Daily Insight: Hunt holds his ground ahead of strike

The strike goes ahead

Ahead of the first ever full walkout of junior doctors, Jeremy Hunt engaged in some tetchy exchanges in the House of Commons on Monday afternoon.

The health secretary called for doctors to cross picket lines during the strike, which will include emergency care, and insisted the contract offered to them was fair. He said the industrial action would have an “unprecedented” impact on patient care.

He repeatedly stressed that the remaining point of contention between the government and the BMA was on the rate of pay for working on Saturdays.

Afterwards, the BMA retorted that Hunt’s claim the industrial action was about pay was “blatantly untrue”, and that the strike could have been avoided if contract imposition had been halted.

Labour shadow health secretary Heidi Alexander attacked Mr Hunt for his handling the dispute and said Tuesday would be “one of the saddest days in the history of the NHS”.

The bottom line is the government’s position remains the same – the contract will be imposed from August – and the BMA will proceed with the strike on Tuesday and Wednesday.

• Follow HSJ Live on Tuesday for comprehensive coverage of the strike

CCGs face pay pickle

Clinical commissioning groups risk unpaid tax bills and fines for breaching rules on off-payroll payments to governing body members, HSJ revealed today.

Our investigation has found widespread variations in the way CCG governing body members are paid, with many remunerated off-payroll, without deductions for income tax and national insurance. Treasury guidance issued in 2012 said CCG board members with significant financial responsibility should be on the public payroll.

HMRC is understood to have carried out a sample review of payments dating back to when CCGs launched in 2013.

HSJ research has found some CCGs have paid senior leaders as NHS employees since they were set up, while others have changed arrangements over the past three years to put staff on the payroll. But some continue to pay GPs on the governing body and others using off-payroll arrangements.

A number of CCGs have made changes to put all their governing body members on the payroll over concerns HMRC could demand back tax and impose fines.

Putting governing body members on the NHS payroll would increase pay bills for CCGs, which would become liable for national insurance contributions worth 13.8 per cent of salary.

Commissioners have been urged to act before HMRC intervenes. However, commissioners have countered that guidance on off-payroll payments has been unclear – something the Department of Health disagrees with.

• Legal battle could cause out of hours costs to rocket
• Explainer: The rules for off-payroll payments

Commissioners’ confidence takes a hit

We’ve published a number of pieces from HSJ’s latest survey of CCG chairs and accountable officers.

Among findings from the 100 respondents – representing nearly of England’s CCGs – were:

• There has been a drop in financial confidence among CCGs. Some are expressing concern about the NHS’s deficit problems being shifted to commissioners.
• CCG leaders are split on the future role of sustainability and transformation plan leaders. Around a third think STP leaders will become responsible for finance and performance, which might be unwelcome news to the STP leaders.
• There’s still heaps of enthusiasm for new integrated contracting and governance models, with some 55 per cent of CCG leaders stating they expect to deploy an “accountable care system” over the next year and a half; and the same number planning an “alliance contract”. Less popular – but still featuring in the hopes of a quarter of CCG leaders – is the more widely discussed “accountable care organisation” model.