GPs have reacted angrily to the NHS England chief’s speech to Royal College conference, plus the rest of today’s news and comment

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3.00pm Job cuts and reorganisation at NHS England will free clinical commissioning groups to become local leaders, an internal document setting out the commissioning body’s planned reform has said.

The Organisational Alignment and Capability Programme consultation document, seen by HSJ, was shared with staff earlier this week.

Overall, the organisation expects to strip out 300 posts and has notified 815 staff they will be “affected by change” either through being at risk of redundancy or potential major changes to their role.

2.53pm The government plans to attach new conditions to bailouts for financially struggling trusts, a health minister has revealed.

Government bailouts for financially struggling trusts could have extra conditions attached under plans outlined by Dan Poulter this week.

Under the plans, senior managers could also be removed from their positions when they fail to demonstrate sufficient savings in procurement and temporary staffing, Dr Poulter told the Conservative Party conference in Birmingham.

2.33pm NICE, the healthcare guidance body, has issued new draft guidance for consultation that does not recommend obinutuzumab, marketed by Roche as Gazyvaro, for untreated chronic lymphocytic leukaemia.

In the preliminary guidance, uncertainties in the company’s data mean that the committee proposes not to recommend obinutuzumab combination therapy for people who are not able to take the standard fludarabine-based therapy.

CLL is a type of cancer that affects the cells in the bone marrow (where blood cells develop) and causes overproduction of abnormal white blood cells. The abnormal white blood cells replace the normal cells in the bone marrow but are unable to function properly. Signs and symptoms can include fatigue, breathlessness, bruising and bleeding. The condition can develop slowly with many people not suffering any symptoms at all in the early stages. Obinutuzumab works by attaching itself to the surface of abnormal white blood cells, which then causes the cells to die.

Commenting on the draft guidance, Sir Andrew Dillon, NICE chief executive, said: “Chronic lymphocytic leukaemia is the most common form of leukaemia in the UK, with around 2,700 people being diagnosed with the condition each year. Half of the people who need treatment for their condition are not able to use the standard first-line therapy.  NICE recommended alternative treatments are already available.

“Although obinutuzumab is a clinically effective treatment, there were too many uncertainties in the company’s submission and we cannot be confident that it is an effective use of NHS resources. It is disappointing that we are not able to add this to the range of treatments already available. However, with limited resources we need to ensure that each treatment we recommend gives patients not only the best care but is also of the best value to the NHS.”

Consultees, including the company, healthcare professionals and members of the public are now able to comment on the preliminary recommendations via the NICE website. Comments received during this consultation will be fully considered by the Committee and following this meeting the next draft guidance will be issued. 

This is preliminary guidance; NICE has not yet issued final guidance to the NHS. Until then, NHS bodies should make decisions locally on the funding of specific treatments.

2.23pm In response to Monitor’s announcement regarding its investigation into governance at South London and Maudsley NHS Foundation Trust, the trust said:

South London and Maudsley NHS Foundation Trust welcomes the news that health regulator Monitor has closed its investigation into the trust. This investigation has not been focused on the quality or safety of SLaM services, which continue to be of a high quality.

Monitor considers that the many steps already taken, alongside the Trust’s continuing commitment to address other issues raised, will ensure that SLaM has governance arrangements that are of a standard that match the Trust’s commitment to excellence in patient care.

Madeliene Long, trust chair, said: “I have always been proud of the excellence that SLaM has achieved in its provision of quality services. I am confident that our patients and local communities will continue to benefit from the very best mental health care for many years to come.”

SLaM chief executive Dr Matthew Patrick said: “This is a very positive outcome and I believe that the trust is in a good place from which to build as a result of our work with Monitor over the past few months.

“Our attention will now be focused on the further actions that we need to deliver to ensure governance arrangements of the very highest quality.”

The SLaM board will continue to work closely with Monitor to deliver the planned improvements.

2.20pm Foundation Trust regulator Monitor has just released the following statement:

South London and Maudsley NHS Foundation Trust will now be providing consistently high quality care to people using its services after an investigation by the health sector regulator.

Monitor launched its investigation in July 2014 after external reviews raised concerns about the way the trust was organised and run. Monitor shared some of these concerns, which it raised with the trust. The trust has now developed a package of measures to address the issues identified, which it has already started to put into action.

