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

Market rate

HSJ pointed out in January that several chief executives in the north east were paid considerably more than their counterparts in similar trusts elsewhere. There’s now the first sign that salaries in the region are falling back into line with elsewhere.

Ian Renwick’s replacement at the helm of Gateshead Health Foundation Trust is expected to be paid at least £62,500 less than he was. The proposed salary for the £264m turnover trust’s incoming chief executive is advertised at between £182,500 and £202,500. That’s in the upper half of the rate NHS Improvement has indicated would be appropriate for a trust of that size but it is notable that the trust had spoken to NHSI before setting this range.

Mr Renwick – who was dismissed last year for reasons not made public – was paid salary and fees of between £265,000 and £270,000 in 2017-18. That’s more than the chief executives of some £1bn turnover teaching trusts and way ahead of chief executives running other district general hospitals.

Comparing chief executives’ pay is, however, becoming more complex. Many are taking on additional responsibilities in sustainability and transformation partnerships or integrated care systems. Others are running chains. Some are opting out of the NHS pension scheme in the latter parts of their careers, which saves their trusts’ money (no employer contributions to the scheme) so should they get an uplift in pay to reflect this?

To be fair to Mr Renwick, no pension contributions were shown in his total package in 2017-18, which may make his pay slightly less out of kilter with his peers. But offering additional pay to senior NHS staff because they have opted out of the pension scheme for whatever reason would set an unfortunate precedent. Some central guidance on this might be useful as senior staff opting out to avoid large tax bills – and younger staff deciding they just can’t afford the contributions – becomes more common.

GP out of hand

As the local commissioning chief executive put it, approval for GP at Hand’s expansion into Birmingham had an air of inevitability about it. But that does not make it less momentous.

The digital GP practice, effectively run by the firm Babylon Health, first tried expanding from London into the country’s second largest city more than a year ago but was blocked by NHS England.

It has tried several times since and NHS England finally relented on Tuesday, lifting its final objections relating to how the service would connect with screening and immunisation in the city.

What GP at Hand proposes in Birmingham is unprecedented. Patients in the city would be able to register with GP at Hand’s physical practice, based 130 miles away in Fulham. There would be a physical satellite clinic in Birmingham but most of the care would be delivered digitally, through video consultations, on a patient’s smartphone.

GP at Hand has made no secret that it is planning to roll this model out nationally and has already approached people in Southampton and Leeds. Getting clearance for further expansion will now be far easier and, as Birmingham and Solihull Clinical Commissioning Group discovered, local CCGs will have limited power to stop it. The logical conclusion of this expansion is patients across England registered to a single London-based GP practice and receiving most of their care digitally.

If its popularity with patients in London is replicated elsewhere, the impact on hundreds of GP practices haemorrhaging patients could be high.

But this is by no means inevitable. GP at Hand will face increasingly stiff competition both from GPs upping their digital game and other digital health companies. The service may not prove as popular elsewhere, or GP at Hand itself may face fresh regulatory difficulties.

However, GPs are clearly worried. British Medical Association GP chair Richard Vautrey said the decision was incredibly disappointing and “flies in the face of place-based care delivered by practices embedded in local communities”. He and others have repeatedly raised concerns about the practice of cherry-picking healthy patients, fragmenting care, and destabilising primary care.

The decision, Dr Vautrey said, was also premature and regulators should have at least waited for the results from an independent evaluation of GP at Hand’s impact in London, expected next month.

But health and social care secretary Matt Hancock, a user of and cheerleader for GP at Hand, welcomed the decision as giving more people more choices within the NHS.

It may now be up to GP practices in Birmingham and elsewhere to improve their digital services if they want to hang onto patients.