Executive summary

This annex provides details of performance and work being undertaken to improve services in additional operational areas.

Primary care and Community Health Services                

1. Primary and Community health face significant challenges in terms of access to GP services and dentistry, and increasing waits in community services. The Primary Care Access Recovery Plan (PCARP) published in May 2023 is a two-year delivery plan to recover access to primary care while taking pressure off general practice. All actions from the first year of the plan have been delivered which includes:

• an additional 71.5 million appointments in general practice, against an ambition of 50 million
• successful launch of Pharmacy First in January 2024 with over 90% of pharmacies signed up, and the expansion of Community Pharmacy Contraception Service Blood Pressure Check services in December 2023
• 90% of practices enabling patients to see their records, send messages, book appointments and order repeat prescriptions using the NHS App
• Over 54,000 self-referrals, in specified pathways, as of March 2024 against an ambition of 45,000

2. Year 2 of the PCARP is focussed on realising the benefits to patients and staff from the foundations built since the launch of the plan. While certain challenges remain, progress has already been made against a number of the deliverables including:

• Reaching over 4 million repeat prescription ordered and 18.6 million record views via the NHS App in May 2024, against March 2025 ambitions of 3.5 million and 18.6 million, respectively
• half of GP practices already using the online registration system as of June 2024
• uptake of Pharmacy First, and other expanded services, has been positive and activity continues to grow

3. Amendments to the GP contract regulations were laid in Parliament at the end of April 2024 to underpin the changes to the core GP contract that came into force on 27 May 2024. The BMA ballot on collective action will close on 29 July 2024 following 2024/25 contract funding, with work ongoing to prepare for any collective action.

4. The Dental Recovery Plan was published in February 2024 to deliver up to 2.5 million additional NHS dental appointments for patients over the next 12 months, including up to 1.5 million extra treatments. Good progress has already been made against the plan, and the New Patient Premium and the revised minimum Unit of Dental Activity (UDA) value of £28 have been implemented. ‘Golden Hello’ guidance has also been issued which is designed to attract dentists to areas of high dental need with a payment of up to £20,000.

5. The number of people on community health service waiting lists grew by around 3% in April with around two thirds of people seen within 12 weeks.

Mental Health

6. Pressures remain across the sector from increased demand, prevalence, and capacity constraints. The NHS continues to focus on addressing the long-standing treatment gap in the Mental Health sector and improving services to deliver against public commitments.

7. The 2024/25 NHS priorities and operational planning guidance committed to increasing the number of adults and older adults completing a course of treatment for anxiety and depression via NHS Talking Therapies (TT) to 700,000, with at least 67% achieving reliable improvement and 48% achieving reliable recovery. In May 2024, 56,960 adults and older adults completed a course of treatment for NHS TT services, with reliable improvement of 67.4% and reliable recovery of 47.9%.

8. While referrals to NHS TT services are broadly at an appropriate level to deliver the current monthly target for courses of treatment, an increase in referrals will be required to achieve the final 2024/25 target. To achieve this, work is continuing to support the re-brand of NHS TT services, with a planned campaign taking place throughout the country at the end of 2024. This will help clarify which referrals are appropriate and reduce the high levels of attrition between referral and beginning a course of treatment. 

9. Access to Individual Placement and Support (IPS) services has significantly improved, with over 36,000 people reported to have accessed an IPS service in the 12 months to March 2024, compared to 26,000 in the year to March 2023. Work is taking place to improve recruitment into IPS services, increase referrals from primary care through sharing learning from five funded pilots, and support expansion in line with requirements from Treasury funding. 

10. The number of Mental Health Support Teams (MHSTs) in schools has increased from 398 teams in Spring 2023 to 498 teams in Spring 2024 with services now covering 44% of the pupil population. MHSTs are on track to cover at least 50% of pupils and learners by Spring 2025.

11. The Urgent and Emergency Mental Health pathway continues to be under significant pressure, experiencing high bed occupancy (between 95-97%) since May 2022. This is caused in part by challenges securing social care and housing support for patients and results in people being sent far away from home to access hospital care highlighting ongoing pressures on the acute mental health pathway. Continued focus remains to improve patient flow and work towards eliminating inappropriate out of area placements.

12. CYP eating disorder (ED) pathways continue to be challenged. As of April 2024, 75.2% of routine CYP ED referrals were seen within 4 weeks and 72.9% of urgent referrals were seen within 1 week. NHS England continues to develop opportunities to improve prevention and early intervention approaches to help improve outcomes for children and young people with eating disorders.

