Daily Insight: Stevens demands more elective activity

Ramp it up

HSJ bounced between very immediate and the unusually long term when we spoke to Simon Stevens for a long interview at the end of last week.

On the former, the NHS England chief showed frustration at an immediate difficulty with getting the waiting list under control. It appears that in planning and contracting, acute trusts signed up to do a bunch more day case procedures early in 2018-19 than they did at the same time last year.

It’s very likely that lengthy winter pressures will again knock off course any ambitions to keep up with demand in the second half of the year. And well known pressures on beds mean getting a lot more inpatient elective procedures done remains difficult even during summer.

So, if the list is to be kept roughly stable through this financial year – as Mr Stevens and colleagues have promised government – hospitals need to get a lot of day cases done right now.

Mr Stevens said early figures suggested this wasn’t happening despite, seemingly, money being there in contracts, and surgeons being ready and willing.

Why is it not happening? Some quick responses from readers suggest overnight inpatients may be spilling over into day care units, meaning day lists are cancelled. Another view is that lack of support and care for after the day procedure may be a limiting factor, meaning operations are cancelled.

Our lead story took us to the longer term, with priorities revealed for outcomes improvements over a 10 year time frame.

In a leader column HSJ editor Alastair McLellan explains this may be part of an expectations management exercise: In the short term, funding is still pretty constrained and the NHS will be able to do little but try to keep the show on the road. Politicians and others can be assuaged to a degree with more ambitious improvements promised in the longer term. To make a reality of those loftier ambitions, taxpayers and Parliament will have to stump up for a better funding settlement in a few years’ time.

Fragmentary care impacting on patients

On Tuesday, GP at Hand’s ambition to change the face of NHS primary care hit another regulatory roadblock. This time from its local clinical commissioning group.

A committee of Hammersmith and Fulham CCG raised a formal objection to the digital first GP practice expanding its reach outside London to accept patients from Birmingham, because of the “risk to patient safety”.

Under GP at Hand’s proposal, a new physical clinic would be opened in Birmingham.

New Birmingham patients would still be technically registered with a single practice in south west London, and receive most of their health care remotely, via video on their mobile.

GP at Hand has made no secret of plans to expand nationally, with Birmingham its first attempt to stretch its legs outside London.

But H&F CCG also faced pressure from Birmingham and Solihull CCG to block the expansion.

In a letter, the CCG chief executive told his south west London counterpart that GP at Hand could destabilise GP practices and integrate poorly with other services in the city.

It is not first time the NHS has intervened to slow or tame the fast growing digital service, with NHS England taking a similar step in November last year.

GP at Hand quickly responded to this decision by calling on the CCG to “immediately revisit its flawed process”.

But the CCG’s decision to object is not final and GP at Hand will have an opportunity to present fresh evidence to overcome concerns in the coming months.

If the objection is withdrawn, GP at Hand’s expansion into Birmingham could serve as a template for spreading to patients in other cities across England.

Each of them registered in a single practice in Fulham.