a total of 15,500 Full Time Equivalent PCN roles by the end of 2022, aligning with the target of 26,000 by 2023/24.

An extra £120 million will be made available in the first half of 2021–2022 to enhance the capacity of general practice. This will taper in the second half of the year as Covid pressures decrease.

Integrated care systems

ICSs will be required to develop priorities that reflect their local circumstances and health inequalities as well as identify the challenges the system faces. These will, however, need to be aligned to the four primary objectives of an ICS; namely enhancing health outcomes; addressing inequalities with regard to outcomes, experience and access; improving productivity and demonstrating value for money; and the support the NHS can provide for wider social and economic development.

Underpinning this will be the development of the digital and data capability to support population health management approaches, an essential component of which is a shared care record for the whole system.

References

Covid-19 vaccinations, NHS England, Statistics » Covid-19 Vaccinations (england.nhs.uk)