HSJ Weekly Catch Up: PCN predictions, missed savings and drug price hike

Ready in the wings

We are at the start of the biggest upheaval of primary care for years. 

GPs are marching to a drum beat played by the British Medical Association and NHS England. This should crescendo until 1 July, when every patient registered with a GP should be living under the aegis of a primary care network.

The GPs will be united by their network agreement. The BMA and NHSE are expected to publish a template network agreement this week.

The BMA-NHSE five-year plan makes clear each year will see a step-up in expectations from PCNs, as well as the cash they are entitled to.

So, we can expect these first year network agreements to be “rudimentary”, according to Richard Vautrey, the BMA’s lead GP, to allow for flexibility in the early days. They will get more sophisticated as time goes by and as relationships develop.

Kark’s stark words

The issue of what to do with NHS managers guilty of misconduct or serious mismanagement has been a persistent point of debate since the Griffiths report first created the notion of general managers.

Sir Ian Kennedy saw the effect of these problems at Bristol with the children’s heart scandal. Subsequent reports from Sir Robert Francis on Mid Staffs, Bill Kirkup on Morecambe Bay and Liverpool Community Health Trusts and the investigations into Southern Health, Winterbourne View and so on all underline the consequences when managers fail ultimately to put their patients first.

Speaking to HSJ, Tom Kark QC, who oversaw a recent review of the NHS’ fit and proper person test, stresses that his recommendations should be taken together rather than split up (even though that is what the government has done).

Carter’s criticisms

How the NHS spends its money is the subject of much scrutiny, but – until recently – the way in which acute hospitals manage their transactions has not received much attention.

That changed with the publication of the Carter Review in 2016, in which NHS efficiency driver Lord Carter set out three clear targets for how hospitals should buy what they need to look after patients.

Lord Carter’s review, which was backed by NHS Improvement, called for all acute non-specialist trusts to get their transaction processes in line by October 2017.

But the deadline has proved too ambitious. HSJ revealed last year only eight trusts were complying with all three metrics.

Fast forward to March 2019 and performance has improved – 18 trusts are now achieving all three targets – but nowhere near the level Lord Carter’s review expected.

Whatever the reasons for the slow progress, the result so far means many missed savings opportunities.

Still waiting

NHS England has just two years to hit the government’s deadline for eliminating so-called “inappropriate” out of area mental health placements, defined by NHS Digital as those placements caused by a lack of available beds.

HSJ appreciates the optimism, but the latest data reveals little change in the numbers of mental health patients being sent out of area since September 2017 and nearly all – 96 per cent – of these placements were classed as inappropriate.

Worryingly, what also emerged was an increase in the proportion of placements lasting 15 days or more, while the proportion for 14 days or less decreased.

Light on the detail

The absence of any detailed workforce proposals in the long-term plan meant hopes had been pinned on the interim workforce strategy, which is expected in April.

However, an interview with national executive lead Julian Hartley has revealed this interim plan will not resolve key questions, as its writers need to know how much money will be available, and that means waiting until autumn’s spending review.

Instead, Mr Hartley confirmed the plan would set out a direction of travel for workforce policy, and that nursing and midwifery staff shortages had been identified as one of the biggest challenges.

The price isn’t right

Clinical commissioning groups are again facing unexpected and uncontrollable rises in generic drug prices.

February saw 90 generic drug concessions – when the government agrees a temporary price increase above the national tariff list price for a drug to help overcome shortages – the highest since at least the start of 2017.

The Department of Health and Social Care announced last summer it was working to stymie the rises to ensure generic wholesale prices reflected the purchase price from manufacturers. It felt there may have been some gaming of the system previously.

And the winners are…

Each year since 2014, HSJ has assembled a group of the good and the great and asked them to determine the NHS’ 50 best provider chief executives.

When the analysis started, the list was dominated by older men running England’s most prestigious teaching trusts. Six years later, the picture looks very different.

The 2014 list had 10 women; the 2019 one has 24. Dame Marianne Griffiths – who has worked wonders at Brighton and Sussex University Hospital Trust – takes first place for the second year running. 

Joining the digital dots

The push to join up patient information digitally has taken another step forward with the signing of a £12m contract to build a single regional record in Thames Valley and Surrey.

Thames Valley and Surrey was one of five “local health and care record exemplars” picked by NHSE to create a single shared digital record by the end of 2020, each covering millions of patients.

These regional records, or “LCHREs”, are a key element of creating integrated care systems, providing detailed information to support direct care and planning across organisational boundaries. The long-term plan states these regional records will cover the country by 2024.

If successful, it could prove a model for other regions to follow.