HSJ’s roundup of Wednesday’s essential stories

GP federations in stats and maps

One of the big issues facing the health service this year will be how primary care provision develops, with NHS England spearheading a push to join up and increase the size of GP practices.

HSJ’s research has found that four-fifths of clinical commissioning groups have at least one large scale GP provider group in their area.

Our snazzy interactive map shows the federations, networks and super practices in each CCG area.

We identified 268 of these organisations across 171 CCGs – giving the most comprehensive picture to date of the large scale providers operating across England.

The analysis suggests that 41 million people – 75 per cent of England’s population – are covered by a group. This is based on extrapolation from population information provided for 179 groups, which shows an average of 153,450.

One HSJ reader suggested that the push for seven day GP access would mean a rise in the number of large scale groupings in order to provide extended capacity.

NHS England chief executive Simon Stevens told HSJ last month he wanted to see proposals for advanced, large scale GP providers formed across a “reasonable chunk” of the country in 2016.

Mike Bewick, a former national deputy medical director at NHS England and GP, who is now working as an adviser, told us the research raised concerns about “a lack of ambition and clear priorities” among GP groups.

He said: “While there were common themes such as improvement in health outcomes, improved clinical governance, improved access over seven days and seasonal issues, the most common theme was ‘no plan at all’.”

Clinical cutoffs

At the end of last year HSJ broke the news that NHS England was planning a major shake-up of its national clinical directors, and the NCD for neurology would be cut.

More detail has now emerged about how the NCDs will be reshaped in 2016-17. Eight NCDs, including those for renal disease, spinal disorders, and gastroenterology and liver disease appear likely to be removed. NHS England has decided not to advertise for replacements in these areas when the existing directors’ contracts end in March.

The national commissioner has also revealed that the 16 NCDs who remain will be split into three types: “major programme”; ”service improvement”; and ”population group” directors.

NHS England says the new look NCDs are part of broader work to rationalise how it gets clinical advice, and that the changes will help it to reduce costs in line with the administrative savings being demanded by the Department of Health.

However, it has already triggered a backlash from patient groups that are losing an NCD in their area. For example, Fiona Loud, policy director of the British Kidney Patient Association, told us NHS England’s actions would send “a really poor message to kidney patients about the disease: the problem is not fixed, the problem hasn’t gone away”.