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Posts Tagged ‘NHS’

NHS England’s medicines optimisation guidance: What are the opportunities to improve uptake of medicines at ICS level?

The NHS has been plagued by difficulty when it comes to variation in the uptake of NICE approved medicines. With the establishment of ICSs, there has been an attempt to position medicines as strategic enablers of improved patient outcomes and NHS productivity and efficiencies rather than just a clinical intervention for patients. The publication of NHS England’s medicines optimisation guidance 2023/24 last week signals a shift to create a national framework around this ambition, which NHS England (NHSE) has linked to integrated care board (ICB) priorities. Reading the guidance, the financial imperative is clear the broader goals of medicines optimisation e.g., reduced wastage, improved outcomes, and improved safety, are consistently correlated to helping systems ‘deliver financial balance’. 

However, with financial constraints placed on ICBs and the ongoing operational pressures facing staff, the root perception that medicines optimisation equates to doing more with less must be tackled first.  

NHS England’s new guidance sets out 16 national medicines optimisation opportunities for 2023/24, and signposts to best practice resources to support implementation. NHS England recommends that ICBs choose at least five medicines optimisation opportunities.  

What does Industry need to know and do following publication of this guidance?  

Here are a few of our thoughts: 

As we look to implementation, many questions remain. Will we see ICSs prioritise the same five ‘opportunities’ and what does it mean for progress in the opportunities that are not selected? How should system partners tailor their approach to targeted interventions in each ICS, each with differing local barriers? Finally, what additional strategies can help ensure that healthcare inequalities are not exacerbated? The ambition is high and must be matched by collaborative action at national, regional and local levels.  

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‘Stopping the 8am rush’ – Is the plan for recovering access to primary care an oversimplification?

The primary care access plan is finally here. A comprehensive plan to mull over but difficult to have a full view in the absence of the workforce plan. It is coined by DHSC as “the first step to address the access challenge ahead of longer-term reforms”, but this is not to undersell its transformative potential. Primary Care Networks (PCNs) are now fully focused on delivering this plan which spans the introduction of better phone and online systems, pharmacies supplying medicines for more conditions, and more staff and more appointments – anything else will be deprioritised.  

The plan has been widely praised as championing innovation. However, there is a feeling that the plan doesn’t duly assess the risks and benefits of what has been put forward and is perhaps an oversimplification from DHSC and NHSE.  

On a micro level, in this blog we explore the potential impact on access of changes to the role of pharmacy, the Investment and Impact Fund (IIF) and Quality and Outcomes Framework (QOF).  

Broadening the role of pharmacists presents both opportunities and risks

Pharmacy First has arguably elicited the strongest discourse and feelings both good and bad. Outwardly, a number of high-profile pharmacy leads are supportive of the initiative but there is cautiousness amongst the health sector. In conversation with David Thorne, Transformation Director at Well Up North PCN, he noted the following challenges:

1. Interoperability: It is vital that GP and pharmacy systems speak to each other, and we avoid the fragmentation that has bedevilled GP systems to date. Currently, robust systems are not in place to inform pharmacists of what medication someone is on to support their prescribing decisions ─ apart from placing faith in very early use of the NHS App. We need consistency and safe links, especially when looking to enable people to use a pharmacy distant from their GP practice.

2. Pharmacy closures:  In theory, the enhanced role of pharmacists could make primary care more accessible. However, data reports that pharmacy closures have disproportionally been in the most deprived areas of England ─ so there is a risk that positive changes to the role of pharmacists’ conflict with national priorities around health inequalities. One of the main drivers of the shortages of community pharmacists is the PCN recruitment of pharmacists to work in primary care roles.

3. Right Place, Right Role: Community Pharmacies may not be able to develop responsive clinical governance systems that adequately respond to case mix escalation, for example when superficially routine consultations escalate to issues of drug/alcohol misuse, mental health and safeguarding. How can we support pharmacists to develop the skill, time and governance systems to manage the types of conversations that GPs have?  Extensive training and public awareness will need to accompany these changes.

