NHS reorganisation causing GP retention crisis, study suggests (The Guardian: 7 January 2016)
The reorganisation of the NHS and increased workload pressures are causing a crisis in the retention of GPs, a study suggests.
Many doctors are leaving general practice early because of rising bureaucracy and reduced time for patient care.
The authors of the study liken the situation faced by GPs as akin to “boiling frogs” - saying internal and external pressures, as well as a tickbox and blame culture, have slowly built up, to a point where for many GPs continuing is no longer sustainable.
The researchers suggest that in order to buck the trend and avert a further crisis in GP retention and recruitment for the NHS, the pace of administrative change must be minimised and the time spent by GPs on work that is not face-to-face patient care needs to be reduced.
They suggest that with the cost to UK taxpayers of the five years of postgraduate training for each GP totalling just under £250,000, there is a real imperative to resolve the challenges faced and to retain these highly trained professionals within the UK primary care workforce...read more
Consultancies in the hunt for £1m contract to design NHS Improvement (HSJ: 27 October 2015)
A contract to design how NHS Improvement will be created and function is due to be awarded this week, HSJ understands.
The wide ranging work will cover all aspects of how the new regulator, formed by the merger of Monitor and the NHS Trust Development Authority, will operate, its structure and culture. HSJ understands the contract is worth more than £1m.
A bid document, obtained by HSJ, said “The principal focus for NHS Improvement will be to drive and support both urgent operational improvement at the front line and the long term sustainability of the healthcare system, working collaboratively with partners to achieve this.
“Alongside that, NHS Improvement will be the health sector regulator.”
The successful bidder could also lead a “leadership review” of existing staff and “leadership development interventions”, the document said. There is no mention of what could happen to Monitor’s competition function in the document.
The successful bidder will work alongside an “internal programme management office” of 15-20 people led by an “integration director”. Monitor this morning confirmed the integration director is John Wilderspin, who is being seconded to the TDA four days a week from NHS England where he is national implementation director. He is working on the Smith review one day a week and the secondment is due to conclude in March.
The selected consultancy must produce “high level organisational design options” and a “high level transition plan and pipeline”, which will see a draft organisational structure produced by the beginning of December and final version by the end of this year.
It will also need to produce a “comprehensive operating model”, including “metrics for assessing quality, finances and sustainability” and models for “intervention and escalation of providers”, “economic regulation” and “approvals of changes to organisational form (for example, applications for foundation trust status or transactions) and capital investments, etc”.
The first version of this must be completed by early February with a final operating model and strategy document submitted in March.
HSJ understands Deloitte, McKinsey and KPMG have been shortlisted for the work.
Asked how the procurement of support fitted with Monitor’s own £50,000 cap on consultancy spending a spokesman said the market exercise had been approved by the Department of Health.
The NHS under the Tories - more bureaucracy, less accountability (Daily Mirrror: 6 February 2015)
The coalition has failed spectacularly in its plan to simplify and make the NHS more accountable, a new report from The King's Fund has found.
The Tories were meant to simplify the NHS by getting rid of layers of bureaucracy, and promised to "stop top-down reorganisation of the NHS".
The other issue is that, along with adding layers of bureaucracy, one of the outcomes of the Tories fiddling with the organisational structure is that there's now a lack of accountability.
CCG budgets £1m in staff costs to take on co-commissioning GPs (Pulse: 22 January 2015)
GP leaders are warning that co-commissioning could come with a hefty price tag, with one budgeting £1m in additional staff costs for delegated responsibility for primary care, Pulse can reveal.
This comes as NHS England confirmed that 77 out of 211 CCGs (36.5%) have so far applied to take on full delegated commissioning powers for general practice, which will see them taking full responsibility for all GP funding.
A Pulse survey of CCGs earlier this month revealed around 40% had applied for a delegated role in commissioning primary care. But GP leaders have warned that practice funding will ‘inevitably’ suffer as CCG management costs increase.
Pulse has learnt that NHS Sandwell and West Birmingham CCG, has applied for delegated (level 3) responsibility for commissioning primary care and it has budgeted close to £1m in recurring annual costs.
NHS spending on management consultants doubles under coalition (Telegraph: 9 December 2014)
NHS spending on management consultants has doubled since the Coalition came to power, despite a promise by former Health Secretary Andrew Lansley to “slash” spending, an investigation has found.
Figures obtained through a Freedom of Information request found costs had more than doubled from £313 million to £640 million between 2010 and 2014, even though the Coalition vowed to clampdown on the practice.
David Oliver, a former clinical director at the Department of Health, who uncovered the spending, likened consultants to ‘racketeers’ profiteering from ‘times of chaos,’ and warned that the staggering fees was hurting the health services.
The billions of wasted NHS cash no-one wants to mention (Our NHS 10 October 2014)
Calls to solve the NHS cash crisis by charging patients have mounted this week, with the NHS Confederation calling for £75 a night ‘hotel fees’ for hospital stays, or much longer waiting lists. But there is one pot of money that sits curiously unexamined, glistening and untouched.