These measures include strengthening processes that ensure patient safety and quality of care, quickly identifying where things have gone wrong, and enabling management to better understand what is going on in its hospitals. Links between clinicians and hospital management will also be strengthened.

The trust has also agreed to improve the quality of its estate more quickly than previously planned, including refurbishing wards.

As part of changes to the way the trust is run, two new non-executive directors have already been appointed and two further appointments are planned by the end of the year.

A priority for the trust will also be recruiting a new chair to take over from the current one who announced in September 2014 that she would be standing down following 14 years in post. Monitor will work closely with the trust to ensure the best candidate is chosen.

The regulator has closed the investigation but will continue to monitor the trust to make sure the planned improvements are made. The trust has also agreed that it will commission an independent review in early 2015 to ensure that all of the necessary changes are in place.

Mark Turner, regional director for Monitor said: “Our investigation has raised concerns about how this trust is run. The trust has developed a package of measures to address these concerns and ensure that those using its services will continue to receive high quality care.

“We will continue our monitoring of this trust to make sure it delivers the planned improvements.”

2.00pm Royal College of General practice has reportedly called for the suspension of the Quality and Outcomes Framework, according to tweets from delegates to the professional body’s annual conference in Liverpool today:

1.40pm Patients could be denied access to a groundbreaking drug that cures Hepatitis C because the NHS cannot afford it, HSJ has learned.

In a move described as setting a “dangerous precedent”, an internal NHS England briefing note - seen by HSJ - describes the cost of offering the drug Sofosbuvir to patients as suggested by the National Institute for Health and Care Excellence as “prohibitive”.

The note puts the price tag of prescribing the drug in line with NICE recommendations of £1bn in 2015.

1.27pm NHS England chief executive Simon Stevens has been given a very hostile reception by delegates at this year’s Royal College of General Practice annual conference.

Here is a selection of tweets from delegates during his speech:

@SueManby @DrDKilroy @bjhospmed @AcuteGP Simon Stevens currently speaking to GPS about outdated models. It isn’t going down well.— Steven Duckworth (@FoxHedgehog) October 3, 2014

11.57am HSJ Editor Alastair McLellan tweets:

11.55am Judith Welikala tweets:

11.53am HSJ reporter Judith Welikala is attending the Royal College of General Practice annual conference in Liverpool this week. Follow her on twitter here for the latest developments.

11.30am Sir Robert Francis QC has released a statement in regards to the ‘Freedom to Speak Up’ review he is carrying out on behalf of the health secretary:

“The call for contributions to the Freedom to Speak Up Review closed last week.

“I have received hundreds of detailed contributions from a wide range of staff working in the NHS and other organisations.

“I am grateful for how candid and helpful people have been in making their contributions: it must have been very difficult for some people to talk about their experiences in this way and I believe they have performed a significant public service in taking the time to do this.

“My team and I will now review all the contributions to draw out key themes on barriers and obstacles, and ideas and solutions on how to overcome them.

“I have already had a number of very helpful meetings with various individuals and organisations at which I have been able to explore some general issues and ideas. I now intend to meet with a small number of individuals and organisations to follow up on specific points made in their contributions. These meetings will take place during October, and will help me to explore some particular challenges and options for resolving them. But while time will not permit us to meet all those who have written in, I’d like to be clear that everyone’s contribution is important to me and will be taken into account as I develop my findings and recommendations.

“Once we have conducted an analysis of all the material people have provided, including findings of the quantitative and qualitative research I have commissioned, I will hold a series of seminars to explore challenges and emerging recommendations.

“We will be inviting a cross-section of interested individuals, organisations and sectors to participate in the seminars. Unfortunately, we will not be able to accommodate everyone who would like to take part in the events, but we will share key discussion points from the seminars on our website shortly afterwards.

“I would like to give my sincere thanks to everyone who has contributed to the review so far, whether by completing our online form, joining a meeting or participating in the research studies. Your contributions to this review are, and will continue to be, invaluable.”

11.10am A ex-adviser to former Lib Dem health minister Paul Burstow, argues that deputy prime minister Nick Clegg has a tightrope to walk over how his party approaches the NHS going into the election.