This is far from a done deal with negotiations on the £645 million supportive investment ongoing. Further, there will be a consultation on upholding patient safety considering greater prescribing powers for pharmacists.

Polling results conducted by WA communications in March 2023 of 1,000 members of the UK public highlight that whilst there is public support for a greater role for pharmacists, there is some way to go to building public awareness of the services pharmacists can provide.

A word of caution surrounding progressive changes to the IIF and QOF

Further details of the streamlining of IIF and QOF were announced within the plan. Redirecting £246 million of IIF funds represents a major shift with 30% to be awarded by ICBs (integrated care board), conditional on PCNs achieving agreed improvement in access and patient experience. DHSC/NHSE guidance is that access improvement plans should prioritise supporting those with the lowest patient satisfaction scores.

Local flexibility must be at the heart of the re-design of incentives, without arbitrary access quotas for certain groups such as ethnic minorities or LGBTQ+, which could lead to under-funding and deepening inequalities. It seems that DHSC/NHSE are cognisant of this, explaining that the plan is designed to move towards a “more equitable approach that will benefit all patients” and “does not call out specific cohort of patients” for that reason. This must be pulled through at an incentive level to ensure certain PCNs such as rural PCNs who may have small numbers of certain communities, are not caught out.

NHSE further announced that, through a consultation this summer, they will explore how to link QOF to key strategies such as the upcoming Major Conditions Strategy. Ultimately, ICBs new commissioning powers will mean ICBs very closely performance manage PCNs. This goes against the ‘neighbourhood’ aspect of integrated care reforms, which will only seek to become more complex as preventative care models are adopted.

As always, implementation will be the true test. The plan comes with no standardisation frameworks or action plans attached. This passes the buck to PCNs and/or ICBs to operationalise, which risks fragmentation in the absence of nationally led advice.

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The Hewitt Review unpacked

In July 2022, Integrated Care Systems (ICSs) were formally established with the intention of delivering joined-up services along a place-based approach, improve outcomes in population health and tackle health inequalities across the country. 

Yet, just six months into their formation, Chancellor Jeremy Hunt announced a review to be undertaken by Patricia Hewitt, former Secretary of State for Health and current chair of Norfolk and Waveney Integrated Care Board.  

The review sought to consider the oversight and governance of ICSs, examining the balance between greater autonomy and accountability for these emerging structures.  

Hewitt’s paper, published yesterday, reiterates the significant potential of the new NHS structures to deliver more strategic and sustainable healthcare – albeit with refinements. However, with a muted response from the DHSC and NHS England on timelines for responding to the review’s findings, there are questions over whether core recommendations will be taken onboard with any sense of urgency. 

What stood out? 

Prevention and population health 

The review reiterates the big opportunity of prevention and proactive population health as key to sustainable solutions to immediate performance pressures in the NHS. This is a well-trodden message – but one that continues to be easier to write about than deliver.  

To address this gap, Hewitt argues for a change in how the health and care system operates. This includes a shift in resources, to which she recommends a 1% increase in the NHS budgets going towards prevention. She also calls for a Government-led national mission on health improvement, with prevention, the reduction of health inequalities and the social determinants of health as musts, rather than ‘nice to haves.’ 

This sentiment is in keeping with other recent policy reports on prevention and early intervention, such as the recent Health and Social Care Committee inquiry into prevention which received over 600 stakeholder responses.  

Largely missing was any focus on industry partnership beyond high level commentary on evolving pathways and vendor management. This suggests that treatments are still not seen as a key part of the approach towards better population health.  

The potential of delivering on placed-based priority and need 

A big theme in the review is the need for a shift from a top-down, centralised system of managing the NHS to a bottom-up system, responsive and responsible to local communities.  

To facilitate this, Hewitt recommends a reduction in national targets with no more than 10 national priorities and the development of ‘High Accountability and Responsibility Partnerships’ (HARPs). These are additional mechanisms aimed at incentivising integration across all partners of a local system.  