It’s the cost of the NHS ‘market’ itself. Administering the hugely expensive artificial ‘marketplace’ created by successive governments to allow both NHS and private ‘providers’ to compete with each other to offer services to NHS and other ‘purchasers’.
No-one knows the exact cost of this bureaucratic ‘marketplace’. A recent estimate by rebel Lib Dems put the figure as high as £30billion a year. Dr Jacky Davis and other doctors and campaigners including the National Health Action Party have put it at £10billion a year. The Centre of Health & the Public Interest put it at a ‘conservative’ £4.5billion a year.
Even the most conservative of these estimates is a yearly amount which would, if re-directed away from useless market activities, fund both the £2billion annual NHS shortfall and free critical social care to everyone, which the Kings Fund’s Barker Commission recently said would cost ‘substantially less’ than £3billion a year...read more
GPs to receive Ofsted-style inspections beginning this month (Gloucester Citizen: 9 October 2014)
Ofsted–style inspections are to be given to GP practices and out-of-hours services in England from this month onwards.
For the first time ever, there will be a clear way for the public and GPs to know which family doctors are providing great care, and which need to improve.
GP practices will be rated as Outstanding, Good, Requires Improvement or Inadequate, giving members of the public clear information about how well their local GP practice is performing to help them make informed choices about their care.
Inspections are being carried out by teams that include trained inspectors, GPs, nurses, practicemanagers and trained members of the public who have experience of care.
The Care and Quality Commission expects to inspect approximately 8,000 GP practices across England. The first GP ratings are expected to be available from November and will be published on CQC’s website.
Cambridgeshire's £800m NHS bid process 'unnecessary' (BBC News: 1 October 2014)
Campaigners have attacked the process to award an £800m contract to supply older people's healthcare in Cambridgeshire as "unnecessary".
NHS-led consortium UnitingCare Partnership was selected from a shortlist of three organisations.
The Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) consultation cost £1m, Stop the NHS Sell-Off claimed.
The CCG said the cost should be seen in the context of the five-year contract.
UnitingCare is a consortium of Cambridgeshire and Peterborough NHS Foundation Trust with Cambridge University Hospitals NHS Foundation Trust.
Martin Booth, from Stop the NHS Sell-Off in Cambridgeshire and Peterborough, said the £1m spent on the process was "both unnecessary and highly wasteful".
NHS England criticised for 'opaque' decisions over practice closures (GP Online: 27 August 2014)
HealthWatch Central West London (CWL) said it was 'most disappointed' by the way local commissioners carried out the consultation after an NHS trust said it was handing back two GP contracts. NHS England has disputed some of the accusations.
Central London Community Healthcare NHS Trust (CLCH) said in July it no longer wished to run Soho Square and Milne House practices after losing half a million pounds on the services last year. The trust gave notice to NHS England and will stop providing the services from 30 September.
NHS England said either the practices would be closed and patients dispersed, or the services reprocured. A third local single-handed practice, West Two Health, is also closing following the GP’s retirement and was also being consulted on.
Last week, NHS England said Soho Square practice would be reprocured while the consultation for Milne House was extended following problems issuing letters to patients.
"Handing patients NHS cash" is just rebranding cuts (Open Democracy: 10 July 2014)
Personal health budgets are to be rolled out to many more patients and combined with social care personal budgets, Simon Stevens, NHS England’s new Chief Executive announced yesterday.
The announcement has been framed as handing money over to patients and giving them more direct control over their lives. Unsurprisingly, this has so far largely been welcomed. Stevens talks of ‘north of five million patients’ having a combined personal health and social care budget by 2018.
But as spending on both social care and the NHS contracts, what is the evidence underpinning this massive shift in resources?
It is helpful to look at what has happened in social care, where personal budgets have been operating for some years. There, advocates promised that they would make support better and cheaper and reduce bureaucracy.
Instead, new layers of bureaucracy were created by the so-called ‘resource allocation system’ (RAS), according to the independent evidence to date. The RAS was intended to let people know the size of their budget upfront to make sensible decisions about how to spend it – but has conspicuously failed to do that. Unfortunately, it looks as though this is the same model that it is planned to run-out in personal health budgets.
GP payment services may be outsourced nationally (GP Online: 5 March 2014)
GP payment services for the whole of England could be handed to a single outsourced company following an NHS England bid to slash £40m from primary care support (PCS) services, it has emerged. NHS England is considering proposals to provide PCS services, also known as family health services, nationally after the body launched a consultation on plans to cut 40% of the £100m budget. The body said in November that it would seek the savings and could reduce the number of regional PCS offices from 37 to 12.
Consultation with practices on the effects of the changes began in January, but GP leaders have warned the cuts could create more payment chaos...read more
NHS clinical staff spend 10 hours a week on bureaucracy (The Telegraph: 20 November 2013)
NHS doctors and nurses spend up to 10 hours a week on bureaucracy - a third of which is unnecessary, a Government review has found. The report suggests that more than £1 billion a year is spent by the health service collecting and checking data, with 70 per cent of staff saying the burden of paperwork has risen in the past five years.
