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

Slipping through the net

Public sector pay-offs have provided many headlines for the tabloids over the last few years. Senior executives leaving with hundreds of thousands of pounds were an easy target for both the media and for politicians who wanted to show how tough they could be when taxpayers’ money was involved.

The £160,000 cap on public sector redundancy payments, introduced in 2015, should have put a stop to this, you might have thought.

But it now looks like these changes were not incorporated into every NHS’ worker’s terms and conditions. While they were automatic for those on Agenda for Change (very few of whom would hit the limit anyway, as it would require a salary of £80,000), they had to be incorporated into very senior managers’ contracts.

But a few contracts seem to have slipped through the net. While no one is willing to say specifically what happened in the cases of Tony Bruce and Wendy Kerr, who left East Staffordshire Clinical Commissioning Group with payments above this, the references in an independent investigation ordered by NHS England to “prior contractual requirements” suggest that their contracts were left unchanged.

The probe into their pay-offs has left them both with amounts well above the £160,000 maximum: £259,689 for Mr Bruce, who was the accountable officer, and £202,183 for Ms Kerr, who was the chief financial officer. The pair were made redundant in 2018 when a combined management team was set up for Staffordshire’s CCGs.

Both were also in their roles when it entered into a controversial community services contract with Virgin Care. HSJ reported last month that Virgin Care had pulled out of this arrangement.

If so, that raises questions about how this process of incorporation of the new requirements was carried out at CCG level – and whether there were other people who slipped through the net. CCG governing bodies might now like to check whether all contracts were changed to restrict redundancy payments: perhaps a job for lay members for finance and performance like… erm… Ms Kerr, who is now fulfilling that role at West Leicestershire CCG?

Following suit

The long-standing separation of primary and secondary care is coming to an end in a handful of areas, as more GPs begin to see the drawbacks of running their own practice.

Under a model which was expected to spread to other areas, multiple practices in Wolverhampton are now run by the acute trust, with GPs voluntarily giving up their NHS England contracts to become salaried employees.

The high-flying St Helens and Knowsley Teaching Hospitals Trust is now following suit and hopes to be running six practices within two years.

It already runs one practice, which it took over when the partners pulled out in 2017, and is currently in talks to run five more.

The big primary care policy in the NHS long-term plan was the creation of primary care networks, which will encourage far greater integration and resource sharing between practices.

In theory, this lessens the chances of practices eventually being run by NHS trusts, under the Wolverhampton model, as practices realise greater efficiencies of scale as they start to combine.

But if PCNs fail to make primary care more sustainable – and fast – the local trust is going to be the obvious home for many.