“Place-based care” makes rational NHS planning and resource allocation well-nigh impossible

Place-based care is a frequent euphemism for accountable care systems (now rebranded as integrated care systems, but same as it ever was).

We’ve been pondering the choice of this euphemism and wonder if it’s intended to hide a mismatch between local authority areas and Clinical Commissioning Group areas. This is a confusing feature of Sustainability and Transformation Partnerships and Accountable Care Ducks. It seems bound to end in tears.

Public Health Professor Allyson Pollock has been tirelessly explaining this to anyone who will listen, and also to those who won’t – like most of the MPs on the Health Select Committee Inquiry into Sustainability and Transformation Plans and Accountable/Integrated Care Models.

Prof Allyson Pollock gives evidence to the House of Commons Health Select Committee, 27.2.18

This mismatch between local authority and clinical commissioning group areas would mean that the NHS in any given “place” no longer provided universal healthcare, and would dangerously impede rational planning and resource allocation.

Local authorities serve an area and all residents within it. Clinical Commissioning Groups don’t – they’re based on GPs’ lists.

In the new STP/Accountable Care Duck arrangements, as Prof Pollock explained to the unreceptive Health Select Committee,  there’s competition between GP practice lists.

The Dept of Health is funding NHS Trusts to establish GP practices and GP practices are federating. This competition for practices is because of dissolving practice boundaries and it means that the Clinical Commissioning Group area and the residents within it will increasingly no longer reflect the Clinical Commissioning Group population.

(And that’s without taking account of app-based GP practices like GP at Hand, which registers patients from outside the GP practice area and Clinical Commissioning Group area, thus de-registering them from their own GP and Clinical Commissioning Group area.)

As Prof Pollock told the un-hearing Health Select Committee,

“So it’s going to be very hard to know how CCGs are going to plan and commission services when they have hundreds – or tens of thousands – of patients who are not actually in their CCG area and when equally many tens of thousands of residents are no longer eligible for services through the CCG where they’re resident. And these provider-driven decisions about CCG populations and resource allocation decisions is very, very worrying.”

Meanwhile, local authorities have to serve everyone living in their area.

Think of the confusion when it comes to providing integrated NHS and social care services for mismatched populations.

To rectify this, a rational system of planning and providing NHS and social care services must be introduced through primary legislation – namely the NHS Reinstatement Bill.

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