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Staff fear a ‘dark force’ in a south London trust

An independent review has found staff warning of a “dark force” within St George’s University Hospital Foundation Trust’s cardiac surgical service, with dysfunction and tribalism contributing to worsening mortality rates.

Fractious relations among St George’s heart surgeons is nothing new. A report in 2010 apparently raised concerns about the cardiac surgeons’ professional behaviour, or lack thereof. But now it is having a knock on effect on mortality rates. Staff reported “a persistent toxic atmosphere and stated that there was a ‘dark force’ in the unit”.

The cardiac surgery mortality rates are out of line with the national average and after two alerts from national auditors the trust commissioned an independent review. It concluded earlier this month and HSJ got hold of a copy of the report. Its authors issued a stern warning to St George’s: sort out the heart surgeons or risk losing the unit altogether.

Chief among the report’s recommendations is to restructure the surgical team “with some urgency” and adopt “radical solutions” if needs be.

There are rival providers with their own cardiac surgical services that staff fear pose an existential threat to the St George’s unit.

The trust seems to have grasped the urgency of the problem and has started acting on the report already, bringing in “on the ground cardiac surgery leadership support” from Guy’s and St Thomas’ FT. But with the reviewers calling for the unit to be completely reformed within 18 months and warning of “a near crisis of confidence in the service”, there is still much more to do.

Make integration work

An acute trust in the West Midlands is racing ahead in the unchartered waters of primary and secondary integration.

Bucking the trend, the Royal Wolverhampton Trust appears to have made a success of getting GPs to jump on board with its integration agenda.

Historically, GPs have always been reluctant to risk their autonomy and hand their contracts over to a seemingly all consuming secondary care provider. This has been quite a nuisance to the accountable care organisation pushers and meant it is quite unlikely we will see any fully integrated ACO contracts handed out in the near future.

However, against the odds The Royal Wolverhampton seems to have come up with a formula that its local GPs do find attractive. Within just two years of launching its programme the trust could be running almost half the GP practices in town.

The provider has revealed to HSJ that it is close to signing eight GP practices, in addition to the nine it already has, which would make it one of largest, if not the largest, secondary and primary care integration programmes in the NHS.