Jenny Ousbey, now an associate director at Lexington Communications, writes that health policy will cause controversy in debates and on the fringes at the Liberal Democrats’ upcoming conference, but Nick Clegg will have to say something very bold to win over voters on the NHS.

The Conservatives will be happy to stand back and watch Labour and the Lib Dems tear each other apart over a private members’ bill debate on repealing the competition elements of the 2012 Health Act, she writes.

10.47am The latest in an annual study of NHS estate resources in England shows that the health service has taken significant strides towards improving the use of its land estate resources, but has made little improvement in achieving a more uniform estate and facility management spend.

A report entitled The NHS estate efficiency review, produced by consultancy EC Harris, identifies the opportunity for £1.5 bn in savings.

With the overall NHS budget deficit estimated at £30 bn, the immediate reallocation of assets within the estate could have a direct impact on vital front-line services, the company said.

The current estate surplus of 4.8 per cent represents 1,306,000m² of space, equivalent to the entire area occupied by 13 and a half trusts.  The total space in the NHS estate is 27,300,000 m², showing a steady overall decline since 2011 when the total area was 29,000,000 m².

Commenting on the study, Conor Ellis, EC Harris’ global head of health, said: “We should applaud the progress made in the NHS. Since 2008 we have seen unused and surplus space in the health service decline by 39%, but there’s still a big opportunity for further savings to be made.

“From our analysis, the current estate has a surplus of 4.8 per cent. In addition, by driving towards the mean average estate performance this would equate to £1.5bn in potential savings. This is not the maximum possible saving – just what is immediately attainable – and that is money that could be used to fund an estimated 260,000 major front-line operations.”

“The fifth NHS estate efficiency review reveals that, since 2008, unused and surplus space within the health service has declined and some 20 of the most efficient trusts are operating at just under 100% efficiency.

“However, six of the least efficient trusts have as much as a quarter of their space unutilised, including: one North West England primary care trust; a London mental health unit; and two acute trusts”

Ellis continues: “The best Trusts operate their estates relatively well, the average still cost too much, while the least efficient quarter, in particular, are far from reaching their potential and wasting resources.”

Progress has also been made in increasing the proportion of NHS buildings that have been built since 2005. In 1995, around half of the entire NHS estate was built pre-1948, but that figure has fallen to just 15% now. The proportion of post-2005 estate has risen steadily over the past five years and now stands at over 20%, a trend which, according to the study, can only enhance the delivery of modern healthcare through improved operational performance, infection control and privacy.

10.40am Accident and emergency departments across England had their worst performance in four years against the target to see, treat, admit or discharge 95 per cent of patients within four hours between July and September.

NHS England’s quarter 2 data shows that the sector managed to just hit the 95 per cent target for all types of A&E – this includes urgent care centres, walk in centres and minor injuries units and is traditionally met by the sector. This is a slump compared to the same period last year where the target was met comfortably, at 96.3 per cent.

Performance has been worsening over the last four years, with 97.3 per cent of patients seen in 2011 and 96.9 per cent in 2012.

Consultant-led A&E performance is also at its lowest ever level, with only 92.5 per cent of patients seen this year, compared to 94.4 per cent last year and 95.4 per cent in 2012.

The summer period is usually when A&Es are able to meet the target before the winter period sets in and performance tends to drop. However, this pattern has declined in recent years and many chief executives have reported that pressures are now being felt all year round.

10.39am The Guardian, meanwhile, reports that GPs’ working hours must be more closely monitored to ensure the safety of patients and wellbeing of staff, the chief inspector of family doctors has said.

Warning against increasing demands on exhausted doctors, Professor Steve Field suggested findings from inspections on 30 out-of-hours services, serving a third of the country’s population, emphasised the need for radical change in healthcare outside hospitals.

Professor Field said inspections this year found no evidence that providers or commissioners of either normal or out-of-hours GP care were encouraging doctors to detail all their working arrangements.

This was a key demand Field, then chairing the Royal College of General Practitioners, first made four years ago in a government-commissioned review following the Daniel Ubani scandal.

