The must read stories and debate from Monday

Slow progress

“I can’t believe there are still people not using e-referrals,” said one HSJ reader under our story on Monday.

From 1 October, all first consultant led outpatient referrals are to be made electronically, under the standard contract.

So it should be bye, bye paper in the autumn.

But trusts have said they cannot control whether this happens and are dependent on GPs being able and willing to use electronic referrals.

As a result, some providers are negotiating local variations to the national contract to ensure they still get paid for outpatient referrals after the NHS switches from paper to electronic referrals

Local solutions include continuing to pay for referrals that are not made using the electronic system and accepting paper referrals so patients are not delayed – but then asking GPs to complete the e-referral process so it complies with the national contract.

GPs have negotiated £10m of funding to improve their readiness for e-referrals and NHS England has said it will take a supportive rather than punitive approach if they struggle – there are no penalties if there are IT issues preventing referral. But no such promises have been made to trusts.

Tough choices

NHS Improvement’s rejection of University Hospitals of North Midlands bid for £15m in capital funding to open 75 new beds has provoked a mixed response from HSJ readers.

Some back the regulator and question the trust’s need for capital to create more beds, when the focus should be on delayed transfers of care, while some are in the trust’s corner putting NHSI’s logic process under scrutiny.

Both sides bring up relevant issues.

On the one hand, you have a trust with up to 200 patients medically fit to be discharged, a bed deficit of 133, continuing pressures on acute services that have forced the trust to cancel electives and (some readers said) lack of robust community service provision.

Considering this, it would seem UHNM has a decent case to be granted the capital it needs to create the extra beds and ease pressure on its struggling acute services.

Another argument is that the capital would be better used to shore up social and community provision with the intention to reduce DTOCs and free up existing beds.

One reader said while new pathways and efficient discharge is “preferable” there still needs to be a “critical” mass of beds in hospital.

Both scenarios leave system leaders in a difficult position. Do they give the trust, which is undeniably struggling to meet demand, the capital to address its current situation; or should the capital go towards shoring up and developing community services for the future?

The latter, however, would need significantly more than £15m.