Daily Insight: What a performance

In order for integrated care boards to be taken seriously, NHS England was always keen on at least some of them being led by chief executives of their system’s main acute trust.

One system where this has happened is Dorset, where Patricia Miller left Dorset County Hospital Foundation Trust to become the Dorset ICB chief executive in February.

Her experience so far sounds like quite a culture shock, and perhaps explains why others would have been reluctant to make the switch.

Speaking at the NHS Confederation conference on Wednesday, she expressed her surprise at the levels of performance management she has so far experienced from NHS England.

She said: “I’m now an ICB chief executive and you can close your ears now David [Sloman, NHSE’s chief operating officer, who chaired the session], because the most common word I’ve used since February is ‘no’.

“That’s because I’ve felt as if I’ve been managed in a straitjacket… I’d had no understanding whatsoever about how [clinical commissioning group] chief executives have been managed in the past. I think there’s something about recognising that you’ve reached a certain level, you’ve got a level of experience.

“I’ve successfully managed an FT for seven years, I might actually know what I’m doing.”

Contract contemplation

NHS England’s medical director for primary care called for a “shift” in the primary care contract and funding this week.

Speaking at the NHS Confederation Expo conference in Liverpool, Nikki Kanani talked about inequalities more widely, saying practices in areas with more deprivation needed more resources but that “our incentive mechanisms haven’t caught up with it”.

She promised a reform of general practice funding allocations as part of GP contract renegotiations for 2024/25. When pressed further by HSJ, she said it was important now to start thinking about what was “really valuable” about the 2019 five-year GP contract and what needs to be bedded into it.

Dr Kanani also said serious thought needs to be given to whether the funding allocation formula is right, adding: “We need to be funded and supported to do what our most deprived, most vulnerable community needs above all. That’s going to be difficult because there are going to be winners and losers, but we have a moral obligation to do that. And that is what I want to focus on as we go into the next round of contractual conversations.”

There have long been calls for reform to the way funding for different GP practices is calculated, which is based on the 2004 ‘Carr Hill formula’. It is often said to insufficiently recognise deprivation and diversity. But the proposals normally falter because of the consequences for those who lose out, and the difficulty of negotiating the change.