The shadow health secretary has attacked attempts by NHS commissioners to restrict routine surgery for overweight patients and smokers, as Labour launched its public health strategy today, plus the rest of today’s news and comment

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5.10pm In response to the CQC’s announcement on inadequate GP practices, Maureen Baker, chair of the Royal College of GPs, said: “Patients should expect high quality and consistent care from their GP practice, and the results of the first CQC inspections show that the vast majority of practices do an excellent job of delivering excellent quality care.

“Those that have been found to be struggling to maintain high standards need support, so I am pleased that the RCGP is able to help them to deliver the best care they possibly can for their patients.

“As the UK’s largest medical royal college representing nearly 50,000 family doctors, we are well-placed to assist practices to compile and implement plans to improve the service for patients.

“GPs and their teams currently carry out 90% of all NHS patient contacts for a record-low 8.3% of the budget – meaning that many practices are struggling through no fault of their own. College research has shown that half of GPs believe they can no longer guarantee safe patient care due to increasing pressures and unsustainable workloads.

“We urgently need more GPs and practice staff so that general practice has the resources and support it needs to deliver safe and high quality care for all our patients.”

4.36pm The Care Quality Commission today set out updated plans for how it will deal with GP practices deemed to be providing inadequate care.  

Any GP practice rated as “inadequate” following a CQC inspection will be immediately put into special measures.

It will be offered a package of help to improve at the earliest opportunity, the regulatory body announced.

The CQC will carry out a second inspection a practice rated inadequate after six months. If its overall rating remains inadequate the regulatory body will  issue a ‘notice of proposal’ to cancel the practice registration.

The CQC will carry out a final inspection after a further six months. If the service remains inadequate overall, the CQC will issue a issue a ‘notice of decision’ to cancel registration.

In such a circumstance, NHS England is responsible for ensuring patients can continue to access GP services.  

The CQC announced it would be introducing a special measures regime for GP practices in August last year.

The regime was introduced in October, coinciding with the introduction of ratings for GP practices, as part of the CQC’s new-style inspection process.  

No GP practices have yet been rated as inadequate.

Steve Field, the chief inspector of general practice, said: “Our inspections are showing the majority of general practices are providing good care, which should be commended.

“Looking at the inspections we have published so far – the overwhelming majority have been rated good or outstanding.

“This is fantastic news and I hope the minority of practices that are not providing this level of care can learn from what these are doing.

“However, when we find that general practices are providing Inadequate services, the public expects us to take action and our special measures regime will give practices clear deadlines to make the necessary improvements.

“We will only cancel the registration of a GP practice if we think it is absolutely necessary – and in any case our priority will be to help the practice improve, if that is appropriate.  

“In these situations we will work closely with NHS England who will ensure that people registered at that practice continue to have access to safe and high quality general practice.

“Our priority is in making sure patients receive safe, high-quality and compassionate care and in supporting services to improve.

“We are now in the final stages of developing the special measures regime and I would like to thank everyone who has been involved so far and encourage anyone who has an interest to share their views with us.”

Nigel Sparrow, the CQC’s senior national GP advisor, said: “The idea behind special measures is to drive improvement.

“We know there is much good care being provided by GPs, but where people are not getting the services they have a right to expect, practices must improve.  

“When a practice has been rated as Inadequate, special measures will ensure that the practice can access the support to improve that is available from NHS England.

“Good quality local GP services mean a stronger local health services overall, with different parts of the health service working well together in the best interests of patients and the public.”  

Mike Bewick, NHS England’s deputy medical director, said: “Closing a GP practice in response to quality concerns would be very rare, and the first response will be work with GPs, LMCs and CCGs to help turn affected practices around.  In all circumstances, patients can be reassured that their safety is the NHS’ overriding concern.”

Katherine Rake, chief of Healthwatch England, said: “This is a bold step by the CQC but it’s exactly the sort of thing patients want to see. 

“Hearing that your family doctor is failing to meet basic standards is deeply troubling, and people need to know that tough measures are being put in place to drive improvement and ensure they get the same high quality care as everyone else. 

“Whilst we sincerely hope that no surgeries will be forced to close, where such action is necessary to protect patients, it is absolutely vital alternative access to GP care is provided.”

3.58pm NHS providers made a concerted effort to treat more elective patients in November, delivering more treatments than were performed in that period in any of the preceding six years.

Newly released figures from NHS England show there were 15,762 patients admitted and 43,772 outpatients treated per working day in November last year. This compares to 15,342 admitted and 41,890 outpatients treated in November 2013.

But despite this national drive, the waiting list continued to grow and at the end of the month there were more patients who had been waiting over 18 weeks to be treated than at the same point in 2013.

3.25pm Shadow health secretary Andy Burnham has attacked attempts by NHS commissioners to restrict routine surgery for overweight patients and smokers.

Mr Burnham made the comments this morning as he outlined Labour’s new public health policy.

The regulator said this morning that a decision would be made on the 2015-16 payment rules at a board meeting “in due course”. This is expected to be this month’s meeting on 28 January.

3.00pm Treatments available through the cancer drugs fund will have to continue being cut, the NHS England official in charge of the fund has said.

