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

Region snubs regulator

Clinical service reconfiguration is never easy, but attempting wide-ranging changes to pathology departments is an especially unenviable task.

It was a brave move, therefore, by NHS Improvement in 2017 to launch grand plans for the creation of 29 pathology networks across England in a bid to save £200m.

The announcement followed years of indecision about the best way to run pathology networks, despite the best efforts of efficiency guru Lord Carter and his consolidation crusade.

NHSI’s pathology project, now in its third year, is progressing well and is “on track” to deliver the savings, according to the regulator.

This is despite some regions’ (and individual trusts’) refusal to sign up to the NHSI model of hubs and spokes, which sees large swathes of pathology services centralised at the biggest provider in a network.

The latest obdurate region to make its views clear is the West of England Pathology Network, which comprises acute trusts in Bristol, North Somerset and South Gloucestershire. So bad are NHSI’s proposals for that area, that it would be better to do nothing, according to the local pathology board.

Sensibly, NHSI accepted from the outset it will not be able to force its model on all regions, and its chiefs can offer an olive branch by allowing other models to be developed.

However, this will only be allowed if local pathologists can prove their preferred model is equally or more efficient than NHSI’s. Daily Insight expects further clashes between local and national bodies when such proposals are worked up in detail, and not just in the Bristol area.

In case you weren’t convinced

There are great things that can be done in primary care networks, according to the leader of one of the largest GP super-partnerships. But not unless NHS England builds a bit of flexibility into its network contract.

There are strong principles in the draft contract put out by the NHS in December last year, according to Modality CEO Vincent Sai, who runs a partnership with more than 40 primary care locations around England, including practices and urgent care centres, caring for half a million patients.

He has added his voice to the chorus expressing their dissatisfaction with what must be an early contender to be the least popular document of 2020.

Geriatricians, commissioners, community health providers, GPs — including their Royal College — and the British Medical Association have all publicly said the draft was unworkable.

NHSE and the BMA general practitioners committee are currently negotiating the PCN contract for the coming financial year.

Mr Sai is clear there are principles in the first draft that are strong, welcome components for PCNs. But he adds they are couched in a contract that is too prescriptive and does not reflect local needs.

This affects networks in two ways, he explains. For areas which are quite mature and have PCNs of GPs who are used to working collaboratively, it is frustrating to have a central prescription of how to deliver services that their networks and practices are already trying to provide.

For those areas with less advanced PCNs, the pace at which NHSE said they should start delivering services could lead to networks breaking apart under the strain.

Modality has been running for a decade and, while it has its struggles, it has a fair bit of experience in building relationships across partners and colleagues in secondary care.