Daily Insight: Group effort

Proving teamwork works

In 2014, the government asked Salford Royal chief executive David Dalton to carry out a review into NHS providers, and make recommendations around their future form and leadership.

A key recommendation was that successful and ambitious organisations should be encouraged to expand their reach and replicate their processes in struggling organisations.

Salford’s board subsequently took over the management of neighbouring Pennine Acute Hospitals Trust in 2016, which had just been rated “inadequate” by the Care Quality Commission. The trusts have since operated under a “group” structure — the Northern Care Alliance — with an overarching corporate board and distinct management teams on each hospital site.

But there has been limited uptake of the review’s recommendations across other parts of England, bar a handful of groups such as those led by South Warwickshire and the Royal Free London (the latter of which has since disbanded). Quite a few trusts have moved to shared chairs and/or chief executives with neighbours — sometimes as a prelude to old-style merger — but very few have taken up the full formal “group” approach.

According to Raj Jain, who succeeded Sir David (as he is now known) last year, this has been partly due to a wait and see approach from regulators, who wanted to see proof that groups worked in practice before pressing others to copy it.

On Friday, PAHT was rated “good” by the CQC — in many ways an impressive achievement — which Mr Jain suggests should provide NHS England/Improvement with the evidence they need.

So, are we about to see a proliferation of new groups?

Perhaps… Mr Jain says he’s been contacted by half a dozen health systems over the last year, with a view to potentially implementing the model.

A minor miracle

NHS England and the British Medical Association have agreed the terms of an updated GP contract, including the specifications for primary care network services in 2020-21. Given the outcry of the last six weeks, that feels like a minor miracle.

On 23 December, NHSE published a draft of the service specifications it wanted the PCNs to deliver in the forthcoming financial year. It opened them up for consultation and feedback — admittedly later than the promised autumn consultation period, but the first December election for 90 years nixed that ambition.

Pretty much from the day the document was published to when the consultation ended on 15 January, GPs and others in primary care voiced their displeasure at the specs.

There were calls for NHSE mandarins to lose their jobs, GP representatives saying members should refuse to sign up to the final PCN contract — regardless of what came out of the consultation and negotiations with the BMA — and medics pondering darkly over whether the timing of the consultation period was intended to bounce them into something sinister.

But now the mood music is changing. It seems like NHSE has won over some fierce critics.

How did it manage this feat? GPs had censured NHSE for producing an undeliverable contract that was overly prescriptive, short on resources to deliver additional services, and asked too much, too soon of greenhorn PCNs.

So the centre cut the number of services PCNs have to start delivering in 2020-21 from five to three; it made them less prescriptive, allowing local systems and PCNs more leeway in how they deliver them; and it delivered more money and more workforce for GPs to deliver the network and core services, thanks in part to election bungs from the Blue Team’s manifesto.

The GPs, of course, now have to examine the small print and to sign up to the contract; how their views adapt over the coming days will be key. But, for the time being, we have a new GP contract.