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.

Pay reform on the agenda

More than 1 million NHS staff are to be offered an average 6 per cent pay rise over three years from next April, after ministers and trade unions agreed a deal to reform the Agenda for Change pay framework.

The agreement will be fully funded by the Treasury at a cost of more than £4.2bn.

Staff will be offered an average pay rise of 3 per cent backdated to April this year, followed by 2 per cent in 2019 and 1 per cent in 2020.

Some NHS staff will see a permanent reduction in their out of hours pay rates as part of the new deal.

The change will only affect the lowest paid NHS workers in bands 1-3, and unions and NHS Employers stressed it will not affect the “cash value” of out of hours pay, due to the new minimum salaries introduced as part of the deal unveiled this week.

But the change does mean a permanent reduction to rates of pay for out of hours work, which has been a key target for the government in previous talks and was a flashpoint in the 2016 junior doctors’ contract dispute.

GIRFT impact

The Getting It First Right Time programme is shaping up to have a bigger impact than other clinical reconfigurations (and with a £60m budget over four years, it should do).

The GIRFT teams are already out and about in the English acute system talking to trusts at a specialty level, with data and specialist knowledge.

The most recent report produced by the team (based at NHS Improvement) was on vascular surgery and showed a situation in which not enough had changed since the last review.

The team led by Professor Michael Horrocks found too much variation in volume and outcomes, and trusts that had still not properly networked their services into a hub and spoke model.

Pleasingly, research by HSJ seems to show significant movement on this front, with many of the trusts that were beneath the thresholds that GIRFT set for vascular surgery hubs working to centralise services.

It’s easier to make plans than implement them, of course. But the signs are positive that work will be concentrated into fewer, bigger centres that do more work. For one thing, there will be regional GIRFT leads tasked with pushing the adoption of these plans.

Landmark merger plan confirmed

Health chiefs in Somerset are planning to create only the second English NHS trust to provide acute, community and mental health services.

Taunton and Somerset Foundation Trust and Somerset Partnership FT set up a joint executive board last year as part of an alliance agreement, and they are now looking to fully merge the organisations.

Somerset Partnership chief executive Peter Lewis told HSJ there were “disbenefits” to running the alliance agreement and a merger would help integrate services such as CAMHS and paediatrics – to name one example.

On the face of it, the merger looks a logical move amid the push for integration in the NHS.

The trusts are a similar size and based just 10 miles apart. Somerset Partnership is forecasting a small surplus this year, while Taunton and Somerset is set to record a small deficit.

The only other trust to currently provide acute, community and mental health services (plus an ambulance service) is Isle of Wight, which is in special measures.

CCG asks for helping hand

A London clinical commissioning group has gone cap in hand to NHS England, after estimating that a new “digital first” GP practice on its patch could cost upwards of £10m next year.

GP at Hand, a partnership between Babylon Health and a single Fulham practice, is trying to shake up NHS primary care with a business model based around attracting NHS patients with the promise of video consultations on their smart phone.

So far, it seems to be working.

The practice’s patient list has grown fivefold in less than six months, three quarters of them from outside its base in north west London (and some from outside the capital entirely).

GP at Hand has five physical premises throughout the city (and would have more if it could) but, for commissioning purposes, the practice is still based in Fulham.

That means GP at Hand’s 25,000 patients (and counting) are Hammersmith and Fulham CCG’s financial responsibility. Hence the appeal to NHS England.

If GP at Hand’s current model continues to expand beyond London (new premises have been mooted for Manchester and Birmingham), the CCG could conceivably end up footing the bill from millions of patients from Hadrian’s Wall to the English Channel.

It is, however, presumably not going to come to that.

Babylon could instead go for a model in which it partners with a different “GP at Hand” practice in each region – rather than running everything through London.

NHS England could potentially step in, more forcibly than it has already, if GP at Hand proves too disruptive, either slowing growth or fiddling with the payment model to distribute the costs more evenly.

Trust turnaround

Congratulations to Princess Alexandra Hospital Trust, which has exited special measures less than a year after new leadership was brought in.

It had been rated inadequate since October 2016 when it was first placed in special measures.

Lance McCarthy took over as chief executive of the trust last May having previously worked at Hinchingbrooke Health Care Trust, which he also led out of special measures.

He told HSJ that the improvement at Princess Alexandra was partly due to a change in culture.

Mr McCarthy said: “It was a very closed culture before and we are now hoping staff can raise concerns when they are risks not problems.”

He also said the non-executives were more “effectively challenging” the trust’s board.