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

Enhanced monitoring

Barking, Havering and Redbridge University Hospitals Trust has had some ups and downs in the recent past. The Care Quality Commission took it out of quality special measures in 2017, only for it to be put into financial special measures by NHS Improvement in 2018.

Now, the General Medical Council has put the trust’s acute and internal medicine training into “enhanced monitoring”. This somewhat sinister-sounding status means BHRUT’s efforts to improve the quality of medical training will come under greater scrutiny.

The issue has garnered close attention from Health Education England in the past but now the GMC has got involved. It told the trust it is failing to deliver 10 of the requirements it says trusts must meet when delivering medical education.

This is the first step on a regulatory path that can ultimately lead to a trust having its trainees taken away, along with the income the students bring with them from HEE.

The trust has already started addressing some of the concerns and more detailed and intensive work lies ahead for BHRUT, all under the watchful eye of the GMC and its enhanced monitoring regime.

Babylon in Birmingham

News that one of the country’s biggest trusts, University Hospitals Birmingham Foundation Trust, is looking to partner with one of the UK’s most high-profile digital providers, Babylon Health, is significant on several fronts.

First, the timing. The news comes ahead of the imminent expansion of Babylon’s NHS GP practice, GP at Hand, out of London and into Birmingham. The trust has said the timing is coincidental and it has no favouritism one way or another for GP at Hand. 

But, in the same breath, the trust has also said it will look to work with GP at Hand to create smooth digital referral between the platform and the trust’s hospitals, which hold a near monopoly on the city’s acute and specialist services. If Birmingham GPs were nervous about losing patients to GP at Hand before, how much more nervous will they be with this close relationship between Babylon and the main hospital provider?

Second, this partnership would be a significant expansion of Babylon’s ambition within the NHS (and globally), from essentially primary care to a digital out-of-hospital service wrapped around an acute provider. Working on outpatient video appointments with UHB is particularly significant given the ambition in the NHS long-term plan to cut face-to-face outpatient appointments by a third, partly by digital means.

Third, it is significant that UHB has turned to outside help to relieve pressure on its front door. In current policy thinking, the trust should be working more closely with its community, mental health and GP partners to solve this problem, through the sustainability and transformation partnership. Significantly, the trust has not told any local GPs about talks with Babylon ahead of the news becoming public and acknowledged some may not be happy.

While the deal is not actually done yet, both parties speak about it with an air of inevitability. How it will shape the delivery of health services in Birmingham and beyond remains to be seen.