Your essential update on health for the week.

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.

Details of the deal

NHS England’s board has formally confirmed agreement of a new five-year GP contract deal.

There will be much to say about a detailed deal which sets out many changes taking place over a five-year period, including a few more or less unprecedented developments.

We’ve set out a number of them, or you can read the full 108 pages from NHS England

Brexit decisions

So far, each provider seems to have worked off the same template for their Brexit assessments, covering the same seven concerns.

But Guy’s and St Thomas’ Foundation Trust this week added an eighth workstream: one considering who should be prioritised for treatment if vital drugs run so low that a choice has to be made whom to treat.

Of course, hospitals make decisions on clinical priority all the time, usually in response to waiting list pressures.

Having to set policies – children take precedence over the elderly, for example – about who gets medicine, and potentially over who lives and dies, because of an avoidable supply chain issue is quite different.

Something has to give

When ever-increasing NHS patient demand constantly pushes up against a limited pot of NHS money, there will always be disagreements about what should give.

HSJ has reported such a disagreement in the West Midlands between South Warwickshire Foundation Trust and the South Warwickshire Clinical Commissioning Group.

The trust has been paying for outside help to meet the 18-week elective waiting time target, specifically hiring a Vanguard mobile theatre and nursing staff to boost its orthopaedic capacity.

The trust has argued the mobile theatre was a necessary expense to meet the legally mandated target and also helped free up capacity elsewhere to improve elective performance across the board.

The CCG agreed the trust had reduced waiting times for some procedures, but said the trust had gone way beyond what is needed to hit the targets and had done so in a way that costs the NHS – and specifically the CCG – more than could be justified.

Final countdown

After several years of trying by commissioner and provider leaders, a controversial reconfiguration of acute services in Shropshire has been given the final go ahead.

The accident and emergency department at the Princess Royal Hospital in Telford will be downgraded under the plans, with the county’s emergency services consolidated at Royal Shrewsbury Hospital.

Shrewsbury and Telford Hospital Trust has been under the spotlight quite a lot over the past six months, thanks to a series of safety warnings from the Care Quality Commission.

Time for a change

Not only is Southend famous for being home to the longest pier in the world, it also holds the accolade for being the last trust to move onto the Agenda for Change contract.

But staff at Southend University Hospital Foundation Trust will move across to the national pay deal at the start of April. 

The saga has been running since 2006 when Southend Hospital staff voted to leave the national contract. However, they’ve since raised concerns they are being paid less than staff elsewhere in the country

Unison has now announced 88 per cent of its members have voted to join the national pay deal.

Not a nurse

Thousands of newly qualified nursing associates are shortly due to join the NHS workforce. But the development of the new role – designed to bridge the gap between healthcare assistant and registered nurse – has been controversial.

There have been legitimate concerns over whether the role could be used to substitute for registered nurses and lead to an overall downskilling of the nursing workforce in the NHS. Some trusts have already been identified as reducing nurse numbers to accommodate new nursing associates

There is also evidence that using non-nursing staff contributes to increases in mortality and poor patient outcomes.

It’s in this context the Care Quality Commission has issued new guidance to providers warning them not to make the mistake of viewing nursing associates as one and the same as nurses and making clear it expects to see evidence of a systematic approach to how these new workers are deployed on wards.

Plug and play

Despite being faced with an ever-shifting target for a “paperless” or “fully digital” NHS, a significant cohort of trusts have made little or no progress in improving their IT.

Now, HSJ has revealed NHS England is considering a national electronic patient record to help these trusts catch up.

Deputy chief executive Matthew Swindells said the idea was to provide a no-frills electronic record on the cloud, which trusts could “plug” into, uploading patient data to share with other providers involved in their care.

Tight timeline

Eleven radiology networks are to be set up by NHS England to standardise the quality of care and simplify its national contractual arrangements.

Trusts have been allocated to one of the 11 networks. By next month, they must decide between them which of the trusts in their regional patch should hold the overall contract with NHS England.

But concerns have been raised that the timeline to agree this is incredibly tight – in part because the new service specification’s release was delayed – and it is not clear what happens if the trusts cannot agree who should lead them.

The Royal College of Radiologists told HSJ it was worried the reorganisation will be “impossible” without funding to help set up the networks and buy in the IT infrastructure needed to make the regional partnerships work.

Given the complexities and concerns raised around the new networks, it wouldn’t be surprising if they aren’t up and running this April as intended.