AOP highlights opportunities and risks in NHS reform plans

AOP clinical director, Dr Peter Hampson, identified the possibilities for “exciting new clinical opportunities” for optometry, but also highlighted areas of the plans to monitor closely

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The AOP has responded to the Government’s plans for reforming the NHS in England, identifying possibilities for “new clinical opportunities” as well as highlighting the potential risks.

On 11 February, the Government published a whitepaper and recommendations for reforming health and social care, with aims of delivering care that is “less legally bureaucratic, more accountable and more joined-up.”

Key to the plans is a proposal to introduce statutory integrated care systems (ICS), with every part of England to be covered by an ICS.

This would involve a combination of an ICS NHS body and a separate ICS Health and Care Partnership, including NHS, local government and partners.

The ICS NHS body would be responsible for day-to-day running of the care system, whilst the ICS Health and Care Partnership would bring together systems to support integration and plans to address the system health, public health and social care needs. The whitepaper indicated that both bodies would need to draw on the experience of front-line staff across health and social care.

Commenting on the announcement, health and social care secretary, Matt Hancock, said: “The proposals build on what the NHS has called for and will become the foundations for a health and care system which is more integrated, more innovative and responsive, and more ready to respond to the challenges of tomorrow, from health inequalities to our ageing population.”

The impact for optometry

Responding to the plans, the AOP suggested the changes offered opportunities for optometry, while also carrying some potential risks.

The AOP had previously noted these areas in its January response to the NHS England and NHS Improvement consultation on the future and structure of ICSs, and has re-affirmed that the organisation will continue working across the sector “to pursue the opportunities and manage the risks.”

Discussing the plans, the AOP’s clinical director, Dr Peter Hampson, suggested the shift in local commissioning from “relatively small” clinical commissioning groups to the larger ICSs, “Should open the way for extended eye care services, delivered in optometry practices, to be commissioned on a wider scale, as we have long called for.”

Pointing to the development of the Coronavirus Urgent Eyecare Service (CUES) in England, Dr Hampson suggested it illustrated how optometrists and dispensing opticians “can take on wider clinical roles and relieve pressure on other parts of the NHS.”

Dr Hampson continued: “Eye care is at the forefront of NHS England’s current outpatient transformation programme, and this together with the new reforms should create exciting new clinical opportunities for the AOP’s members.”

He advised that optical professionals would need to participate in the governance of the ICSs, typically through their Local Optical Committee, in order to ensure patients’ needs are understood.

Amongst the opportunities, however, are some potential risks. Dr Hampson suggested that the sector would need to closely monitor the risk that the commissioning of the GOS contract in England could move to ICSs.

“This would create extra cost and complexity but do nothing to help patients,” Dr Hampson warned. He added: “NHS England’s recommendations for legislative change, published alongside the White Paper, confirmed the NHS’ continued commitment to national contractual arrangements across the primary care contractor professions. The sector will need to ensure GOS remains national.”

Plans for reform

The Government suggested the blueprints for reform would build on the proposals of the NHS Long Term Plan and is in line with recommendations that recognise the need to bring organisations together to deliver a more “joined-up” approach.

This approach would be supported by a “broad duty to collaborate,” the whitepaper outlined. This is in addition to a triple-aim duty on health bodies, requiring them to pursue better health and wellbeing for everyone, better quality of health services for all individuals and sustainable use of NHS resources.

The Government suggested these systems could “plan health and care services around their patients’ needs, and quickly implement innovative solutions to problems which would normally take years to fix, including moving services out of hospitals and into the community, focusing on preventative healthcare.”

Plans for NHS reform also include enabling joint committees and enabling more effective data sharing, as well as removing “unnecessary tendering processes,” meaning the NHS would only need to tender services when it has the potential to lead to better outcomes for patients.

The upcoming bill proposes putting the Healthcare Safety Investigations Branch into law as a statutory body, as well as proposals to ensure the level of regulatory oversight of health care professions is proportionate to the risks to the public.

The Government also plans to introduce new requirements regarding calorie labelling and the advertising of junk food before the 9pm watershed, as part of aims to “level up” health across the country.

Reflecting on the need to build back after COVID-19, the paper authors wrote: “Collaboration across health and social care has accelerated at a pace showing what we can do when we work together, flexibly, adopting new technology focused on the needs of the patient, and set aside bureaucratic rules.”

A bill will be laid out to Parliament later this year, and separate proposals on social care reform will also be shared this year.

Responding to the proposals, the NHS Confederation, a membership body that brings together organisations involved in NHS services across the country, also recognised the need for reforms, “to help unlock some of the barriers front-line services face when trying to join up care for the public.”

“The future of health and care must be based on collaboration and partnership working – these reforms will provide the necessary updates to legislation to make this happen,” Danny Mortimer, chief executive for the NHS Confederation, said.

While welcoming the move to enable collaboration, he warned, “this doesn’t mean should end up with local monopolies as we must continue to work effectively, as we do now, with independent and voluntary sector providers.”

The NHS Confederation also warned against the “temptation to centralise the NHS further.”