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

A row between senior leaders in Norfolk and Waveney over the volume of work being passed to GPs by the acute sector vividly illustrates a problem that primary care leaders say is widespread.

As we reported yesterday, Norfolk and Waveney Local Medical Committee set out a series of concerns about contractual breaches by providers relating to the interface with GPs, in a letter to its local integrated care board.

The arguments centre on the volume of work being passed to primary care, with factors including the expectation that GPs will check and act on test results organised by secondary care, GPs being asked to undertake additional tests, and trusts rejecting “reasonable” referrals.

The argument represents the latest local example of interface problems which national GP leaders have long highlighted as an issue.

Policy Exchange report published last year also estimated “at least 15 million GP appointments per year [were lost] to managing issues with the breakdown of this interface” the previous year alone.

So, whatever the rights and wrongs, the challenges at the primary-acute interface clearly represent a major productivity challenge NHS leaders must address, and of course the detrimental impact these disputes and additional work have on staff morale.

Emergency exit

The national director of urgent and emergency care at NHS England is joining a major trust’s executive team.

NHSE’s director of urgent and emergency care transformation Iain Pickles is due to join University Hospitals Birmingham Foundation Trust as its group chief operating officer in the coming weeks.

Mr Pickles was a manager at Luton and Dunstable Hospital FT from 2008 until 2018, before becoming divisional director of planned care at Bedford Hospital Trust until he joined NHSE in April 2019.

His first position at NHSE was to lead the clinical review of standards field testing programme, and he became UEC director in January 2020. 

He replaces UHB’s former chief transformation officer Cherry West, who is interim COO until the end of February.

University Hospitals of Coventry and Warwickshire’s chief medical officer Kiran Patel is also joining the trust to take on the newly created role of “group” chief medical officer. 

Professor Patel replaces Simon Ball, who left the CMO role in early January.

Former NHSE West Midlands finance director Mark Mansfield also joined the trust before Christmas as an associate non-executive director. 

It comes amid a major board shake-up following a series of high-profile investigations into UHB’s safety, culture, and leadership.

Also on today

In The Download, Nick Carding reveals exclusive research that has found nearly a quarter of integrated care systems still lack a required digital transformation strategy, and we report that NHSE has announced plans to procure expert “Tiger Teams” to support the delivery of electronic patient records in provider organisations in a contract worth £16m.