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

Insufficient support systems

The board of United Lincolnshire Hospitals Trust got a ticking off recently, when a non-executive director raised concerns about the high number of doctors in the trust with General Medical Council restrictions

Medical director Neill Hepburn confirmed there were indeed nine locums on the books with GMC restrictions, but he added an agreement was already in place not to take on any new locums with restrictions. Those already hired “would be worked out but consideration would need to be given to fragile services” and the trust would put in place a requirement for all locums to be on the speciality register prior to working at the trust.

But what is interesting is, when HSJ approached the trust for more details, Dr Hepburn said the call was made not only to make “sure our patients are kept safe and have the best experience” but also because the trust “does not have sufficient systems in place to give them the support they require”.

GMC restrictions aren’t all doom and gloom. While they are partly designed to protect patient safety, they also allow doctors to carry on working and, ultimately, remediate any shortcomings. But such redress doesn’t happen by itself and would require support from an employer – support, it seems, United Lincolnshire doesn’t feel it is quite in the right place to provide at the moment. 

It’s also worth noting the special measures trust finds itself dipping into the locum bank regularly. According to its most recent annual report, it spent £37m on agency staff in 2018-19, exceeding both its NHS Improvement-set £21m cap and its £29m spend from the year before. 

When two become one

Mergers between NHS trusts are becoming increasingly fashionable, and one such scheme should be viewed with particular interest.

The coming together of Taunton and Somerset Foundation Trust and Somerset Partnership FT will create a near unique type of organisation for the NHS.

Somerset Foundation Trust, as the new trust will be known, will provide a full raft of acute, community and mental health services. Although Isle of Wight Trust currently does this, it’s on a far smaller scale.

But – as HSJ revealed this week – the merger has been delayed by some months. This is unlikely to cause many problems and is most likely a reflection that the initial target of October 2019 was a little too optimistic.

Assuming the merger is delivered, the new organisation will be firmly in control of its aim to fully integrate secondary care services for its population.

It also means the Somerset Sustainability and Transformation Partnership will only comprise four major organisations (the merged trust, Yeovil FT, Somerset Clinical Commissioning Group and Somerset County Council). The low membership number should make decision-making easier.

Supporters of integrated care providers should therefore keep a close eye on the county in the next year, at a time when the centre is pushing heavily for local collaboration.