Peter Clarke, chair of the cancer drugs fund, said that given the growth in the cost of the fund, “there will be a need for further reprioritisation of what sits” in it in order to deal with its spiralling cost.

2.40pm The Guardian reports that ambulance staff who left the dead body of a man on the floor so they could finish their shift on time understood it was common practice to do so, an inquest heard yesterday.

James Harrison, who collapsed and died on the street in Littleport, Cambridgeshire, was left in a local ambulance station for another crew to take to the mortuary at Addenbrooke’s hospital, Cambidge.

The inquest heard that investigations into the incident revealed that East of England ambulance crews in that area had failed to take bodies directly to hospital on seven occasions before, twice leaving them on the floor and on five occasions in an ambulance during shift swaps.

1.57pm A few more tweets from the Westminster Hall debate on specialised commissioning:

1.43pm HSJ correspondent Will Hazell has this from St Austell and Newquay MP Stephen Gilbert:

1.39pm A Westminister Hall debate on specialised commissioning is now underway.

Follow HSJ Live and HSJ’s Will Hazell (@whazell) on Twitter for updates from the debate.

1.37pm Family doctors will have to increase the number of appointments they offer and improve their care of older patients in order to share in a new £1bn fund to overhaul GP surgeries, The Guardian reports.

NHS England has decided that GP practices must offer patients more time with doctors and expand the services they offer in return for receiving some of the money.

Dame Barbara Hakin wrote to practices saying “the key metrics for prioritisation will be: access to general practice, including increased appointment and patient contact time; and/or reduction in emergency attendance or admission to hospital of over-75s”.

1.10pm The Guardian reports there are the first signs of a US-style epidemic in the abuse of prescription drugs in Britain with an upsurge in the misuse of two anticonvulsant dugs being reported around the country.

The 2014 annual DrugScope survey shows drug workers reporting a significant upsurge in the use of prescription drugs, pregabalin and gabapentin, especially amongst heroin addicts and within prisons.

12.10pm It is essential that the NHS get services right for frail older people because pressures on the acute sector are continuing to grow, write Eileen Burns and David Oliver, in a comment piece for HSJ.

11.45am A hospital chief executive has confirmed that the decision to have his trust taken over by a Hinchingbrooke style private management franchise will be deferred until after the general election.

Peterborough and Stamford Hospitals Foundation Trust is the last trust in the country where a franchise deal was mooted and not formally ruled out.

11.33am Relations between a Devon trust and its local clinical commissioning group are ‘strained’, the chief executive of the NHS Trust Development Authority has said.

David Flory wrote to Ben Bradshaw last month, in response to a letter the Exeter MP had sent him enquiring about an “apparent breakdown in relations” between Northern, Eastern and Western Devon CCG and Northern Devon Healthcare Trust. Mr Flory said relationships in the health economy were not always professional and constructive.

11.14am Service improvements and organisational change in the NHS are more effective when led by “hydrid” managers - clinicians with management responsibilities-  rather than by full-time managers, according to research by Oxford University.

The study was led Louise Fitzgerald of the university’s Saïd Business School, who found that these “hybrid” managers are currently struggling without support and training in management.

“The popular image that the NHS is overrun by managers with no medical expertise is inaccurate,” said Professor Fitzgerald said.

“Hybrid managers, who combine managerial responsibilities with clinical or medical duties, outnumber the full-time managers by four to one. But many find the role a tough challenge, partly because of a historic conflict between how medical professionals view themselves and their roles and their perception of management, and partly because they have not been taught how to manage.”

“Although our research has suggested that it may be more important to learn how to be a hybrid than to do management, even the most proactive hybrid managers can be slowed down by a lack of knowledge of basic issues – which can be taught,” she added.

“Better management training alongside professional training, as well as improved financial rewards for those taking on a hybrid management role, would have the benefits both of encouraging more professionals to become hybrids, and making them more effective when they do.”

However, Professor Fitzgerald found that medical professionals in all fields identify themselves as medics primarily. If they take on a management role, they often see it seen as a sideline project – either they have been asked to “take a turn” or they feel that they need to “protect” the profession from encroaching managerialism.

“These ‘incidental’ hybrid managers typically use their roles to keep medical professional work separate from the demands of politics and management and to protect it from change,” Professor Fitzgerald explained.

“They are not really interested in service improvement, seeing it as a ‘box-ticking’ exercise. To effect real change, the NHS will have to identify these incidental hybrids and find ways of either engaging them in genuine service improvement or encouraging them to vacate the role for others who wish to achieve this – those we have called ‘willing hybrids’.”

Clinicians taking on management responsibilities may also face accusations of “going over to the dark side”, of becoming “a poacher turned gamekeeper… fraternising with the enemy”.  

Nevertheless, they are proactive in seeking service improvements and used their roles to disrupt and challenge unrealistic and out-dated professionalism, the study found.

Our research showed that these hybrids were interested in inter-professional teamwork, focused on delivering ‘the best service’ for patients collectively, in contrast to the institutionalised lone professional who focuses on individual patients” Professor Fitzgerald said.

