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

The £180,000 question

Bonus payments in the NHS are always likely to be a hot potato, particularly given the financial pressures the health service finds itself under currently.

But the pressures on the NHS pound have not stopped some organisations from issuing bonuses of significant value, despite others ending the practice entirely.

In 2017-18, NHS Property Services paid £180,000 to four senior managers, with chief executive Elaine Hewitt alone pocketing £75,000. What disinguishes it from most of the other agencies is it is established as a private firm, albeit one wholly owned by the secretary of state for health and social care.

The company topped the ranking for bonuses paid to senior staff by national health agencies, with an amount more than six times the average for the year (£27,400).

Other NHS organisations, such as NHS England, have decided to scrap their bonus schemes due to the current economic climate.

NHS Property Services, which introduced a new bonus scheme during 2016-17, did not share what objectives the individuals had to fulfil to get the extra payments. 

Instead, the company said targets triggering bonus payments included areas such as customer satisfaction, cost efficiencies, technical compliance, disposals, and service delivery.

Without more information, it is difficult to judge if the bonuses are an accurate reflection of the company’s performance for the year.

But the argument put forward by NHS Professionals (among others) that public sector bonus schemes must compete with the private sector to retain top talent is undermined by the fact that most other health agencies paid little or nothing in bonuses, despite their own need to attract the best people in their sectors.   

A classic divide

Where 2014’s Five Year Forward View promised a “future that dissolves the classic divide, set almost in stone since 1948, between family doctors and hospitals”, 2019’s NHS long-term plan offers instead the “creation – for the first time since the NHS was set up in 1948 – of fully integrated community based health care”.

If the latter is a slightly more modest ambition, it reflects the more pragmatic tack in NHS England’s strategy since about 2016 and reflected in the long-term plan, endorsing relationship building over structural reinvention.

Even so, turning primary care networks into something capable of taking on staff, budgets and accountability – as the LTP proposes – is a big ask, especially when they’re poorly understood. And getting general practice to work in a seamless way with community teams is a major conundrum of both resource and working culture.

The LTP says there will be “expanded community multidisciplinary teams aligned [our emphasis] with new primary care networks based on neighbouring GP practices” and asserts that: “In many parts of the country, functions such as district nursing are already configured on network footprints and this will now become the required norm.”

Nigel Watson, a well respected GP who spent a lot of time on NHS England’s new care model vanguard programme, today published his take on this approach, as part of his review of the GP partnership model, commissioned by the Department of Health and Social Care early last year and also reporting to NHS England.

He’s a lot more blunt about progress so far – telling HSJ: “There are many of us who have tried working in an integrated way with community nursing and it does not happen.”

Based on that failure, Dr Watson’s review is sharper than the LTP about the link between primary care and community health staff – stating the latter should be “based in” and “under the clinical and service direction” of PCNs.

That’s inevitably stirred debate about this classic divide. One former NHS chief executive, commenting on our coverage, welcomed the recommendations, but warned: “Any attempt by some GPs to recreate community fundholding with highly experienced community nurses becoming GP handmaidens (yes it happened) needs to be stopped dead in its tracks.”

Other interesting recommendations in the report include reviewing recent pension tax changes, the NHS guaranteeing funds for some GPs’ long-term leases, and better tech to support mobile working, with the observation: “Continuity of care may no longer need to be constrained by geographical location.”