Daily Insight: Under pressure and overspending

The Department of Health and Social Care decided that Monday afternoon, when the eyes of the country were trained on the chamber of the House of Commons, was the perfect time to publish its 2020-21 annual report and accounts.

They emerged 10 months after the year ended, though still within the allowed time limit, with some pretty stark details.

Included in the pages are details of a loss in value of £8.7bn of the £12.1bn worth of personal protective equipment bought in 2020-21, largely due to the significant drop in value of the kit now, compared to when it was bought, during a time of endless demand and high prices.

It includes details of how the DHSC’s inventory management systems “were unable to cope with the significant, rapid increase in procurement,” how it “did not maintain adequate records of the location or condition of £3.6bn of inventory”.

And it details how £1.3bn of DHSC spending was “irregular because it had spent these funds without the necessary HM Treasury approvals or in express breach of conditions set by HM Treasury”. This included a consultancy contract extension, which pushed the contract over £150m – the threshold at which the department should have sought approval.

The accounts say HMT also “declined to give retrospective approval to the contract, having considered the relevant facts”.

The DHSC, NHS and government as a whole were operating in incredibly challenging circumstances – under “extraordinary pressure”, as the auditor put it – so we cannot be too surprised when departments take on greater risks, operate beyond their normal processes and procedures.

Unfortunately, the DHSC “was not able to manage adequately some of the elevated risks”, according to the auditor, which meant there were “significant losses for the taxpayer”.

The poorly served get poorer

New HSJ analysis has revealed several areas that already had low numbers of GPs in 2015 have seen some of the largest declines over the past six years.

The new analysis – which looks at the full-time equivalent workforce – suggests wide variation between local systems in their efforts to boost GP numbers in their areas and comes amid an intense political focus on general practice, with health and social care secretary Sajid Javid planning a national review of workforce and funding and employment models.

Some systems, including West Yorkshire and Birmingham and Solihull, have managed to grow their numbers significantly, while those starting with lower numbers have tended to recruit or retain more GPs.

However, the systems covering Kent and Medway, Bedfordshire, Luton and Milton Keynes, Mid and South Essex, and Cambridgeshire and Peterborough have all seen relatively sharp declines, despite already having some of the lowest numbers of GPs per head of population.

The clinical commissioning groups covering these areas told HSJ of difficulties in attracting GPs and the steps they have taken to attempt to get and retain more GPs; including working on new “attraction packages” that include “financial incentives”, running “large scale programmes” to increase GP trainee numbers, “target support” at newly qualified GPs and offering occupational health support for practices.

Whether these efforts will come to fruition remains to be seen. Meanwhile, a pledge made by the Conservative government to increase GP numbers in 2015 was missed as numbers fell in subsequent years, and a renewed pledge in 2019 (6,000 by 2024-25) is also set to be missed.