Joint Forward Plans: What are they and what do they mean for Systems?
The PSC Strategy and Transformation teams break down the recently published guidance on Joint Forward Plans (JFPs) and consider how systems can get the most out of developing new five-year plans in the face of limited time and resource.
As part of the updated Health and Care Act 2022, Joint Forward Plans (JFPs) became an annual requirement for all Integrated Care Boards. Although the Act officially passed in April 2022, guidance on JFPs was only recently published in December 2022.
We break down this guidance and consider how systems can get the most out of developing these new five-year plans.
What is a Joint Forward Plan?
Joint Forward Plans (JFPs) are mandatory five-year plans that Integrated Care Boards (ICBs) and their partner NHS trusts must produce by 30th June 2023.
In the words of the recently published planning guidance, JFPs should “describe how the ICB and its partner trusts intend to arrange and/or provide NHS services to meet their population’s physical and mental health needs,” including “the delivery of universal NHS commitments, address[ing] Integrated Care Sysytems’ (ICSs) four core purposes and meet[ing] legal requirements.”
The guidance explicitly states that these plans should build upon existing local work and plans - such as Joint Strategic Needs Assessments (JSNAs), Joint Local Health & Wellbeing Strategies (JLHWSs), and NHS delivery plans. The guidance acknowledges that there may be overlap in the content of all of these documents, and that preventing duplication and ensuring alignment is a key aim of JFPs. As part of this alignment, JFPs will be public-facing documents and will require consultation with a wide range of stakeholders (including the Integrated Care Partnerships (ICPs), primary care providers, local authorities, Voluntary, Community and Social Care Enterprise (VCSE) organisations, and people and communities affected by specific parts of the plan, among others).
JFPs, therefore, provide an opportunity for ICBs and partner trusts to be clearly delivery-oriented and align all stakeholders on their approach to meeting ambitions in the NHS Long Term Plan and NHS planning guidance. As such, JFPs offer an opportunity to think through difficult questions relating to the actualisation of key objectives in existing plans, including setting out clear milestones and trajectories. This will ultimately help systems better meet the health needs of their populations and collect data to better understand the efficacy of models of care.
What challenges do systems face when developing JFPs?
While JFPs will need to include a wide range of content (potentially totalling up to 50 pages) and draw upon multiple existing plans and guidance, the key challenge will be developing meaningful JFPs in the context of limited time and resources.
The timelines for developing JFPs are tight: a draft JFP must be completed by the end of the financial year on March 31st, 2023, and all consultation and revisions must be incorporated and finalised by 30th June 2023.
System plans, such as JFPs, are often very helpful in aligning system organisations and stakeholders, especially when changes have been introduced. As referenced earlier, JFPs provide a positive opportunity to focus on delivery, better meet the health needs of their populations, and lay out key milestones for achieving these. But to be effective, they will take time and resource to develop – in addition to the required consultations, JFPs will need meaningful clinical input and leadership engagement from across the system to resolve key issues.
Beyond just the short timeframes, and the need to engage widely with stakeholders, JFPs are also being developed in the context of performance pressures and the submission of annual financial and operational plans in time for the next financial year (beginning April 2023). Therefore, there is currently very limited clinical or leadership bandwidth to engage in a depth of problem-solving or discussion to solve the knotty issues needed as part of a JFP’s development.
These challenges mean that there is a risk that systems will not be able to develop useful and meaningful JFPs. Instead, these plans could just restate previous plans and documents, to absorb as minimal clinical or leadership time. As a result, the development of JFPs could become a box-ticking exercise, rather than an important exploration of key challenges systems face when delivering services to best meet their population’s mental and physical health needs.
So, how can systems best approach JFPs?
Systems must be realistic about how to approach the development of their first JFP. It may be the case that, given the limited time and resource, it will not be possible for systems to produce a JFP that delves into many knotty problems and contentious challenges before June 2023. Instead, time and resource might need to go to 2023/24 operational plans and for the specific workforce, capacity, pathway, and financial improvements that will be within these one-year plans.
However, this does not mean that JFPs cannot provide an opportunity for deep thinking on these challenges in the future; by producing a solid document in 2023 that meets all legislative requirements, builds upon existing plans, and is updated based upon consultation, systems are setting themselves up well to add to this in 2024. JFPs will become an annual requirement and this is only the first year of their development and use. By taking the learnings from their first experience with JFPs in 2023, systems can return to review and update these plans in 2024 and continue to use JFPs to better meet the needs of their populations.
Authors: Russell Cake and Posy Putnam, The PSC Strategy and Transformation teams
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