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

Light on the detail

The absence of any detailed workforce proposals in the long-term plan meant hopes were been pinned on the interim workforce strategy, which is expected in April.

However, an interview with national executive lead Julian Hartley has revealed this interim plan will not resolve key questions, as its writers need to know how much money will be available, and that means waiting until autumn’s spending review. 

Instead, Mr Hartley confirmed the plan would set out a direction of travel for workforce policy, and that nursing and midwifery staff shortages had been identified as one of the biggest challenges.

He also shed some light on the types of changes he and his team would like to see made to NHS England/Improvement’s national oversight framework, but he was clear a solution to the ongoing pensions crisis would also not be found in the interim plan.

It seems that the workforce must continue to wait patiently for concrete answers.

The price isn’t right

Clinical commissioning groups are again facing unexpected and uncontrollable rises in generic drug prices.

February saw 90 generic drug concessions – when the government agrees a temporary price increase above the national tariff list price for a drug to help overcome shortages – the highest since at least the start of 2017.

CCGs can do very little to mitigate these costs, and most have to absorb the extra expense into their annual budgets.

What many will be frustrated about is that commissioners are again facing huge unexpected bills in this financial year, despite being told not to plan for any such price rises.

The Department of Health and Social Care announced last summer it was working to stymie the rises to ensure generic wholesale prices reflected the purchase price from manufacturers. It felt there may have been some gaming of the system previously.

NHS England and NHS Improvement subsequently told CCGs not to plan in for concession increases in their 2018-19 budgets. And yet the number of generic drugs being sold above tariff has continued to be higher than was seen during 2016 and 2017.

Global shortages, a weak pound and Brexit uncertainty are all playing a part in the shortages. A solution does not appear likely anytime soon.

While CCGs may sensibly make contingency plans in case of price increases in 2019-20, they will have to do so under tight budgets and rising patient demand.

NHS England may have to rethink demands for central reimbursement for these costs that CCGs can do nothing to control.