The must-read stories and debate in health policy and leadership.
- Today’s broadside at PCNs: Confusion and tensions over primary care networks
- Today’s covid cash: £150m extra for new list of requests from GP practices
The immense release of excitement and relief at the news a prospective vaccine is over 90 per cent effective at stopping covid shows the pent-up tension and anxiety among the public.
This news does come with the caveats that it is not yet ready for use and it is not known how effective it will be at stopping transmission. However, it is clearly an encouraging moment amid the mounting pressure on the health service from the second wave of the pandemic.
It also means plans must be set in place for the enormous task of distributing the vaccines to as many people as possible, as quickly as possible, as soon as possible after the stocks are delivered.
As promised, GPs are going to be at the forefront of the covid vaccine programme. Primary care networks have been charged with finding at least one site from which they can assess patients and administer the vaccine, keep them under observation for 15 minutes afterwards, and do all this with safe social distancing.
There will be challenges with the cold chain to keep the vaccine doses at the right temperature as one vaccine candidate can be kept between 2C and 8C only for up to a week; beyond that it must be stored at -70C. This means doses will have to be delivered to the PCN vaccination sites every week. There are around 1,200 PCNs in England at the moment – no small task.
The already stretched primary care workforce will have to do all this while trying to do all their daily clinical tasks. Inevitably this logistical challenge has been described as Herculean. In England it looks like it will be down to GPs to make sure it does not end up Sisyphean.
The dangers of a quick death
The NHS has witnessed dramatic changes to the way it manages its money this year and it appears the pace isn’t slowing down.
Amid a huge remodelling to meet the demands of covid, staff were recently asked whether they wanted to effectively kill off payment-by-results tariff once and for all.
The PbR tariff, whereby providers were paid for the volumes of work they perform, was slowly making its exit stage left and, after more than six months working without it, it seems NHS England/Improvement want to cement its departure.
The national body wants to instead introduce a blended tariff model, by default, across the health service. The tariff includes a “fixed” element based on the actual costs of delivering services and a “variable” element which increases/decreases against activity plans.
While many finance leaders won’t be sad to see PbR leave, having begun adapting blended payments in emergency care last year, one has to consider how quickly these changes have been brought together. The details of the plans so far have been confined to online presentations and few other documents have been made available.
These changes have also been propelled forward while the health service remains in an amorphous state, moulded by the demands of the pandemic. What may seem like a useful innovation now could become regarded as premature. While you might not wish to waste a crisis, experimenting with such vast alterations in such a volatile environment could be deeply damaging if not thought considered cautiously.