13. Access to specialist community perinatal mental health (PMH) and maternal mental health services (MMHS) has been increasing since July 2023. In the 12 months to April 2024, 58,898 women accessed these services which is an increase from 58,303 in the 12 months to March 2024. Work continues with regions to provide delivery support to systems to increase access to these services through collating and sharing best practice from high performing systems, as well as strengthening links across the PMH pathway.

14. The dementia diagnosis rate has been demonstrating steady improvement since January 2023, and stands at 65.0% as of June 2024. If this trajectory is maintained, it is expected that the 66.7% ambition could be achieved in 2024/25. A new dementia steering group has been set up bringing together other arms-length bodies and voluntary sector partners.

15. Workforce expansion and addressing high vacancy rates remain a priority to enable service delivery and transformation. Progress is being made in this area, with the mental health secondary care NHS workforce having grown by over 39% (c. 43,100 FTE) between March 2016 and March 2024. Vacancy rates for nurses employed by mental health trusts stood at around 15% in March 2024.

16. The Patient and Carer Race Equality Framework (PCREF) has been included in the 2024/25 NHS Standard contract to help drive delivery and ensure mental health providers are co-producing and implementing concrete actions to reduce racial inequality. All mental health providers are expected to implement the PCREF by March 2025 and currently 13 pilot sites are working with NHS England to assist with implementation and shared learning, furthering system readiness. A PCREF dashboard is being developed during 2024/25 to support systems, regions and providers and further improve the approach to overall PCREF reporting.

Learning Disabilities and Autism

17. At the end of May 2024 there were 2,030 people with a learning disability and autistic people in a mental health inpatient setting – a reduction of 25% from the March 2017 total. Of the current inpatient population, 90% of under 18s and 43% of adults are autistic with no learning disability. Work is continuing with local systems to focus on what can be done to support autistic people and people with a learning disability to remain living well within the community, and to deliver our housing capital programme to support people in hospital with the most complex needs to find a home.

18. During 2023/24 77.6% of people aged 14 and over on a GP learning disability register received an annual health check, exceeding the target of 75%. Data for May 2024 shows that 7.8% of health checks had been completed so far this financial year, 1.2% higher than at the same point last year.

19. There have been significant year-on-year increases in the number of people waiting for an autism assessment, with demand for assessment continuing to outstrip the capacity needed to deliver them. As of March 2024, there were 183,733 people with an open referral for an assessment for suspected autism, a 39% increase since March 2023. Of these, 160,396 people had a referral that had been open for at least 13 weeks. There were 133,288 new referrals and 119,136 closed referrals in the 12 months up to March 2024, an increase of 11.9% for new referrals and 46.4% for closed referrals compared to the 12 months to March 2023. Work is continuing with local systems to implement the All-Age Autism Assessment Framework and Operational Guidance as well as supporting assessment improvement initiatives.

20. Work to deliver the Partnerships for Inclusion of Neurodiversity in Schools (PINS) project is ongoing, and is aiming to recruit 40 primary schools in each ICB area. We continue to support local areas with their delivery of keyworker services and implementation of Care (Education) and Treatment Reviews and the Dynamic Support Register policy to support children and young people at risk of admission to mental health inpatient care.

Children and Young People

21. The CYP Transformation Programme continues to deliver against its commitments:

• over 2,500 children have now started treatment in one of the Complications of Excess Weight (CEW) clinics since their launch, exceeding the former NHS Long Term Plan target of 1,000 new patients a year. The CEW clinics will continue to expand during 2024/25, improving access to treatment and using medical technology to provide further support for these CYP outside of the clinics
• an initial evaluation of the national bundle of care for children and young people with asthma has been completed and will be published in the summer

22. Progress is also being made to deliver the commitments set out in the national urgent and emergency care strategy. This includes:

• family Support Workers now being established in selected A&E sites
• the Paediatric Clinical Assessment Service with the latest data showing over 80,000 calls received since go-live, and plans to extend the service
• the continued roll-out of the paediatric early warning system (PEWS) in all in-patient settings and plans underway for expansion into A&E

23. Work is ongoing to develop proposals for Integrated Neighbourhood Teams for CYP, which include plans to embed paediatric expertise into primary care through a multi-disciplinary team approach. This will seek to build on the evidence from the Connecting Care for Children model in North West London which has shown 40% fewer outpatient appointments, 22% fewer emergency department presentations, 17% fewer hospital admissions and 16% few GP attendance.

24. Work continues to develop a Children and Young People’s Strategy, building on the progress made since the Long Term Plan in improving child health. Underpinning the emerging strategy is a commitment to provide the highest quality of care to children and young people, providing support as early as possible to prevent and reduce health complications.