10.28am Looking towards this morning’s papers, the Daily Telegraph reports that at least seven times as many elderly and disabled people are being routinely restrained or locked up in care homes and hospitals as previously thought, new Government figures suggest.

Councils have faced a surge in applications for legal clearance to deprive patients of their liberty following what the paper calls a “landmark” Supreme Court ruling earlier this year upholding the right of those deemed to lack mental capacity to the same basic freedoms as everyone else.

New figures from the Health and Social Care Information Centre show there were 21,600 applications made to councils in England between April and of June of this year.

The paper also covers the announcement today by the head of NHS England that GP surgeries could be set up in hospitals under “radical” plans to prevent elderly people being needlessly admitted as emergencies.

NHS England chief executive Simon Stevens will today unveil the strategy to tackle a critical shortage of GPs, and stop hospitals from being flooded with patients.

Elsewhere, the paper reports that the parents of a boy who was sexually abused by a cancer doctor have criticised an NHS hospital for failing to protect their son and have called for a government inquiry.

Miles Bradbury, 41, abused boys in his care at Addenbrooke’s Hospital in Cambridge, between 2009 and 2013.

The victim, now a teenager, said the assaults made him “feel sick” but he had placed his trust in Bradbury had assumed that what was happening was normal.

His father has said that the government should find out if Bradbury had carried out attacks at other hospitals at which he worked.

In a comment piece for the Telegraph, Spectator editor Fraser Nelson argues that the Conservatives’ pledge on further ring-fenced NHS funding will mean “crunch time” for other parts of government spending.

10.00am Staff at Barts Health Trust have been subject to bullying behaviour, race discrimination and ill treatment, according to a report commissioned by the trust.

The study of 2,000 employees by Plymouth University’s Graduate School of Management also found 23 per cent of respondents considered themselves the subject of gossip or malicious rumours.

Researchers received accounts from Barts’ employees of discrimination based on religion, disability, and race - with the latter named as “the most prevalent”.

Both black minority ethnic and white staff perceived themselves as being discriminated against.

8.00am Good morning and welcome to HSJ Live.

Simon Stevens will today propose that hospitals should be allowed to open their own GP surgeries in some circumstances.

The NHS England chief executive will also suggest that GPs could form expanded group practices with other health professionals, including hospital consultants, to control delegated budgets for a whole population. 

Speaking to at Royal College of GPs annual conference in Liverpool this morning, he is expected describe the “need to tear-up the design flaw in the 1948 NHS model where family doctors were organised entirely separately from hospital specialists”.

He will say in under some circumstances, such as in deprived, urban communities, where practices are struggling to recruit GPs, hospitals might be allowed to open their own GP surgeries with registered lists.

This would mean primary care premises in these areas could benefit investment from their local foundation trusts.

Mr Stevens will also say GPs could form expanded group practices that either directly employ hospital consultants or take them on as practice partners, and take on a delegated annual budget to look after the whole health care needs of their group of patients.

The groups could include a broad spectrum of health professionals, such as GPs, consultant physicians, geriatricians, psychiatrists, community nurses, therapists and pharmacists, and potentially some social workers, he will suggest.

They could take on ownership of their local community hospital, which they could use to as add more local services, such as hi tech scans, outpatient chemotherapy, and dialysis.

Mr Stevens’ proposal is similar to the “accountable care organisation” model, a term created in the US, refers to a group of providers being contracted to jointly provide all care for a given population for a defined period, with their funding based to some extent on quality and efficiency performance.

Mr Stevens is expected to say: “The national debate on the NHS is now picking up steam, and GP services are rightly at the centre of it.

“But alongside more doctors and more funding, we also need new and better ways of caring for patients, especially older people at home.

“GPs themselves say that in many parts of the country the corner shop model of primary care is past its use-by date.

“So we need to tear-up the design flaw in the 1948 NHS model where family doctors were organised entirely separately from hospital specialists, and where patients with chronic health conditions are increasingly passed from pillar to post between different bits of the health and social services.”

He will point out that 30 per cent of emergency patients admitted to hospital are there for less than a day, which suggests their admission could have been prevented by better primary and social care.

NHS England is due to publish a “NHS Five Year Forward View” this month, which will include details on new provider models for out of hospital services.