Manchester: A New NHS Care Transformation
With an increasing demand on diminishing resources there is little doubt that the NHS is facing some of its biggest challenges since its birth in 1948. However, with these 21st century challenges comes the potential for some of the most exciting transformations in the lifetime of the NHS. The Greater Manchester Health and Social Care Devolution represents the infancy of this change.
Following the successes of the Whole Place Community Budget Pilot (WPCB) studies, it was decided that Greater Manchester would be the first region to undertake the complete devolution of public services. Commissioning responsibilities have been delegated from Whitehall to the Greater Manchester Combined Authority, which have been allocated £6bn for the provision of NHS resources.
Greater Manchester, generating £56bn Gross Value Added (GVA) per annum, is the second largest economy outside of London. With a population smaller than Wales and Scotland, it provides a GVA per capita greater than Wales and, under current conditions, potentially in excess of Scotland within 5 years.
Evidently, Greater Manchester is a thriving economic entity with vast potential for devolution. Perhaps then, it should enjoy the freedoms granted to the devolved nations.
In spite of this, at present Greater Manchester is confined to the economic boundaries of an unsustainable system. In absolute terms, the region suffers an annual deficit approaching £5b; a result of high demand for public services (£22.5bn) and low tax revenue (£17.5bn).
Fiscal devolution will empower the region to generate and retain a significantly higher proportion of tax in order to fund the under-resourced provision of public services.
With nationally high levels of obesity, alcohol consumption and smoking, Greater Manchester faces large health inequalities that stem from a deeply entrenched dependency on public services. These unique challenges require an entirely bespoke approach to health and social care delivery; one that NHS frameworks cannot supply at national level.
Devolution is expected to reduce the constraints from regulatory pressures, allowing Greater Manchester to allocate resources differently to NHS England. This freedom will enable faster and more radical improvements to health, all tailored to the specific needs of the region.
Greater Manchester has a deeply engrained culture of innovation. Devolution will provide the level of autonomy to nurture this culture and to facilitate the pursuit of specialist excellence, aside from NHS targets, preserving innovation and allowing Greater Manchester to pioneer in these specialist areas. 
Integration of health and social care has long been a requisite for future progress of the NHS. The devolution of Greater Manchester will allow the freedoms to continue the progress of the WPCB Pilots through holistic integration of education and child safeguarding; employment and criminal justice; and health and social care. 
Integration, in the past, has tended to undermine the work of general practice. With a fundamental role across all the facets of holistic integration, as previous, it has been decided that general practice must lead integration in the future.  However, generalist medicine is currently in short supply and so there must be an emphasis on recruitment and retention of general practitioners, through communicating the value of generalist medicine and exposing students to this throughout medical training.
The Shape of Training Review exemplifies this new direction: ‘It is perfectly feasible for a well-trained doctor to be simultaneously a good generalist and specialist. The early years of training could be improved to provide doctors with a more general grounding in their speciality.’ This proposal does not come without risks, one being the potential negative impact on the provision of specialist care. Nevertheless it is clear to see the intended emphasis on generalist medicine.
Due to the current challenges facing the NHS there is a collective will across the nation for Greater Manchester to flourish through devolution, with many regions with similarly specific needs eager to follow suit, in order to prosper through these testing times.
Joe Hearle, MBBS Year 2