HSJ’s round up of the day’s must read stories and debate

Not quite total control

Sources have told HSJ around 60 out of 238 NHS trusts have yet to agree their financial “control total” for 2017-18.

NHS providers have again been asked to deliver efficiency savings of around 4 per cent in 2017-18, which has led to a significant number rejecting their target.

Last week, NHS Improvement chief executive Jim Mackey told MPs that trusts would be required to deliver average efficiency savings of 4 per cent next year, which matches the requirement for 2016-17. He has previously called for trusts to be given more realistic savings targets.

Trusts that do not agree their target are not eligible to receive a share of the £1.8bn sustainability and transformation fund.

The proportion rejecting their control total is roughly in line with those that initially rejected their target for the current year.

Meanwhile, a majority of providers have agreed their contracts with commissioners, with fewer than 10 thought to require a formal arbitration process.

Finding the ‘fragile’ services

NHS Improvement will use the satisfaction rates of junior doctors to assess which trusts could have “fragile or unsustainable services”, a document obtained by HSJ reveals.

A paper presented to the private session of the regulators’ September board meeting, obtained under the Freedom of Information Act, said: “Regional teams are now looking closely at those trusts which are in the lower quintile for the General Medical Council’s doctors in training survey…

“There tends to be a correlation between trusts declaring fragile or unsustainable services and their having one or more ‘red flags’ from other information sources.”

The NHS Improvement document said officials were “looking closely” at trusts in the lowest quintile of satisfaction.

The regulator already looks closely at trusts with inadequate ratings from the Care Quality Commission and those with high spending on agency staff.

Derbyshire Community Health Services Foundation Trust was the lowest performing trust in the overall satisfaction section of the GMC survey in 2016, with a satisfaction rate of 65.3 per cent of junior doctors, against the national mean of 81.6 per cent.