Oli Hudson, Content Director at Wilmington Healthcare, explores the latest from the NHS on managing six major therapy areas.
One of the NHS’s major policy releases of 2024 has been the framework document for the Major Conditions Strategy.
It’s not the full thing: for that we will have to wait until next year. But the framework offers some real insight into how the NHS will work in the future in six major therapy areas that almost everyone in pharma will have worked in at some point in their career: CVD (including stroke and diabetes), Cancer, Musculoskeletal, Dementia, Chronic Respiratory and Mental Health.
There are three ‘big ideas’ in the framework document.
Firstly, spotlighting these six conditions as the major challenge of the NHS. Together they account for over 60% of ill health and early death in England, and are all extremely resource-intensive areas, liable to create clinical and managerial complications, and tend towards complex pathways with lots of different treatment access points.
Secondly, acknowledging that major conditions are rarely experienced in isolation but come with co-morbidities. In fact, one in four adults has at least two major health conditions. In order to address this, the NHS must create pathways and services which acknowledge, cost out and then find solutions for these crossovers, by the smart use of staff, money, locations and new technologies.
Thirdly, clinicians and services that deal with these six conditions are currently siloed and the work they do for patients needs to be more joined up – not only to see conditions and co-morbidities with the full clinical lens, but also to ensure patient care does not become sub-optimal because of multiple NHS access points, being told different things by different staff groups, or getting variable quality of treatment or management as they go from appointment to appointment.
It’s clear that the cures as set out by NHS England in the framework document involve a lot of collaboration and integration.
Major conditions: the customer base
One of the main points is to create a more integrated workforce to treat patients with the six. This will involve both ‘generalists’ and ‘specialists’.
Generalists such as GPs will be expected to specialise more and be able to contribute to the major conditions care with special interest qualifications and the ability to act as a consulting physician for some patients. It could mean prescribing rules are amended to allow this.
On the other hand, specialists are being asked to become more general and apply secondary care standard clinical care in setting outside hospitals such as the community and practices.
All this points in the future to a team coalescing around the condition – say ‘the diabetes system team’ – rather than being divided in health sectors such as tertiary specialist endocrinologists, acute diabetologists, community diabetes nurses or GPs with a special interest in diabetes, all working separately.
Teams in a field like oncology will be used to dealing with specialists in acute care; more and more, according to NHS policy, this will become flexible and companies may have to rethink how they place reps and moreover how they think of the condition within the health system.
Furthermore, at primary care network (PCN) level, teams are expected to work together with integrated neighbourhood teams dedicated to each of the six conditions.
Prevention is an area that policy makers have talked up for years but many in the NHS feels it needs a far stronger focus.
The strategy framework talks about “rebalancing the health and care system, over time, towards a personalised approach to prevention through the management of risk factors”. This will surely be key whichever government moves it forward and will raise the familiar debates around lifestyle choices, smoking, diabetes and obesity prevention, but what’s also clear is the NHS needs to engage in “secondary prevention” – managing patients already experiencing long-term conditions so they do not have to undergo unnecessary referrals or appointments – or worse, emergency admissions.
This is very much something that Industry can get behind – it should put the secondary prevention of exacerbations and emergencies front and centre in its value proposition.
Aside from the benefits that optimal control of these six major conditions and their overlapping co-morbidities can have on clinical outcomes, there are many important facets of this forthcoming strategy that pharma can use for leverage.
There’s a patient empowerment angle here too – patients want independence and control over their lives and pharma should stress the impact controlling these conditions can have on quality of life.
Resource use will also be of huge importance in the cash-strapped, crisis-riven NHS. By creating business cases that take into account resource-intensive conditions and optimal pathways – that take into account co-morbidities and the overall impact of them on NHS staff, NHS healthcare settings, social care and the wider local economy – Industry can form a partnership with the NHS on what will be the biggest long-term challenge of the next decade and beyond.
Want to find out more about the NHS Major Conditions Strategy? Attend or download our webinar on 12 December, 1230-1315.
To explore any of the opportunities arising for your company from the Major Conditions Strategy, contact our consultancy team.