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

Bidding to fast forward board diversity 

A flagship equalities target for all NHS boards to mirror the overall composition of their workforce, in terms of the number of members from a black, Asian or minority ethnic backgrounds, has been brought forward by three years, under plans set out in the phase three letter.

The guidance says all NHS organisations must draw up plans for how they will match the composition of their ethnic minority workforces or communities at board level by 2025 – significantly earlier than when the target was initially set out in January.

The aspiration appears to have been well received by senior NHS figures familiar with the equalities’ agenda, but some questioned whether it was realistic to expect such a shift within five years. Some trusts could struggle to meet such an aspiration without additional support, they said.

There is quite simply no one-size-fits-all approach to such a complex issue. The target may deliver a robust message on the aspirations of system leaders, but, equally, it may prove a bit clunky in practice.

Unintended consequences

In March the NHS brought in new operating procedures for primary care to mitigate the impending pandemic onslaught from overwhelming already burdened GP services.

It included a new concept dubbed “Total Triage” which involves streaming patients into cohorts of those with and without covid symptoms. Patients were no longer allowed to walk into their GP practice seeking an appointment. First, patients were assessed online or over the phone. However, the repeated instances of GPs being told by NHS England they must offer appointments in person “where clinically appropriate” has provoked umbrage among some in GP land.

It has now transpired the diktat was spurred by some practices stopping face-to-face appointments completely, which “led to significant incidents and events,” according to NHSE’s primary care director Nikki Kanani.

Hitting pause on tenders

The Community Network — a group run by NHS Providers and the NHS Confederation — has called for a 21 month pause on the retendering of community heath and public health contracts.

The uncertainty brought about by constant retendering damages staff morale, its claims and could also hamper much-needed collaboration between councils and community service providers which has been vital during the pandemic.

But if no funding comes soon to help close the £7.6bn short fall facing councils, retendering will be inevitable, as local authorities desperately try to plug budgets without cutting services even further.

With winter, a potential covid-19 spike and a flu season all in the pipeline, expect council budgets to get even tighter. The network warned community services may become even further overstretched as a result as they try to manage some of the growing unmet need in the community.

Corrected at 11.35am on 10 August to state that the report about tendering was published by the Community Network, which is run by NHSP and NHSC.