A business critical briefing from HSJ’s Fundamentals of the NHS conference.


  • Roger Paffard, chair, Sue Ryder Care
  • Niall Dickson, chief executive, General Medical Council
  • Tim Smart, chief executive, King’s College Hospital Foundation Trust
  • Dr Ruth O’Hare, chair, Central London Healthcare
  • Peter Crutchfield, managing director, Central London Healthcare
  • Julie Hunt, director of nursing and quality, NHS West Kent
  • Karen Walker, director of policy, Skills for Health
  • Fiona Boyse, associate, Mills & Reeve
  • Dr James P Kingsland, president, National Association of Primary Care, national PBC clinical network lead, Department of Health

Chair’s opening remarks, Roger Paffard, chair, Sue Ryder Care

  • There is a level of uncertainty regarding the future of the NHS.
  • Attendees should come away from the conference with a clearer picture about the NHS.

Revalidation and the new professional, Niall Dickson, chief executive, General Medical Council

  • The GMC is now introducing the greatest change in the system of revalidation for over 150 years.
  • The focus of revalidation is to integrate a safe and quality healthcare system, particularly with the government’s outcome focused care agenda.
  • The GMC is one of the world’s largest healthcare regulators, with an aim to protect patient safety.
  • It focuses not only one fitness to practise but also education and demonstration of competence.
  • Revalidation will affect all doctors, including locums and those working in the private sector.
  • Every doctor must have a responsible officer who will enforce the legal duties, clinical governance, CPD and appraisal requirements, and will be given feedback from colleagues and patients.
  • Failure to revalidate impairs fitness to practise and those doctors should be referred to the GMC.
  • Benefits to patients will include increased trust and public confidence in encouraging doctors to be more self-reflective and for employers will strengthen appraisal processes, quality and clinical governance systems.

Targets within a changing NHS, Tim Smart, chief executive, King’s College Hospital Foundation Trust

  • Keen for the commissioning landscape to be stable
  • Outcomes focused – avoiding undesirable consequences i.e. using NICE quality standards
  • Increasing scope of role for the private sector
  • Integration of service models
  • Patient safety remains at the heart of service delivery for healthcare providers despite the pending changes.

Future of PCTs, Dr Ruth O’Hare, chair and Peter Crutchfield, managing director, Central London Healthcare

  • Practice based commissioners are using the opportunity to learn about the areas that they currently do not have responsibility for.
  • The future of PCTs is inextricably linked with GP consortia and both need to working together.
  • Changes are occurring by the day so we cannot worry about the unknown.
  • As a GP consortium, Central London Healthcare is directing commissioning, QIPP, planning for the future and contract monitoring on behalf of NHS Westminster.
  • GP commissioning will give a corporate identity to primary care.
  • The expertise required for commissioning is not underestimated but inconsistencies patients experience are fed back every day and consortia are best placed to spot systems flaws.

Ensuring quality of care and performance during the transition of services from strategic health authorities to commissioning board, Julie Hunt, director of nursing and quality, NHS West Kent

  • The white paper asks as many questions as it answers.
  • Good governance, accountability, applying contractual leverage and incentivising quality improvements will continue to be key during the transition.
  • There will be an increasing role in patient choice and relating requirements will be explained.
  • Information revolution will allow comparable data to be made available to GP consortia that PCTs have not before had access to.

Management: integrating leadership across the NHS, Karen Walker, director of policy, Skills for Health

  • Workforce planning often sits on the periphery but it is essential considering the challenges facing the healthcare sector.
  • There has not been a linear increase in levels of investment and productivity.
  • Workforce planning and management allows for better use of skills.
  • The focus for leadership will now be on change management and quality improvement as well as maintaining staff morale and engagement.
  • The transformation needs to focus on staff that are flexible, skilled and productive who are outcomes focused and future oriented.
  • Skills for Health will be introducing the skills passport to ensure staff do not have to repeat training that they have already undertaken.

Legal policy challenges of GP commissioning, Fiona Boyse, associate at Mills & Reeve

  • GP commissioning consortia will be statutory public bodies, and this may reduce the flexibility anticipated in the white paper.
  • Procurement law and policy will apply to GP consortia.
  • NHS contracts that are currently in place are often bureaucratic and complex, and this will pose complications around resources.
  • Disputes between providers and PCTs could damage partnership working between consortia and providers.
  • Other duties will include freedom of information requests, duty to consult, right to seek judicial review, contestability.
  • There could be legal issues around workforce and TUPE rules and property leased or owned by the PCT.

How will practice based commissioning change with a GP led consortium? Dr James Kingsland, Department of Health    

  • Primary legislation is still under debate, but the white paper recommendations are not up for discussion as there is no plan B.
  • General practice has always been a cornerstone for demand management and captures the spirit of fundholding as well as commissioning, allowing clinicians to make better decisions for the use of resources.
  • The challenge is to look at capacity and see what would be better administered by other professionals.
  • Simple inefficiencies, duplication and waste can be targeted at a micro level before macro level changes, i.e. to care pathways, are implemented.

Sarada Chunduri-Shoesmith is risk manager at Hillingdon Community Health.

Fundamentals of the NHS