However, integration and true place-based care cannot be fully achieved without local government and social care involvement. This has already been somewhat muted with the decision to create two local bodies – healthcare-led Integrated Care Boards and wider community involvement through the Integrated Care Partnerships. And there is an irony that on the same day as Hewitt review was published calling for better integration of health and social care, a £250m of budget committed to support social care innovation and training was withdrawn. Without a genuine joined-up approach, the opportunity for integration is unlikely to be truly realised.  

Decisions on accountability and governance  

Fundamentally, the review was commissioned to consider the oversight and governance of ICSs. However, it is not immediately clear whether this question has been answered and the critical question of whether ICBs or NHS England manages Trusts has been fudged.  

The review recommends that any intervention from NHS England direct to Trusts should come through the ICB structures. However, it then peddles back on that ambition by stating that it needs to be proportionate to the strength of the relationships, leadership and challenges facing a local system. 

Therefore, there is still considerable room for NHS England to be involved in the performance of local care providers. This takes away from the intended freedoms and flexibility at the forefront of the ICS model. 

Better funding flows 

The review does not call for any additional funding for NHS services but rather scratches beneath the surface to offer a remedy for how operationally government spending on health can achieve value for money.  

Hewitt identifies “over-complex, uncoordinated funding systems” as an impediment to achieving this principle. She calls for ICS funding to “be largely multi-year and recurrent” and for budgets across health and local government to be better aligned.  

Greater financial autonomy as well as simplified and coordinated funding behind ICSs has been welcomed as a recommendation. However, the varying degree of maturity of ICSs across the country, as recognised in the review, risks investors needing to adopt a more cumbersome and tailored approach depending on the ICS. 

What’s next? 

As yet, next steps remain unclear. The Government will respond to the central recommendations, but not immediately. Clarity around responsibility and accountability between NHS bodies may take more time. Many other key points may be chalked up as ‘requiring further consideration’. 

Jeremy Hunt – who commissioned the review – retains his interest in health improvement and is keen to drive better outcomes and efficiencies for patients and the public purse. How far he is prepared to loosen the grip on NHS budgets remains to be seen.  

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Scottish National Priority: how the SNP leadership contest could shape the NHS

This SNP leadership election will, for the first time in almost a decade put a new face at the forefront of Scottish politics.

While independence is unsurprisingly at the top of the agenda for the candidates, healthcare is a key battleground: a recent Ipsos poll found the NHS is the issue of greatest concern for Scottish voters.

Scotland is facing a healthcare crisis. The gap in life expectancy between the least and most deprived areas now stands at 13.3 years for men and 9.8 years for women, A&E waiting times are increasing, and the Government is set to miss key targets this year in NHS recruitment and tackling elective waiting lists.

How do the leadership candidates plan to address the healthcare crisis?

Humza Yousaf

With almost two years of health and social care experience under his belt, Humza Yousaf expectedly has the most developed set of healthcare policy goals, stating that he will make the NHS a priority as First Minister. As such, his ability to follow through on campaign commitments will be closely scrutinised if he is selected at the end of March.

Kate Forbes

Kate Forbes has also leant on her experience as Finance Secretary for the policy basis of her campaign.

Uniting both Forbes and Yousaf is their commitment to delivering the controversial National Care Service, an NHS-style centrally managed care service pitched as a solution to social care. Scottish Labour has framed the plans as a ‘power grab’ from local authorities; however, given the state of the social care sector across the rest of the UK, the SNP’s ‘top two’ are eager to promote Scotland’s solution.

Ash Regan

Despite being the clear underdog in the contest, the third and final leadership candidate, Ash Regan, proposes solutions that demonstrate the political breadth of the SNP.

While Ash Regan is unlikely to triumph in the contest, she represents the scale of the challenge that Kate Forbes or Humza Yousaf will have in uniting the Party to tackle the issue of greatest concern to Scottish voters, and the broad spectrum of policy ideas that lie within it.

