Andrew Goddard: STPs are currently the only game in town

We as clinicians need to get playing that game

The Hospital Consultants and Specialists Association (HCSA) report confirms what most of my colleagues tell me—that many hospital clinicians have very little understanding about STPs (and the Five Year Forward View for that matter) and even fewer feel that they have had the opportunity to contribute to local plans.

The report shows that many consultants fear that STPs are a way to cut NHS funding. I think we need to try to take a more holistic view of health and social care and the STPs are the first step in that process. This will in the end shift funding from secondary to primary care, but that is not necessarily a bad thing. It is clear to me, though, that the savings envisaged through bed reconfiguration are unachievable in the time frame set out by most STPs, let alone the aspirational reductions in out-patient attendances, or A&E attendances and admissions.

The three tenets of the Five Year Forward View (5YFV) are to be supported and the focus on prevention and primary care is essential. I had the joy of reading all of the STPs when they came out last year and the proportion of funding needed for prevention and public health was really very small, yet the potential gains were huge. This needs to be highlighted more.

As the HCSA report says, the achilles heel of all of the STPs is workforce. Every part of the system is struggling and local government and social care are probably struggling more than other parts. Some STPs acknowledge this and are looking at ways to improve local recruitment. This is admirable, but will take a lot of effort to achieve. Given the undersupply in carer, nursing, and medical workforces (let alone the worries of a world post-Brexit) it is hard to see how STPs will work. Having said that, the direction and destination of the 5YFV is the right one and STPs are currently the only game in town. We as clinicians need to get playing that game.

On the issue of engagement, I gave a talk to STP communications staff earlier this year at an event organised by NHS England to try and facilitate clinical engagement. This shows that NHS England know it is an issue and are trying to do something about it. They also readily admit that clinicians should have been involved from the outset. Most STP comms leads have little access to clinicians and the busyness of both sides will make engagement a challenge. It is probably easiest for clinicians to get involved in the clinical areas they work in on a daily basis as not only do STPs have to demonstrate to doctors that they know what they are doing, but to patients as well. Knowing their doctors are involved will help reassure patients that care is not being sacrificed for costs.

Getting STPs to achieve just some of their aims is like climbing a mountain in flip-flops. In good weather it is just about achievable, but the NHS climate is currently hostile and proper footwear is needed. Clinicians are the mountain boots for STPs. Without us it is all going to go horribly wrong.

When clinicians hear NHS leaders talk about “exciting plans to improve the health of patients and communities by redesigning services to use funding more wisely” what clinicians hear is “blah blah blah patients blah blah blah cuts.” The HCSA survey suggests this isn’t too far off the mark.

The RCP has produced a video to help members engage with STPs:

See also: Wanted: clinicians to avert NHS transformation failure

Andrew Goddard, registrar, Royal College of Physicians, and consultant gastroenterologist, Royal Derby Hospital.

Competing interests: None declared.