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

A theoretical veto

What can we take from the news that Nottingham City Council – which suspended its involvement in the area’s integrated care system for six months in December – has now rejoined the fold, a bit earlier than planned?

First, that perhaps it is possible for an ICS to keep the show on the road with local government even in cities with strong Labour politics, influenced by Momentum and people who will oppose any flavour of health reform under a Conservative government. It will though, if Nottingham is anything to go by, receive close scrutiny; require commitments that privatisation is not on the table; and, as here, involve some legal gymnastics to offering a theoretical “veto” on outsourcing.

Second is a reminder that borders and boundaries matter. Nottingham was won over in large part by a decision that there will, as part of the ICS, be an additional “integrated care provider” which matches the city’s boundaries (and it can therefore have a strong influence over). Previously, the ICP had been expected to span a wider area, including some Tory parts of south Nottinghamshire. As clinical commissioning groups are dissolved, ICPs will play a growing part in assuring communities NHS structures will not forget them.

Third is a signal on transparency. Nottinghamshire and Nottingham ICS held its first public board meeting, with published and substantial board papers, last month. It’s not clear what influence this had on the city council. It will undoubtedly be uncomfortable for some. But it helps deal with the easy critique that ICS are secretive and, if ICS are to be important players, as they often profess, then this is what will be expected.

Inspecting scale

A large, multisite GP practice in the north of England had cause to celebrate this week after being rated “outstanding” by the Care Quality Commission.

The Haxby Group runs GP practices in York and Hull, covering 60,000 patients in total. It has a practice in each city, each one operating across several sites.

The two practices are registered with the CQC so the regulators inspected each. But both practices are united by a shared business support unit and are under the aegis of the group leadership.

GP practices operating on a large scale over several sites are posing challenges for the CQC as it moves towards its new, lighter touch inspection regime.

The watchdog has been working with the large super-practices to try to determine the best way of inspecting and rating organisations with staff providing services in multiple locations across different cities.

This work is ongoing and has taken on new relevance as primary care networks promise greater collaboration in the sector.