Regardless of who is voted in as Party leader, the Health and Social Care in-tray will be busier than every other department. Before the next General Election, the incoming First Minister, and their new Health and Social Care Minister will need to drive significant improvements in healthcare if they want to have any chance of matching the flawless electoral performance of their predecessor.

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The challenges that remain for tackling variation in CVD prevention in England

Cardiovascular disease (CVD) is one of the leading causes of morbidity, disability and health inequalities, affecting approximately 6% of the adult population in England.  

To provide greater understanding on the state of CVD prevention services across England, the NHS Benchmarking Network publishes an annual CVDPrevent audit report. The latest iteration is much more oriented to looking through the lens of health inequalities and regional variation in care, highlighting the significant issue of a postcode lottery in cardiovascular care across the country. This new angle of focus of putting inequalities in the spotlight in the CVDPrevent report rightfully signals that this is where the focus should be for both health system leaders and industry working in this space alike.  

The report indicates some positive highlights for example with the prescription of anticoagulation drug therapy for those with atrial fibrillation at high-risk of stroke rising to 88.9% – only 1.1 percentage point below the national ambition to reach 90% by 2029.  

However, there remains some distance to go on the road to recovery from the pandemic with hypertension services particularly lagging behind others and health inequalities and variation remaining prevalent. Notably, individuals from a Black, Asian or Minority Ethnic background were identified as being the least likely to be prescribed an appropriate drug therapy, receive monitoring, or be treated to target with similar issues present across sex, age and deprivation level.   

Alongside variation in treatment and management, there is also significant variation in local approaches to CVD prevention. Our research and analysis of ICS strategies, planning documents and data relating to CVD-prevention, has found that there is a significant level of variation present in the level of planning for CVD prevention services, as well in care and outcomes.  

It is therefore particularly welcome to see the recent prioritisation of CVD services on the national policy agenda through the intention to publish a Major Conditions Strategy later this year and more recently through the appointment of Professor John Deanfield as the first ever Government Champion for Personalised Prevention. Both developments recognise the issue of inequality and unwarranted variation in the absence of a dedicated Health Disparities White Paper.   

However, the test of any such policy is whether it can be implemented uniformly to impact change across the country and not exacerbate variation as well as whether it can truly trickle down and impact at the local place-based level. To do so these policies will need to balance national direction with a sufficient amount of autonomy to allow for population-based CVD prevention strategies, an ambition of newly formed integrated care systems.  

Although the report demonstrates that progress is being made in this hugely important disease area, it is clear to see that much work remains to be done. Promising policies with high potential are a welcome sight to see and only time will tell if they can truly make the impact they set out to achieve.  

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Major ambitions in a new Major Conditions Strategy

A new health strategy is coming – finally! And it threatens to be a whopper.  

A Major Conditions Strategy will be consulted on – and potentially published – in 2023. After months of firefighting on day-to-day NHS operational performance the Government is looking to get back on the front foot and show the world it still has ambitions to improve the long term health of this nation. 

2022’s political turbulence put the 10-year cancer, dementia and mental health plans on ice, saw off the health disparities white paper, delayed the workforce plan, stalled the implementation of the Life Sciences Vision, and neutered the joint DHSC and NHS England Long-Term Plan refresh. Pressure on NHS services across the country and at every point in the system made long term strategising – however urgently needed – impossible. 

Steve Barclay’s ministerial statement today is an attempt to correct this perception, while streamlining the numerous strategies his predecessors committed the Department to.  

In short, the Government and NHS England will be developing a new strategy for ‘major conditions’ including cancers, cardiovascular disease – including stroke and diabetes, dementia, mental ill health and musculoskeletal disorders.  

The ambition is to develop a ‘strong and coherent policy agenda’ building on the progress of the NHS Long Term Plan to deliver the Government’s manifesto commitment of gaining five extra years of Healthy Life Expectancy by 2035.  