“They were willing to challenge professionals who ignored resource limitations and were willing to work with government targets as a means of providing good patient care.”

The study also noted that hybrid managers tend to learn the management side of their roles on the job, which could be advantageous in that they are not seen to distance themselves too much from clinical or medical practice.

However, some do not feel supported in their roles, while others are hampered by a lack of knowledge about management, particularly in specialised areas such as change management.

Further research in “hybrid managers” can be found here.

10.52am The Labour Party said tougher action would be taken to protect children from commercial pressures and the harm caused by alcohol, sugar and smoke as part of its new approach to public health, launched today.

As part of the party’s new food policy, maximum limits will be set on levels of fat, salt and sugar in food marketed substantially to children and food levelling would be improved.

All young people would have access to emergency first aid training, including cardiopulmonary resuscitation and the use of defibrillators, by the time they leave school.

Labour also plans to put automated external defibrillators (AEDs) in major public places, such as shopping centres, airports, rail stations and sports stadia, and to introduce new national open register of AEDs to enable people to find their nearest AED in an emergency situation.

Other proposed measures include:

  • Placing the promotion of physical activity at the centre of public health policy with new, easily-understandable recommended levels of physical activity and a new national ambition. Promotimg a include a basic minimum of physical activity everyone who can should try to do, and a recommended level that we should aspire to get at least 50 per cent of people achieving by 2025
  • Targeted action on high-strength, low-cost alcohol which fuels binge drinking and does most harm to health, with a range of options on both price and bottle-size being explored
  • Immediate introduction of standardised cigarette packaging, with a goal for children born in 2015 to  become the first ‘smoke-free generation’

Speaking at an event hosted by the Demos think tank to launch the strategy, shadow health secretary Andy Burnham said:“Labour has traditionally led the way on public health and this new approach will chart a new course towards a healthy nation in the 21st Century.

“In a century of rising demand, helping people take more responsibility for their own health will be essential if we are to ensure the NHS remains affordable and sustainable for the future.

“As part of this, children will need better protection from the pressures of modern living and the harm caused by alcohol, sugar and smoke and Labour will not flinch from taking the action needed to provide it.

“David Cameron and his Government are too close to powerful vested interests to stand up for our children.

“This new positive approach will help give all children a healthy start and help adults to get the most out of life.”

Luciana Berger, shadow minister for public health, said: “Labour wants the next generation to be healthier than the last.

“We want every adult to be able to make informed, healthy choices that are right for them. Whether it is deciding to cycle to work, taking up a sport or quitting cigarettes, today we are setting a range of actions we will take to support people to achieve this.

“Alongside this, we are setting our clear intention to take robust action to protect children from harm where voluntary measures have failed including regulating to limit the amount of sugar, fat salt in food marketed substantially to children, introducing standardised packaging of tobacco that this Government has failed to achieve, and cracking down on the high-strength, low-cost alcohol products that fuel binge drinking and do most harm to health.”

10.28am More than half of voters reject austerity, with two fifths willing to pay higher taxes to protect public services, The Times reports.

In two YouGov surveys, one found that 32 per cent wanted the next government to spend more on trying to improve public services even if it meant borrowing more, and the second found 42 per cent favoured increased public spending funded by tax rises.

10.22am Labour shadow health minister Luciana Berger says the party will introduce standardised tobacco packaging.

10.18am Mr Burnham has said a Labour government will legislate on fatty food:

10.05am Labour has announced a number of policies this morning on preventing ill health. Speaking at an event hosted by the Demos think tank, shadow health secretary Andy Burnham has accused the government of stalling on improving public health:

10.01am Community service providers are positioning themselves to lead efforts to establish the new integrated models of care recommended in the NHS Five Year Forward View.

Two trusts and a social enterprise have told HSJ they are likely to submit expressions of interest to NHS England by 2 February to be included in the “vanguard” of sites setting up prototypes of the forward view’s “multispecialty community provider”, or MCP, model.

The document indicated that MCPs would be formed through GP practices scaling up and providing an extended range of services, including community services and some specialist inpatient provision, rather than via community service providers moving into primary care.

Southern Health Foundation Trust, Kent Community Health Trust and the social enterprise Locala Community Partnerships all told HSJ they were interested in becoming MCPs.

7.00am Good morning and welcome to HSJ Live. We start the day with the news that NHS England’s plans to co-commission specialised services with clinical commissioning groups have been attacked by a group representing patient organisations, who claim they will lead to ‘poorer access’ because the ‘vast majority’ of services will be exposed to ‘competing local pressures’.

NHS England last month published “notional allocations” for the 2015-16 specialised commissioning budget – £13.5bn was “mapped to CCGs” and £1.1bn remained solely at national level.

NHS England produced the notional allocations to give an impression of how the specialised commissioning budget, which is held by the national body, could be distributed across the country when co-commissioning starts.

The Specialised Healthcare Alliance, a coalition of more than 100 patient related organisations, claimed that if co-commissioning happens on such a scale, access to the majority of services will deteriorate because CCGs will be “incentivised to redirect funding away from specialised care”.