Your essential update on the week in health

HSJ Catch Up

This weekly email gives HSJ subscribers a vital update on the biggest stories from the last week in health. If you have been out of the office or otherwise just too busy to keep up, HSJ Catch Up will ensure you are still in the know.

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Provider deficit won’t be cleared this year

When Jim Mackey leaves NHS Improvement this autumn, we will dearly miss his zero-nonsense style.

In an exclusive interview with HSJ, the NHSI chief executive was typically upfront about the provider sector deficit for 2017-18, the regulator’s recent U-turn on agency staff, and winter pressures.

He said: “The provider sector won’t be in balance in 2017-18. It’s possible to get there in 2018-19, ceteris paribus and all that. But we’re not in control of all those other things.” He said even the timetable to achieve overall balance in 2018-19 was “very, very risky”.

In a further demonstration of candour, Mr Mackey said “silly” community bed closures had made winter even more difficult for acute trusts. On the standoff between trusts and locum doctors over new tax rules (more on this below) he said: “I don’t know how they’re on the register as doctors – if that’s doctor behaviour, I don’t know how that will work.”

NHS Improvement announced rules to prevent trusts from using agency staff who are also employed by the NHS in February, but then said it was “pausing” the policy last week after the Royal College of Nursing warned it could drive more nurses to work in the private sector.

Mr Mackey’s response: “It’s my fault, I didn’t read every line of the document and then eventually did read it and thought ‘oh poop, I wish I’d read that bit’… We dropped a clanger but we fixed it.”

Taming primary care’s ‘wild west’

Dr Arvind Madan, NHS England’s primary care director, has signalled an end to what he calls the “wild west” general practice.

His comments came as NHS England set out plans to have GP practices organised in to “hubs or networks” covering populations of 30,000 to 50,000 over the next two years.

He said organising practices this way would send a signal to CCGs about how they should be commissioning primary care services – giving it a more “organised” structure.

According to Dr Madan, a 30,000 to 50,000 population is the “magic” number for a hub.

STPs given savings tips

Sustainability and transformation partnerships are to be given tailored guidance on how to integrate physical and mental health services and what savings they can make.

Bespoke data packs for each of the 44 STP regions have been commissioned by NHS England and are due to be sent out at the end of April.

Produced by Midlands and Lancashire CSU, the packs will set out how each STP can improve patient care and also model any financial savings that can be made.

The £150,000 project will provide data and analysis to support STPs and commissioners to develop investment cases for key priorities recommended by the Mental Health Taskforce.

Integrating physical and mental health is a key plank of the NHS England’s implementation plans for the Five Year Forward View for Mental Health.

The key question is what additional insight the data packs are going to provide STPs, given that NHS England has set out national saving estimates and STPs have been running financial models of their own.

Locums and trusts in standoff

The NHS is in a “Mexican standoff” with locum doctors, agency nurses and private contractors, with some threatening not to work when new tax rules came into force this week.

HSJ has learned some locum doctors are demanding uplifts of more than 50 per cent in their pay as NHS trusts take on responsibility for paying their tax and national insurance, under new IR35 regulations from HMRC.

The regulations apply to any temporary staff being paid through a personal service company and could reduce income for temporary staff by more than 20 per cent.

Sir Bruce Keogh resigns

HSJ readers and figures from across the NHS have been paying tribute to Sir Bruce Keogh – NHS England’s national medical director, who has announced he will be stepping down at the end of the year.

Sir Bruce will then become chair of Birmingham Women’s and Children’s Hospitals FT.

On Twitter, commentators said he had led the way for clinical leadership, “attracted too much unfair criticism and too little well deserved praise”, and was a role model for junior doctors.

The theme among HSJ commenters was that Sir Bruce will be an almost impossible act to follow, as well as being the nicest man in healthcare – so nice that he once saved the life of a Cyberman.

Naylor: STPs need £10bn more in capital funding 

Sir Robert Naylor’s review into NHS property and estates was published last week.

The former University College London Hospitals Foundation Trust chief executive concluded that increase of at least £10bn in capital funding is required to deliver proposals in STPs and make NHS facilities fit for purpose – and this was based on a “conservative estimate of backlog maintenance at £5bn”.

However, the review also says the NHS can raise nearly £6bn itself by having a more “commercial approach” to selling land and buildings.