The statement makes for dizzying reading as it sweeps across healthcare hot topics: 

Given the breadth of the scope, it will likely generate cynicism as well as hope. There is no doubt that there are many big challenges that need addressing – conditions like diabetes and dementia have a huge impact on society and individual lives, and have consistently not received the attention they need to drive meaningful improvements in care.  

However, there is also a very real risk that this new attempt at a sweeping strategy is seen primarily as a move to kick action into the long grass, while giving ministers an answer to the persistent questions about progress on long awaited strategies in cancer, dementia and mental health. As healthcare has become increasingly political, today’s announcement is primarily about providing a degree of political cover.  

The consultation will need to address how any new strategy aligns with the wider approach to delivery. A major national review across multiple disease areas doesn’t naturally lend itself to the agenda of greater delegation of powers to ICSs through Hewitt Review or the removal of centrally imposed targets. It is also unlikely that significant funding will accompany reforms when all signals point to the expectation of efficiency and restraint.  

The health community will inevitably, and rightly, want to engage again: sharing evidence, policies, and best practice examples to try and shape this latest attempt at a vision for the future of care.  

But how many times can stakeholders and patients be walked up the hill without seeing any tangible change? 

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A guide to the challenges of 2023: A tell-all year

As the second week of 2023 draws to a close, it’s clear the year ahead will be rife with economic and political challenges.

WA Partner Rhoda McDonald was joined by WA Senior Adviser, broadcaster and journalist Steve Richards to discuss the issues that will dominate 2023.

Here are our key takeaways from the event:

Labour finding it’s feet

The Labour party enters 2023 with renewed enthusiasm. Starmer is keen to whip the Party in to shape and prove they are a Government in waiting. As he prepares for an offensive, there will be high expectations for his cabinet to perform, and with reshuffle rumours circling, there will be no room for idlers.

His team has largely been moulded by a new New Labour era, with some Blair flair, and it is clear that top of his agenda is modernising central government, stimulating economic growth, and reforming the British energy sector.

One of the key policy differences between the Conservative Party and Labour is around industrial policy – Rishi Sunak shows no great interest in an overarching Industrial Strategy, whereas Labour’s looks potentially very substantial, extending to light manufacturing, transport, and even retail, to underpin their ambitions for higher productivity and growth.

A Tory Party divided

Meanwhile the Prime Minister is tending to a wounded Tory party and attempting to rebuild political and economic stability. With wavering Tory voters, and the threat of a new Reform Party poaching his MPs, Sunak needs to be constantly appealing to the public and his backbenchers if he is to retain control.

Although Sunak appears to be relishing the challenge and leaning in to his role as the peace maker of the party, it is unlikely to be smooth sailing as the year kicks off with headlines dominated by strikes and pay disputes.

It’s all about the economy

The country’s economy is top of the inbox for the current Government and the Opposition alike. As Sunak’s forte, he is busy emphasising his brand as the fiscally minded Prime Minister who can stabilise the markets and bring public spending under control.

For Sunak the pivotal moment will come in the March Budget. The Prime Minister had prepared a draft budget during the leadership campaign, which was very business focused – looking at tax rates, business needs, and how to get people back into the workforce. As Corporation Tax rises take effect this year, against a background of a dire economic environment, the message of ‘growth, growth, growth’, and delivering the incentives needed to shape company and labour market decisions, are likely to be at the forefront when the Chancellor stands up at the Dispatch Box on 15th March.

On the other side, Labour are in the midst of deciding whether they follow a New Labour approach and stick to Tory spending plans, or to reinvent the fiscal wheel and risk further unease. Either way, the position they take will be determined by Shadow Chancellor Rachel Reeves.

Fixing the NHS

With the NHS hitting the headlines every week, healthcare reform will be a prominent issue throughout the year. The Government cannot shy away from the mounting pressure to act.

