What is going on in England’s biggest health economy, by Ben Clover

The great levelling

The London Eye was pleased to witness a rare public appearance by one of the senior team at NHS England London last week.

Finance director David Slegg had some interesting things to tell the Healthcare Financial Management Association’s London Branch meeting, not least about the shape of funding in the capital over the next few years. In fundamentals, there will be more money coming for investment in primary care. But the system as a whole has to hit its headline targets or it risks a £4.8bn funding gap.

He added that five clinical commissioning groups were facing deficit this year, up from three that finished 2015-16 in the red.

There was some better medium-term news for commissioners: the significant underfunding of some boroughs (and overfunding of others) will soon be a thing of the past.

This has long been a significant issue in London, with some boroughs more than 5 per cent below their “target” share of funding, while their neighbours are above target to a similar extent.

Mr Slegg produced tables showing how the levelling out of allocations ordered by NHS England chief executive Simon Stevens will play out in London, with the problem solved before the end of the comprehensive spending review period.

In the meantime, there are various mechanisms that can be used to transfer funds from overfunded to underfunded areas, some of which have been employed in London for many years.

David Slegg also sits on ACRA (Advisory Committee on Resource Allocation), the quiet but important committee that determines the formulae used to distribute NHS funding between different areas.

Mr Slegg revealed there was fresh debate over whether the primary care funding formula should be based on the health of its population or the workload of its GPs.

Costly dermatologists

Among other bombshells NHS Improvement chief executive Jim Mackey dropped on the provider sector last week was one with particular resonance for Londoners: apparently there’s a dermatology service in the capital paying so much for temporary staff it has managed to singlehandedly inflate the locum rate.

Really? What happened here? (And where did it happen? All emails treated in confidence ben.clover@emap.com).

London Eye has heard of another dermatology service, in an isolated bit of the east of England, wholly dependent on one locum who, predictably, charged an arm and a leg.

Did England simply not train enough dermatologists a few years back?

Centralising electives

A few weeks back HSJ’s intelligence service reported on Barts Health Trust’s plan to start a centralised elective treatment centre, similar to the one the south west London trusts have run for years.

Barts chief executive Alwen Williams might be ahead of the game, as a new era dawns in electives.

At the same HFMA meeting I mentioned earlier, Professor Tim Briggs spoke bluntly about the problems facing trusts and the warrantless variation in outcomes and costs between trusts.

One snippet: 40 per cent of the trusts he visited as part of his soon-to-be-expanded Getting It Right First Time programme did not have ring-fenced beds for electives. A significant proportion of those that did saw them nonetheless used as overflow when emergency work demanded it.

“In that case don’t do elective,” he said – centralise it elsewhere.

This might have been written off as the bullishness of a senior surgeon if it weren’t for the facts that a) his team is getting significantly expanded and b) Jim Mackey has also signalled that, seriously now, lots of specialties are going to get centralised.

It’s going to be a tough couple of years for medical directors trying to sell such moves (which will have implications for their consultants’ private work) to their staff.

London Eye features a look at what’s going on in England’s biggest health economy. London has the best and worst regarded hospital trusts in the country. It has excellence and dysfunction in commissioning and primary care. I will cover all of this.

Please get in touch to tip me off about stories you think I should cover: ben.clover@emap.com.