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

Eleventh hour

Free money is always an attractive proposition, so no one can blame trusts for taking advantage of NHS regulations which allow them to use some of the proceeds from land sales to access extra provider sustainability funding.

Two Surrey trusts – Ashford and St Peter’s Hospitals Foundation Trust and Surrey and Borders Partnership FT – have done just that, scraping under the wire with a major land sale in March, just days ahead of changes in the regulations around how this money is used.

From this financial year onwards, trusts will not be able to use “profits on disposal” – the difference between the sale price of an asset and the value recorded in its accounts – towards their control total. Accepting a higher control total – knowing that profits on a land sale will help meet it – allows trusts to access additional PSF. In 2017-18, this was offered on a £2 for £1 basis, effectively tripling trusts’ windfalls from property sales.

ASPH and SABP both point out the cash from their £42.75m sale at St Peter’s, Chertsey, will be used for much-needed major building and refurbishment projects, and is not being used as revenue.

But there is an inherent unfairness in this. Not all trusts are lucky enough to have spare land to sell in the south east, meaning they miss out on both the proceeds of land sales and the chance to leverage this extra money through enhanced PSF payments.

Guide the way

Primary care networks are being presented as the building blocks of integrated care systems. They will, at least in theory, enable GPs and other primary clinicians to collaborate like never before to tackle the specific needs of their local neighbourhoods of between 30,000 and 50,000 patients. This is scheduled to be the new normal from 1 July. 

But there has been some speculation as to how already scaled-up primary care organisations will slot into the PCN model.

The chief executive of one such at-scale provider, the Modality Partnership, provided some clarity in a recent interview with HSJ

Modality is a super-partnership of GPs based all over the country. They operate in divisions (or spokes) around a Birmingham hub, where a small team handles their back office work. Vincent Sai said it has a decade of experience working at scale, across multiple practices, and is eager to share its knowledge.

Some networks are already making use of its expertise and are using it as the designated payee or network bank to hold new funds coming in from the centre to be distributed to the network practices.

The offer of this service is available for others but Modality is being careful not to foist its expertise on GP colleagues. If practices in a nascent network believe their local federation is the best fit for this role, then Modality’s partners will be happy to support it.

“If it makes sense for us to help host different things, we’re open to that,” he said. “But we’ll do it in consultation with our colleagues, respecting the history and politics of it.”