Having already passed the 2022 Health and Social Care Act, the Conservatives are unlikely to introduce new reforms this side of the election. However, talk of how to use the private sector and discussions of outsourcing are starting to snowball, with Labour saying they would consider this approach to relieve demand on the NHS.

Energy crisis

While the energy crisis continues and with geopolitical factors such as the war in Ukraine determining future supply issues, the Government is facing further spending pressures. The clock on household support is running down, and businesses are already feeling the pinch.

The risk for Sunak is inaction should the energy crisis become more acute. Although he has been avoiding Government intervention, he will be forced to change tact and avoid taking heavy fire from Labour as they seek to differentiate themselves.

The Deregulation agenda

With growth set to be the buzz word of the year, the regulatory landscape remains a battle ground yet to be won. As the realities of an EU regulatory bonfire threaten chaos, the Government is looking at lighter regulatory initiatives.

With businesses calling for clarity over the regulatory landscape, there are opportunities for both the Conservatives to make their mark and for Labour to carve out fresh ground for putting the UK on the front foot.

All eyes on GE2024

2023 is set to be the tell all year. Sunak and Starmer are facing the toughest set of challenges any leader, especially a newly incoming Prime Minister, have faced for decades. How they respond to and address the economic turbulence and address the nation’s discontent will ultimately determine their fate at the ballot box.

While Labour may be 20 points ahead in the polls, Sunak’s momentum over the summer appears to have closed a once-gaping gap. However, unless either party makes marked progress on the issues of the year, the prospect of a hung parliament with a minority government will become a looming possibility.

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What the new integrated care model means for specialised services

In July this year, the Government passed the long-awaited Health and Care Act 2022. A major part of the legislation was designed to drive integration of local services with the aim of enabling areas to adopt a preventative approach that focuses on population health.

After many years of movement in this direction, 42 Integrated Care Systems (ICSs) were formalised and tasked with bringing local health services together to provide more joined up care. Unlike unpopular health system reforms of the past, the broad consensus is that this reform is both important and progressive. Indeed, this was a reform that NHS England itself had called for.

However, major changes to specialised commissioning have raised concerns. In particular, patient groups have many questions around the impact these changes may have on the day-to-day care of people living with complex conditions.

Previously, NHS England commissioned many specialised services. As a result of the Act, the majority will now be commissioned locally by Integrated Care Boards (ICBs).

But complex conditions need complex care. The move to local commissioning is risky, mainly because a population management approach is not suitable for rare and complex conditions and commissioner expertise may be lost in the transfer.

Against this backdrop, WA Communications has been working with Muscular Dystrophy UK, the charity for the 110,000 people living with muscle-wasting conditions in the UK to understand the situation better.

Together, we’ve been exploring how ICSs should approach their new commissioning responsibilities to ensure people with muscle-wasting conditions receive best-practice care from 2023.

It’s vital that ICSs get this right, so that patients with muscle-wasting conditions experience at least a maintenance, or at best an improvement, in their care.

Our work culminated in a report, based on insights gained through workshops with clinicians and an APPG on Muscular Dystrophy meeting. The report can be accessed here. We identified three key areas that ICSs need to focus on:

  1. Building understanding: Inevitably, ICS commissioners and community clinicians may be less familiar with muscle-wasting conditions than specialist commissioners. However, it is fundamental to the commissioning and provision of good care that there is appropriate understanding of the condition and the level of care required. Finding ways to rapidly boost knowledge must be a priority.
  2. Holistic approach: There is a real opportunity for ICSs to improve care due to their in-built, joined-up approach. This means moving away from a sole focus on medical care to one that includes social care, education, physical activity, all of which takes place closer to home.
  3. Data: High quality and regularly updated data are vital for oversight of the quality of care, service planning and improvements. NHS England could support effective local commissioning through the creation of a data dashboard across ICS regions. This could outline key datasets for muscle-wasting conditions, such as condition prevalence, time and route to diagnosis, mortality, admissions and treatment.

