HSJ’s roundup of a busy day in health policy

A bad day for NHS finances

The hotly awaited “month 9” figures from NHS Improvement were released on Friday afternoon, confirming that (as is now traditional for NHS finances) things are looking much worse than the last time we checked.

The report showed that by the end of December NHS providers were on course for a £2.8bn deficit in 2015-16, compared with the £2.2bn deficit the sector was forecasting at 30 September.

Either of those numbers would be unhappy news for the Department of Health, which, it is understood, needs the deficit to come down to £1.8bn to avoid blowing its own budget.

However, as HSJ readers know, NHS Improvement has been busy since the end of December encouraging providers to try every last trick possible to improve their 2015-16 bottom lines, ranging from further delays to capital expenditure to exotic manoeuvres known as “shaking the balance sheet”.

The month 9 figures also show the initial fruits of this exercise, revealing that in response to NHSI’s January letter writing efforts, providers have come up with further improvements worth £452m-£579m.

On which basis, NHSI is currently forecasting a deficit of £2.37bn for the sector, which might become £2.2bn. Which is still too high.

But don’t worry, because the regulator reckons there are still further improvements to be found in the six odd weeks before the end of the financial year.

There’s a clue as to how this might be accomplished in a report going to a joint board meeting on Thursday, which says: “We need boards and executive teams to pursue all possible and legitimate savings that can be made from reviewing balance sheets (eg: specifically reviewing areas such as accruals and bad debt provisions). As we complete the aggregate accounts for the sector we will consider whether any final national adjustments in these areas are justified.”

A bad day for NHS transparency

The explosive report into governance issues and conflict of interest concerns at Barnet CCG has implications outside of that single organisation.

The authors of the 75 page document (obtained by HSJ) spoke to senior figures at NHS England London who said in all likelihood these problems were widespread.

That it has been left to individual CCGs to decide where the line should be between commissioner and provider was always going to cause problems – as the whistleblower found out to his cost.

The concerns he had would simply have been “shrugged off” by other staff, the investigators Verita said.

It is bizarre that NHS England would clear Barnet CCG to have a greater say in commissioning primary care in October – a month after the report was delivered to them.

NHS England refused to say who has seen the report, but HSJ is aware of senior figures in the national commissioning body who haven’t and feel they should.

Other questions remain for the CCG and for NHS England:

  • How widespread is the practice of GPs receiving private “retainers” from care homes?
  • Are there too many CCGs? Barnet clearly could not perform many of the most basic accounting checks with the number of staff it had – this only became clear after a whistleblower lost their job; how many other groups are in a similar position?
  • Can it really be possible that a manager sending an email with the subject line “raising a conflict of interest affecting commissioning decisions” was not recognised as whistleblowing?

But GPs finally have a new contract

National talks between NHS England and the British Medical Association on next year’s core national GP contract have finally concluded.

The doctors’ union has said the general medical services contract settlement for 2016-17 represents “limited changes” to practices’ care and funding terms.

But it is awaiting what the trailed “GP roadmap” support package will bring in coming weeks before deciding whether to canvas its members over potential industrial action against an increase in workload pressures.

Next year’s deal will see an additional £220m, from which practices will be entitled to a 1 per cent uplift in the budget set aside for GPs’ pay.

The contract will also mean practices are required to record the number of instances where a practice pays a locum doctor more than an indicative maximum rate, as set out by NHS England.

Practices will also be required to record data on the availability of evening and weekend opening for routine appointments until 2020-21.

The full package will include new support with new approaches to indemnity cover, changes to extended opening hours arrangements and funding for more staff, according to Simon Stevens.

Next year’s contract will also see GP practices having to record the number of instances where a practice pays a locum doctor more than an indicative maximum rate, as set out by NHS England. It has not said what this maximum rate is.

NHS Employers and the BMA have agreed to explore ending the quality and outcomes framework voluntary incentive scheme during talks for the 2017-18 contract.