The biggest stories in healthcare from Monday

Keep it 100

The HSJ100 is our analysis of the most powerful and influential people in the English NHS and health policy. We have published it at the end of each calendar year since 2005 but this year we decided to produce a summer “refresh” – recognising that much can change in a year.

The original plan was to publish the refresh in May or June, but the election put paid to that plan and the change the refresh captures is, therefore, even greater than it would have otherwise been.

Names missing from the HSJ100 – in some cases for the first time in many years – include: Sir Mike Richards, Ed Smith, Lord Prior, Mark Porter, Sir Bruce Keogh, Samantha Jones, Professor Keith McNeil and Jonathan Fielden.

The turnover created by these high profile departures and a series of seismic events – most significantly this year’s “snap” election – mean there are 32 new entries, while eight figures have fallen by 20 places or more and 14 have risen by the same amount. Of the top 20, only nine people survive from 2016, while five are new entries and the remaining six have all risen at least 15 places.

Problems keep flowing

Trusts are facing increasing cash flow pressures after NHS England instructed local commissioners to stop making advance payments on block contracts, HSJ can reveal.

Clinical commissioning groups in the North have received a directive from NHS England to pay block contracts via 12 monthly payments, after some had entered local agreements to pay trusts in 10 instalments.

Using 10 instalments means providers receive all their 2017-18 revenue by January, and ensures trusts are not short of cash if their cost improvement plans do not yield savings in the first part of the year.

However, HSJ understands some trusts, particularly those behind their financial plans at the end of the first quarter of the year, will be seeking distress funding over the next few months to cope with having less cash.

York Teaching Hospitals Foundation Trust, Harrogate and District FT and Northern Lincolnshire and Goole FT confirmed their cash flow was coming under pressure due to moving to 12 instalments. They will be seeking talks with NHS Improvement and the Department of Health to ensure they have enough working capital.

It is likely other trusts will be affected because 10 instalment payments were agreed between some commissioners and providers, in part, to support acute trusts while financial plans and cost improvement programmes had time to deliver.

West Country club

Three CCGs that cover one of the most financially strained health economies in the country have proposed a full merger as part of a wider reconfiguration of services.

Bristol, North Somerset and South Gloucestershire CCGs have confirmed plans for a formal merger. The new organisation would have a combined health budget of £1.15bn.

The proposal is unlikely to come as a surprise with suggestions as early as September 2016 of a move towards a “single commissioning voice”.

The CCGs already run a joint commissioning board with a single chief executive, Julia Ross. Ms Ross was appointed earlier this year to lead a turnaround of the organisations that preside over one of the most financially challenged health economies in the country.