You can download the full report here:

The new integrated care model and muscle-wasting conditions: How Integrated Care Systems can implement best-practice

Change of this nature is never easy, especially in a period of financial constraint and workforce pressures. However, focusing on the opportunities for better, more joint-up care – ideally backed up by robust data – could deliver important outcomes for people with muscle wasting conditions. Because ensuring the best possible integrated care for patients with all complex conditions can only be achieved through collaboration, communication and consistency.

We have been proud to support Muscular Dystrophy UK in this important pro bono project. You can read the full Muscular Dystrophy UK report on The new integrated care model and muscle-wasting conditions: How Integrated Care Systems can implement best practice here. If you are interested in learning more about how we can help you, please get in touch with carolinegordon@wacomms.co.uk

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Like pulling teeth: has the government finally got to grips with dental contract reform?

More than a decade after the coalition government announced its intention to reform the dental contract in England, action may finally be on the horizon. The new Health Secretary Therese Coffey has announced her focus will be on “ABCD: Ambulances, Backlogs of routine treatment, Care, Doctors and Dentistry.” It is no secret that NHS dentistry has been facing a growing crisis, with patients across the country struggling to access treatment due to the number of dentists moving to the private sector. Coffey’s challenge is significant – stabilizing the system and restoring public and professional trust in a system that has seen a number of false starts in the quest for a new dental contract.

The current dental contract has long been criticized by dentists for its sole focus on activity, which reimburses dentists for the volume of activity ‘units’ they complete. Dentists argue that this process is overly simplistic, and prevents them from focusing on preventative treatment, as they are financially incentivized to carry out more invasive work.

To remedy this, in 2015 the coalition government announced the launch of two new prototype contracts, with the aim of reducing dependency on activity as the only means of measuring activity and allocating funding. After the timetable for reform was pushed back repeatedly for a number of years, the government announced it would abandon the protypes in March 2022 and would work to find an alternative means of reform.

Against this backdrop of long term uncertainty, NHS dentistry has struggled to recover from the disruption caused by Covid-19, and is now suffering from an accessibility crisis. Since the pandemic, many practices have been operating at full capacity with patients waiting months for an appointment. At the same time, dentists are leaving the NHS, with over 2,000 ending their NHS contracts in 2021 alone. This leaves those remaining struggling to keep pace with demand. Currently, 90% of dental practices in England are unable to take on new patients, driving patients to the private sector (where they can afford it).

In July 2022 the Johnson government announced some significant revisions to the contract, with the aim of stabilizing NHS dentistry. These changes included establishing a new minimum UDA value, which increases the amount dentists will receive for their work, funding practices to deliver more work where possible and removing some of the barriers preventing dental therapists from carrying out treatment.

The reforms have been largely well received, but some sector leaders have warned that they lack the ambition to truly solve the issues the sector faces. Nigel Edwards, Chief Executive of the Nuffield Trust has argued that ”a lack of investment and misalignment between costs and funding have made it increasingly unattractive to be an NHS dentist. The resulting exodus of dentists has fuelled growing waiting times. While more money to help high-performing dental surgeries see more NHS patients is helpful, it does not address the problem that many areas in England have little or no access to an NHS dentist.” This view is shared by the British Dental Association, which has warned that the changes will not stop the ongoing exodus of staff from NHS dentistry, or solve patient access issues.

We may have already seen some preliminary reform to the dental contract, but Coffey’s very public focus on dentistry as an issue indicates that further reform is on the horizon for the NHS dental sector, an admission of how much change is needed. It also potentially signals that dentistry, long seen as a Cinderella service in comparison to other parts of the health system, may finally be getting the recognition and attention it needs to be able to secure real and lasting change.

In the meantime, however, more dentists are likely to switch their focus to private practice, in turn driving those who can pay for dental treatment to do so. The government is unlikely to seek to alter this dynamic and is likely to instead focus on addressing the lack of NHS dentists taking on new patients to attempt to stem the accessibility crisis.

