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

Just so no to racist patients

It is hard to believe that it is necessary in 2019 to remind people that racism is unacceptable, but it appears it is.

Health and social care secretary Matt Hancock wrote to all NHS staff on Wednesday making it very clear that patients who express racist attitudes should not have their prejudices catered to.

Crucially, he made it clear he expected “senior management” to back up staff whenever they were confronted by racist patients.

This is the crux of the matter. The overwhelming majority of NHS staff do not want to pander to racists — and know that it is wrong to do so. But many fear the consequences of not doing so.

At worst, there is the threat of violence and/or abuse. There is also the belief they will “get into trouble” for challenging a patient’s wishes. Hopefully, Mr Hancock’s letter will help address at least the second of those problems.

Far more common, however, is the wish for a quiet life. That it is simpler just to work around racist prejudices, that the trouble and time it takes to confront unacceptable behavior will not be recognised and/or supported by line management and organisational leadership.

This accommodating behaviour is often “hidden” from leaders, who need to spend time on the front line to witness it. Mr Hancock writes that he expects “all appropriate steps are taken by organisations to ensure their staff know they can come to a workplace that is free from abuse and harassment”. In this febrile time, this will take concerted focus by those who wish to protect and value their staff.

Primary care networks are fast approaching the midway point of their first year of operation. Using freedom of information rules to finagle details from commissioners, HSJ has started to piece together a picture of these PCNs.

PCNs are groups of GPs working together to provide some nationally mandated services under a network contract with NHS England. They came together at pace through the spring and early summer this year and their formation was heralded as one of the biggest overhauls of primary care since the NHS was founded.

At risk of being accused of cynicism, part of the reason more than 1,250 PCNs were able to form in such a short amount of time was because funding for the networks was promised as soon as the go-live date on 1 July. Part of the PCN setup process was to appoint a network banker, or “nominated payee” in NHS parlance, which would be responsible for the bookkeeping and disbursement of funds to member practices.

The idea was a range of entities, from member practices and GP Federations to social enterprises and provider trusts would fill this role. But bankers were limited to organisations that hold one of the three types of GP contract and are therefore included on the NHS primary care payment system.

Consequently, the majority of bankers are network member practices, with less than a fifth of such roles filled by GP Federations and just four acute trusts doing the job.

HSJ has also found that most networks have abided with NHSE’s wishes to form into networks covering between 30,000 to 50,000, with most around the 45,000 mark. Two out of every five, however, are outside these bounds. There are fewer under the lower limit than there are above the upper limit, which had been characterised by NHSE as a “hard bottom, soft top”.

The truly tiny PCNs, under 20,000 patients, are the product of GPs trying to cover large but sparsely populated rural areas. At the top end of the picture, large, highly urban networks of above 100,000 are operating across whole boroughs or even cities.