25. Selected Operational Delivery Network sites are to test a paediatric approach to Martha’s Rule over summer 2024. These are distinct from the Trust-level pilots announced earlier this year and will look at alternative models that provide a networked approach for trusts that don’t have dedicated paediatric critical care outreach onsite.

Prevention and Long-Term Conditions

26. Increasing access to intravenous thrombolysis and mechanical thrombectomy (MT) to remove blood clots is being facilitated by the piloting of pre-hospital video triage (PVT) and the adoption of AI brain imaging decision support software, which is now available in all stroke units across England. Thrombectomy training academies are being developed to increase the number of doctors capable of providing MT, and there has been an increase in the number of patients now accessing community-based stroke rehabilitation which is vital for recovery and to reduce levels of disability.

27. Over 1.6 million referrals have been made into the NHS Diabetes Prevention Programme to date. Following rollout of the NHS Type 2 Diabetes Path to Remission Programme to the whole of England, over 25,000 referrals have been made to this initiative, to support participants to improve their diabetes control, reduce diabetes-related medication and wherever possible to put their type 2 diabetes into remission.

28. The number of people completing pulmonary rehabilitation (PR) in 2023/24 exceeded the pre-pandemic levels of 2019/20. At the same time, the proportion of people having an initial assessment and completing PR remains in line with the trend over the past four years (60% in March 2024). The increase in numbers completing reflects both a recovery in service delivery, and an increase in the number of people who are eligible for PR.

Screening and Vaccinations

29. The NHS Bowel Cancer screening programme continues to exceed the 60% national target, with coverage of 71.8% in November 2023. Progress is being made towards extending testing to 50 to 74-year-olds by March 2025 with 9 centres now live for the 52-year-old cohort, and 5 centres operational for the 50-year-old cohort.

30. The NHS Breast Screening Programme commitment to increasing uptake continues, with work underway to implement the improvement plan approved in December 2023. Q4 2023/24 data shows uptake at 4%. Work is ongoing with Breast Cancer Now and other charities to respond to their consensus statement on health inequalities within breast screening.

31. Coverage for the NHS Cervical Screening Programme is steady but below the 80% programme standard for both older and younger cohorts. National and regional actions to support improvements in coverage continue, including initiatives undertaken Cervical Screening Awareness Week in June 2024, the development of HPV self-sampling in-service evaluation, and digitisation of invitation and reminder letters.

32. NHS England is committed to support the World Health Organisation ambition to eliminate cervical cancer by 2040, with work underway to consolidate HPV improvement plans. From a vaccination perspective, the elimination of cervical cancer will only be achievable when 90% uptake is reached for females by age 15 (in school Year 10). In order to improve uptake from 8.3% (the HPV dose 1 coverage in year 10 females for 2022/23), work is ongoing to raise awareness, review barriers to vaccine uptake, and improve digital capabilities for the school-aged vaccination teams.

33. Following Joint Committee on Vaccination and Immunisation guidance, NHS England is planning for the introduction of RSV immunisation protection programmes from 1 September 2024. These will be delivered to pregnant women from 28 week gestation and older adults (people turning 75 from the 1 September 2024, with a catch-up programme for those between 75-79 years). Planning is also underway for an early adopter model to support the delivery of the RSV programme in a small number of community pharmacies.

Recovery Support Programme

34. The Recovery Support Programme (RSP) provides national mandated intensive support to trusts and integrated care boards (ICBs) in NHS Oversight Framework segment 4 that have complex, deep-seated concerns around leadership, governance, finance, patient safety, quality, or performance.

35. The programme now has 22 trusts (5 legacy special measures) and 3 ICBs enrolled. Since the last update in May 2024, there have been no new entries or exits from the RSP.

Genomics

36. The NHS continues to provide the NHS Genomic Medicine Service (GMS), delivering over 782,180 genomic tests in 2023/24, representing an increase of over 10% on the number of tests in 2022/23. In June 2024, the NHS GMS achieved the significant milestone of sequencing over 100,000 Whole Genome Equivalents since the inception of the Whole Genome Sequencing service in November 2021, including more than 16,000 cancer genomes and more than 84,000 rare disease genomes.

37. NHS England is continuing to support the Generation Study delivered by Genomics England and supported by the NHS GMS, to sequence the genomes of 100,000 newborn babies. Discussions are ongoing to increase the number of sites participating in the Study, ensuring geographical coverage across the country.

Publication reference:  Public Board paper (BM/24/27(i)(Pu))