Essential insight into NHS matters in the North West of England, with a particular focus on the devolution project in Greater Manchester. This week by Rebecca Thomas, who covers Cheshire, and Lawrence Dunhill, who covers Merseyside, Lancashire and Greater Manchester

In this week’s North by North West:

  • Cheshire and Merseyside trails on GP access
  • Mergers and management moves
  • Greater Manchester bags more money
  • The next reconfiguration
  • Lancashire’s mental health trust goes backwards

Cheshire and Merseyside has been weighed, measured and found wanting on GP access, according to NHS England’s latest data.

Figures from the latest biannual extended access to general practice survey show one in five people across the region are not able to access evening and weekend appointments. 

Providing GP appointments from 8am to 8pm on weekdays and weekends will be high on clinical commissioning groups’ agenda over the next five months, as each one is expected to meet this requirement for their whole population by October 2018.

This deadline was originally set for April 2019 but was brought forward by NHS England, in the revised 2018-19 planning guidance.

Split by NHS England’s local office areas, Cheshire and Merseyside has the highest proportion without access to extended hours appointments.

The biggest CCG contributors to the region’s poor performance are South Sefton (63 per cent of the population have “no provision” of extended GP opening), Liverpool (50 per cent) and St Helens (also 50 per cent).

These three are rated red in this data, while the rest of North West is largely rated green.

All three CCGs told HSJ they intended to meet the national target by launching a procurement to find a provider before the autumn.

In fairness to these commissioners, access to additional national funding for extended access only became available to them – as with the majority of CCGs – in this financial year. Then again there are plenty of other commissioners which seemingly managed to open extended access before the extra money arrived.

Unsurprisingly, CCGs in Greater Manchester which received a significant chunk of national funding attached to the GP Forward View are the region’s closest to hitting the target. Rebecca Thomas

Mergers and management moves

Consolidating is somewhere between en vogue and compulsory among CCGs at present, and Cheshire is one of those now getting in line.

Even Jeremy Hunt got stuck in last week, suggesting CCGs should perhaps have always been coterminous with top-tier local councils.

Cheshire’s four CCGs – Eastern Cheshire, South Cheshire, Vale Royal and West Cheshire – aim by next year to have a single accountable officer and by 2020 expect to completely merge.

Meanwhile, in the county’s provider land, North by North West hears that the medical director at the scandal-hit Wirral Teaching University Hospitals FT – who raised concerns over the trust’s staff survey results last year – will be jumping ship to the Countess of Chester Hospital FT.

That may be a shame for Wirral, which according to NHS Improvement has “deep cultural issues”RT

Greater Manchester bags more money

Greater Manchester has managed to throw its cap on another wave of transformation funding, with which it will aim for a major breakthrough in information sharing.

The region is one of three to be awarded up to £7.5m from NHS England to implement an integrated health and social care record across its 2.8 million population.

The money will be used to roll out the CareCentric system designed by tech firm Graphnet, across Rochdale, Bury, Oldham, Tameside and Wigan. The system is already used in the other boroughs.

Patient records held on various platforms within the region feed into the shared record, which means information can be more easily viewed between different organisations.

Meanwhile, eight of the 10 borough councils already use a system called Liquid Logic for adult social care, with the other two to follow. Graphnet and Liquid Logic share the same parent company, System C, so the two systems should run smoothly together. Lawrence Dunhill

The next reconfiguration

Greater Manchester is still waiting to implement a major reconfiguration of emergency services that was first agreed in 2015.

But despite the delays in securing capital funding for the Healthier Together changes, the region continues to plan its next big hospital shake-up, which will affect around 70 per cent of acute services.

Specialties such as respiratory, cardiology, orthopaedics and paediatrics are part of the latest review, although maternity and obstetrics are not now part of this programme.

Reconfiguring maternity services usually proves highly contentious and I’m told it will instead be considered as part of a separate “local maternity system review”. With paediatrics in the other workstream, there will need to be a link between the two.

One HSJ reader seemed to know where this is going already, commenting: “Hmmm. Let me look into my Crystal Ball and predict the future: I predict that all the tertiary services that make money will go to the hospitals where the CEOs have knighthoods.” LD

Going backwards

Lancashire Care Foundation Trust is the latest provider in the north west to slip back to a “requires improvement” rating, after previously been rated as “good” by the Care Quality Commission.

Among the shortcomings identified by the regulator at the mental health and community services provider were staff and bed shortages, low morale, and a lack of support from managers. The inspection took place in January and February.

The findings mirror troubling results from last year’s NHS staff survey, in which LCFT reported some of the worst scores in the country for staff recommending it as a place to work or receive treatment.

The trust’s long serving chief executive Heather Tierney-Moore announced her resignation a month before the CQC report was published, although she remains in the post for another year. LD