The must-read stories and debate in health policy and leadership.

A 21st century budget?

The Care Quality Commission chief executive Ian Trenholm has not wasted time tackling the big issue facing the regulator. He made clear in his November interview with HSJ that the CQC’s legacy systems needed to be tackled and the watchdog placed on a 21st century footing.

Now a leaked email passed to HSJ has revealed the regulator is moving ahead with plans to top slice the budget of its five directorates to release £12m to invest in a new central change team to deliver the digital transformation work.

But, as one insider pointed out, an arbitrary top slice of directorates as opposed to a careful working out of from where the money comes is a concerning approach.

The regulator has confirmed there will be fewer people working in its hospital inspectorate team by the end of 2019-20 as a result of the decision. However, the watchdog added staff would be encouraged to take on secondments within the new central team so no redundancies were planned overall.

The CQC has long promised to be intelligence-led in its regulation. The regulator needs to be absolutely sure its systems can deliver on this promise.

Getting it wrong could undo all of the gains the CQC has made over the past five years, not to mention leave patients at risk of receiving poor care that goes undetected.

Network subversion

Late last week, NHS England published another trove of papers, fleshing out the details of how it wants GPs to develop primary care networks – and, perhaps more importantly, how it doesn’t want them carrying out the task. 

The deadline for getting all of England covered by these networks – groups of GPs working together with a range of other providers to “offer more personalised, coordinated health and social care to their local populations” – is roughly three months away. NHSE and the British Medical Association have agreed a five-year contract to govern the set-up and running of PCNs until 2024.

The latest document release gave clinical commissioning groups some significant roles to play in monitoring and governing how the networks develop.

PCNs will be entitled to funds to cover most of the salaries for new members of staff hired to fill five specific clinical roles in the networks. But these new team members must be brought on-board in addition to existing staff.

To make sure nobody tries to get around these rules by relabelling their existing staff members to pocket the cash, CCGs have been tasked with carrying out a baseline exercise to figure out how many of the non-GP clinical staff already work in primary care.

This “additionality principle” is to protect existing investment in workforce and NHSE is not going to hold back in defending it. It said, if there is “any suspicion” of deliberate attempts “to subvert the additionality principle” then that will lead to a fraud investigation.