Daily Insight: Spring statement lacks bounce

Thoroughly modern Phil

In the spring statement today, chancellor Philip Hammond pledged to provide extra cash for an NHS pay rise if management and unions can reach a deal on “pay modernisation”.

This sounded like a return to the old debate over pay progression and automatic increments, though this would conflict with an apparent unofficial briefing to The Guardian last week, which suggested ministers had agreed to take pay progression off the table.

Instead, the newspaper reported that the government’s demand for greater productivity would come from staff sacrificing one day of annual leave.

Or perhaps a reduction in annual leave is exactly what the chancellor means by modernisation.

The lack of clarity reflects the fact that negotiations are still live, and as the BBC’s political editor reported this morning, there is no consensus at the top of government about NHS funding.

The question at hand

GP at Hand (the controversial video consultation service by Babylon Health) has ruffled plenty of feathers since its arrival in November, with some people claiming its very existence threatens the stability of primary care.

NHS England too has entered the fray, though more quietly than most (for more details on whys of this read our story from January).

If the centre hadn’t put on the regulatory brakes, GP at Hand would already be in Manchester, Birmingham and who knows where else by now.

How far and fast the online focused GP practice will spread depends on both regional and national commissioners.

On Tuesday, HSJ published an interview with NHS England’s chief digital officer, Juliet Bauer, her first on the digital GP service causing such consternation.

Ms Bauer acknowledged that questions around the “cherry picking” of younger, healthier patients, creating unsupported costs for Clinical Commissioning Groups and other GPs, and increasing accident and emergency demand were legitimate and needed robust answers.

But she also pointed out there was clear patient demand for GP at Hand – the practice’s patient list has grown fivefold in six months.

So, if the service is safe and effective, Ms Bauer suggested maybe the NHS will need to change to accommodate GP at Hand and similar digital health providers.

It’s a fine line to draw between encouraging digitally enabled new care models (which is essentially what GP at Hand is) and making sure the system and patients get the services they need rather than the services they are sold.

Running in parallel, NHS England is building an online health service offering (often with the same suppliers), which, once up and running, it hopes will be the preferred option for NHS patients.

Ms Bauer said getting the pace of digital innovation in the NHS right is one of the biggest challenges of her job.

But as digital health services become increasingly ubiquitous, maintaining the right pace for NHS adoption will only become more difficult.