Solving the issues facing the dental sector is no mean feat, but in putting the issue so high on the political agenda, Therese Coffey has indicated that there is now a feeling of greater urgency in finding a solution to long running issues affecting the sector. Regardless of what this change looks like, demand for affordable, accessible dental care will remain extremely high, particularly for patients who are unwilling and unable to pay high prices for treatment in light of the growing cost of living crisis.

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WA Investor Services supports Agathos’ investment in Hunter Healthcare

WA Investor Services is proud to announce it has supported Agathos’ acquisition of Hunter Healthcare, a specialist recruiter working across the healthcare and life sciences sectors. The investment will help support Hunter’s ambitious growth plans, providing vital staffing solutions to healthcare providers and medical researchers, including developing its offer in international markets.

WA provided political due diligence to support the transaction, with its team of healthcare policy experts providing insights integral to the deal process, working closely with Agathos and other due diligence providers to deliver clarity on how ongoing structural changes to the NHS, the elective recovery and acceleration of the digital transformation agenda will affect healthcare recruitment decisions and priorities.

Commenting on the deal, WA Partner and Head of Investor Services Lizzie Wills said: “We are extremely pleased to have worked with Agathos on this deal. NHS staffing is a very high-profile issue at the moment and ensuring the NHS meets patient demand while undertaking fundamental system reform is a priority for political and NHS leaders, not least as they tackle the post-Covid backlog. As a market leading provider of political due diligence in healthcare transactions we were in an extremely strong position to support Agathos’ successful deal and we look forward to seeing the business develop over the coming years.”

Hugh Costello, Investment Director at Agathos said: “WA Comms produced a comprehensive report with insightful conclusions that were well supported by desktop research and interviews with sector participants. The team was available for calls as and when required and were always a total pleasure to deal with. Ultimately, the output produced by WA was instrumental in our decision to complete our investment. I would recommend their services wholeheartedly.”

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WA Investor Services supports Livingbridge’s investment in Everlight

WA Investor Services is proud to announce it has supported Livingbridge’s acquisition of Everlight, an innovative 24-hour teleradiology business. Livingbridge’s investment will help support Everlight in building its pool of exceptional radiologists, driving technological innovation and propelling international growth.

WA provided political due diligence to support the transaction, with its team of specialist political risk analysts assessing the impact of structural changes in the NHS on the business, NHS strategies for recovering from the Covid-19 pandemic, and the potential implications of long-term workforce and technological issues affecting the sector.

Commenting on the deal, WA Partner and Head of Investor Services Lizzie Wills said: “We are extremely pleased to have worked with Livingbridge on this deal. Everlight is very well placed to assist the NHS in delivering cost-effective, high quality services and providing much needed capacity at a time when the health service is experiencing unprecedented demand.  Our market leading expertise in the health sector put us in a strong position to support Livingbridge’s successful deal and we look forward to seeing the business develop over the coming years.”

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WA Investor Services supports Livingbridge’s investment in AJM Healthcare

WA Investor Services is proud to announce it has supported Livingbridge’s investment in AJM Healthcare, a leading provider of NHS wheelchair services. The investment will help support AJM’s continued growth, enabling more users to benefit from its innovative, comprehensive and tailored solutions.

WA provided political due diligence to support the transaction, drawing on its market-leading expertise of evolving NHS commissioning policy, changes to the government’s procurement processes, and the wider reform agenda for health and social care. This insight was supported by the views of key decision makers and policy influencers from across WA’s extensive network.

Commenting on the deal, WA Partner and Head of Investor Services Lizzie Wills said: “We were delighted to support Livingbridge on this deal, at a time when the NHS is going through a substantial period of change. The restructuring of the commissioning process and the government’s wider focus on reform in the sector will have a significant impact on all businesses working in health and social care. WA’s deep network in both government and the NHS has informed our understanding of what the new landscape will look like and allowed us to generate valuable insights for Livingbridge. Our congratulations to everyone involved in the deal; we look forward to seeing AJM go from strength to strength in the years ahead.”

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