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Small Translucent Penguins

Still practising

Chris Preece

Tuesday, 22 November 2016

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penguin_shutterstock_1164519_v2.jpgAccording to a recent BMA survey, one in three doctors have no idea what an STP is, with roughly two thirds saying they have not been consulted in any way. Which isn’t entirely surprising – certainly the only direct invitation I’ve received to be consulted regarding the STP was an invite, sent via Facebook, from a colleague. (For a meeting I wasn’t able to attend.) So, for those who are feeling completely left out of the loop, here is a brief Q&A guide to the STP.

What does STP stand for? Significantly Taller People? Sinister Tory Propaganda? Sentient Tea Pots? 

Sadly, it’s none of these. STP stands for Sustainability and Transformation Plan.

OK. But what does that actually mean?

STPs are plans for future health and social care in England – roughly fitting in with the Five Year Forward View. The expectation is that all providers will work together in order to deliver this shining utopian vision for the future – laying down the template for Health and Social Care in your region for the next five years. (Whether you like it or not.)

Wait - aren’t they all supposed to be in competition with each other? Wasn’t that supposed to be the secret of achieving “efficiency”?

Pffft. You’re so 2012. Competition’s out, co-operation’s in. Admittedly pretty much all the existing bits of policy firmly establish accountability at an organisational level, meaning that each NHS provider would rather be on the front page of the Daily Mail then knowingly share its risks with another, but don’t let that put you off. Everyone’s totally happy working together. Honest.

So it’s a single unified plan?

Erm, no. Forty-four different STP “footprints” have been identified to ensure plans are “Place Based” to make sure they’re built around the needs of local populations. 

What clever calculation did they use to develop the footprints? Are they based on population size, Local Authority Boundaries, Laylines?

It’s apparently based on geography, scale, existing projects, financial sustainability and leadership. 

So they got a toddler to colour in a map of England, and then based it on that?

It certainly looks like it. Footprint sizes vary from populations of 0.3 million to 2 million, which certainly seems to be a pretty large range. Meanwhile, my Local Authority alone appears to be stuck across three separate “footprints” without wholly occupying any of them.

That doesn’t sound all that joined up. Is there at least extra funding for this?

There is funding, although whether it’s really “new” is up for debate. According to NHS England, the “most compelling and credible STPs will secure the earliest additional funding”.

So if you want the money, you’d better play nice?

It was always thus.

Still, it’s nice that all this work’s being done to improve quality, develop those new models of care everyone’s been talking about, and prioritise prevention, right?

Absolutely - although as The King’s Fund’s recent report pointed out, the focus has pretty much completely shifted to achieving financial balance rather than all that “good medicine” nonsense.

Meanwhile, all the people who would normally be working incredibly hard to try and steer the NHS through its current upheavals are instead frantically trying to re-arrange the deck chairs again for the STPs. Don’t be surprised if a few CCGs and Trusts wind up hitting an iceberg.

A metaphorical iceberg?

Obviously. Climate change won’t get that badly out of hand for at least another 15 years.

So, now I know what an STP is, presumably I’ll be consulted on the contents any day now?

Well, in theory they should have been submitted in June with implementation in “Autumn 2016”, which implies you’ve missed the boat, or at least the first launch of what will likely be many. It’s also probably worth pointing out that the NHS guidance for “engaging local people” around STPs only came out in September, so it appears to be the very definition of an after thought.

To be fair on the managers writing these things, they are, as I’ve already implied, basically having to come up with this stuff in their spare time whilst also trying to do their day job. If you did all your working out on the back of a napkin over lunch, you probably wouldn’t want to take time out to share your ketchup stained plans with the rest of the world either.

Why aren’t people making more of a fuss about this?

Because it’s complicated, and if there’s one thing the last year has demonstrated it’s that people aren’t interested in having to think about anything too complicated. In retrospect, I could have just written “STP means STP” at the top of the page and saved us all a bit of time.

Anyway, do you think you understand it now?

Not really.

Do you at least know what STP stands for now?

Suspiciously Terrible Policy?

Close enough.

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Chris Preece

Chris has worked as a GP Partner in North Yorkshire since 2004, and still relishes the peculiar challenge of never quite knowing what the next person through the door is going to present with. He was the chair of his local Practice Based Commissioning Group, and when this evolved into a CCG he joined the Governing Body, ultimately leaving in April 2015. He continues to work with the CCG in an advisory capacity. When not being consumed by all things medical, Chris occupies himself by writing, gaming, and indulging the whims of his children. He has previously written and performed in a number of pantomimes and occupied the fourth plinth in Trafalgar Square. Tragically, his patients no longer tell him he looks too young to be a doctor.
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