The NHS Long Term Plan (LTP) makes the case that the NHS will need to work together with partners across the local health and care system, local government, and community organisations to achieve maximum impact in preventing disease and improving population health. It states the ambition to have Integrated Care Systems across England by 2021 with the explicit role to improve health at a population level. Crucially, funding for these organisations will move from activity based payments to population based funding.
Integrated care systems will be supported in this role by a digital strategy encouraging better use of population level data through population management tools.
The LTP highlights the important potential role NHS organisations can play in their local communities, both as anchor institutions –fixed community assets impacting local employment, business, planning policy, and air pollution – and by acting independently and in partnership to re-orientate services towards prevention.
Achieving the prevention vision and deliver the LTP whilst growth in UK healthy life expectancy is stalling – and inequalities are widening – will require NHS trusts to work with their local health systems and take bold steps to prevent disease and improve population health.,
For Example., Prevention is a stated strategic priority for the Shelford Group of NHS hospital trusts.
 Hospitals as anchor institutions: how the NHS can act beyond healthcare to support communities. BMJ 2018;361:k2101. doi: https://doi.org/10.1136/bmj.k2101
 Health state life expectancies, UK: 2015 to 2017 accessed at; https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/2015to2017
 Webber L, Chalkidou K, Morrow S, Ferguson B, McPherson K. What are the best societal investments for improving people’s health? BMJ. 2018 Aug 30;362:k3377. https://doi.org/10.1136/bmj.k3377
 Shelford Group; Working Together To Improve Patient And Population Health Outcomes. May 2019.
Primary care networks will work more closely with community and social care and the voluntary sector to support better those people living with multi-morbidity and frailty. Patients identified by the electronic frailty index as being at risk will be given targeted and personalised support through a network of health and social care professionals. This includes access to falls prevention services and exercise opportunities.
There is a commitment to reduce delayed transfer of care to 4000 or fewer delays over next 5 years. Part of this will be achieved through placing vital teams, such as therapy teams, at the start of a patients pathway to reduce hospital de-conditioning and subsequent delays. Our inpatient medical ward case study shows suggested physical activity interventions to support this goal.
There is a recognition that ‘what matters to someone’ is more important than ‘what’s the matter with someone’. This gives rise to a commitment to train more staff to have impactful conversations with patients through behavioural change frameworks. Prescribing Movement gives examples of how this can work for conversations about physical activity and Active Conversations offer training courses to train health professionals in these skills.
As part of ‘shared responsibility for health’ there is an undertaking to increase support for people to improve their own health. This will start with people with diabetes and will spread to other patients with long term conditions and for women in pregnancy. Moving Medicine patient information downloadables (such as this patient information leaflet for Type 2 Diabetes) provide evidence based infographics to support this.
In terms of digital technology, there are two aspects of the Long Term Plan relevant to physical activity interventions. The first is the introduction of population management tools to be used by ICS’s to identify those at greatest risk and to reduce inequalities. Low physical activity levels are an important predictor of morbidity. It is important to incorporate physical activity levels into these tools.
The second is the suggestion that patient held data through personal devices such as smartphones may eventually interact with patient health records.
Social prescribing will be expanded and rolled out nationally following successful pilots. There is an undertaking to train 1,000 link workers by 2021, rising further by 2024. Through trained link workers, GP’s and other health workers will be able to confidently link people with community activities and other support. Link workers could become a key additional resource to provide a signposting service to patients about opportunities to be physically active in their communities.
There is limited published data which explores the characteristics of link workers in terms of their potential impact. If link workers are supported to use evidence-based behavioural change techniques their impact could be maximised.
Health and wellbeing of NHS staff is given prominence in the Long Term Plan. Encouraging physical activity in work and when returning after sickness or pregnancy is an important component of staff wellbeing.