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

Ready in the wings

We are at the start of the biggest upheaval of primary care for years. 

GPs are marching to a drum beat played by the British Medical Association and NHS England. This should crescendo until 1 July, when every patient registered with a GP should be living under the aegis of a primary care network.

These PCNs are preparing to cover the land with discrete zones containing 30,000 to 50,000 patients. The GPs will be united by their network agreement.

The BMA and NHSE are expected to publish a template network agreement this week. It will be the basis upon which PCNs build their own agreements, which will govern how the networks share services and additional workforce who will staff emerging multidisciplinary teams. These initial agreements will need to be submitted to commissioners by 15 May.

And this is where the story will really start. The BMA-NHSE five-year plan makes clear each year will see a step-up in expectations from PCNs, as well as the cash they are entitled to.

So, we can expect these first year network agreements to be “rudimentary”, according to Richard Vautrey, the BMA’s lead GP, to allow for flexibility in the early days. They will get more sophisticated as time goes by and as relationships develop.

Kark’s stark words

The issue of what to do with NHS managers guilty of misconduct or serious mismanagement has been a persistent point of debate since the Griffiths report first created the notion of general managers.

Sir Ian Kennedy saw the effect of these problems at Bristol with the children’s heart scandal. Subsequent reports from Sir Robert Francis on Mid Staffs, Bill Kirkup on Morecambe Bay and Liverpool Community Health Trusts and the investigations into Southern Health, Winterbourne View and so on all underline the consequences when managers fail ultimately to put their patients first.

Speaking to HSJ, Tom Kark QC, who oversaw a recent review of the NHS’ fit and proper person test, stresses that his recommendations should be taken together rather than split up (even though that is what the government has done)

The leading barrister, who was also lead counsel to the Mid Staffs inquiry, quite rightly takes issue with the suggestion his report was solely about stick with no carrot and emphasises the recommendations, if implemented in full, should make management easier and more attractive.

As he points out, it is quite clear what needs to be done – the issue is the lack of effective action.

Dido Harding has indicated her support for regulation of managers. She must have regard to Mr Kark’s warnings that his recommendations should not be treated as an a la carte menu.