The review by the NHS Confederation, which represents health service managers, said duplication and poor use of technology meant staff were wasting their time completing bureaucratic processes. Clinical staff interviewed for the review said they spent up to 10 hours a week collecting or checking data - more than a quarter of their average week - and that more than one third of the work was neither useful nor relevant to patient care.
Around one quarter of the bureaucratic demands came from national bodies, such as regulators and NHS England, with the rest coming from NHS trusts or other organisations. The review suggests the recent reorganisation of the NHS, with 150 primary care trusts replaced by 210 clinical commissioning groups, could have increased the amount of bureaucracy in the system. It describes “a lack of clarity of roles and responsibilities, resulting in duplicated requests”.
It follows a study by the Royal College of Nursing (RCN) which found the amount of time nurses spent away from patients, on non-essential paperwork, has doubled, with 2.5 million hours lost a week.
Hunt orders hospitals to publish ward staffing levels every month (The Guardian: 19 November 2013)
Jeremy Hunt, the health secretary, will on Tuesday introduce monthly mandatory reporting of numbers of staff on hospital wards but will reject a fixed minimum nurse-patient ratio. Hunt's proposal is in response to the Francis report commissioned in the wake of the Mid Staffordshire scandal, where hundreds of patients died amid appalling failings in care. He will propose that the National Institute for Health and Care Excellence (Nice) be required to draw up a "toolkit" suggesting minimum staffing levels in wards according to the size of ward, acuteness of patient illness, age profile and other factors. NHS trusts will then be required by law to publish the staffing in each ward – and will be subject to an immediate health inspection by the Care Quality Commission if they are not meeting the guidelines. The Safe Staffing Alliance, which includes the Royal College of Nursing, Unison and the Patients Association, backs the idea of a fixed staff ratio of no more than eight patients to one nurse.
Number of NHS 'super managers' earning up to £240,000 soars amid pay freeze fear (The Guardian: 10 November 2013)
The number of elite NHS "super-managers" being paid up to £240,000 a year to implement the government's controversial health service reforms has soared to more than four times the level originally expected by ministers, the Observer can reveal. The latest official figures – which show a total of 428 "very senior managers" (VSMs) working in the newly constituted NHS bureaucracy – undermine David Cameron's repeated claims to be slashing management posts and costs at every level in the service. (...) In 2010, as the coalition embarked on its controversial reforms aimed at opening the service up to more private competition, ministers told the Senior Salaries Review Body (SSRB) that by the time the changes were completed in April this year, there would be fewer than 100 very senior managers working in the top salary bracket of between £70,000 and £240,000 a year. But the Department of Health last night confirmed recent SSRB data which shows the number is now 428, including 211 super-managers at NHS England, the new body which oversees the budget and delivery of day-to-day services. The average pay of these managers is around £123,000 a year.
David Cameron wasted £1.39BILLION of taxpayers' money rehiring redundant NHS staff (The Mirror: 6 November 2013)
Health Department figures showed that 330 workers each received exit packages of more than £200,000. A further 1,970 each got at least £100,000. “Clueless” David Cameron has shelled out £1.39billion of taxpayers’ money on making NHS staff redundant – before rehiring many of the biggest earners. Angry Labour leader Ed Miliband, who revealed the figures yesterday, said the strategy was stealing money from frontline services . In total 32,089 NHS staff have been axed since 2010 when the Government came to power. The Health Department figures showed that 330 of the workers each received exit packages of more than £200,000. A further 1,970 each got at least £100,000. And an astonishing 2,200 of the highest paid managers have been axed then brought back.
Private equity firms invited to get involved with commissioning (BMJ: 5 November 2013)
Health campaigners have reacted angrily to reports that private equity companies have been approached to help run organisations that advise the NHS on purchasing billions of pounds of healthcare services in England. The Financial Times reported on 4 November1 that several companies had been approached by the NHS about the possibility of taking over or merging with 19 commissioning support units (CSUs), set up under the Health and Social Care Act 2012 to advise clinical commissioning groups (CCGs) on NHS spending. NHS England told the BMJ that it had held “exploratory” talks with potential providers and investors from the private and voluntary sectors to discuss how they may become involved in the organisations, which provide services such as contract management, procurement advice, and back office IT support.
NHS merry-go-round for senior staff "is a disgrace" (Express: 2 November 2013)
The massive reorganisation of the NHS brought in by Andrew Lansley is a case in point. Despite a pre-election promise of no more top-down health service revamps Mr Lansley pushed through the biggest set of administrative changes in the history of the NHS. Now we are learning just how much his blueprint cost us in terms of redundancy payments to managers who left jobs in one branch of the labyrinthine NHS structure only to fill vacancies shortly afterwards in another. Dozens pocketed payments of more than £100,000 and one married couple shared nearly £1million between them before being taken on again in new senior roles. This is an outrage and a predictable one at that. At a time of austerity it is an unforgivable extravagance to be spending fortunes on a game of NHS musical chairs.
Almost half of GPs still affected by payment chaos (Pulse: 1 November 2013)
A Pulse survey has revealed that almost half of GPs in England are still facing unresolved issues with late or incomplete payments, indicating just how long-term and widespread the chaos has been since the transfer of responsibilities from PCTs to NHS England. There have been numerous reports about practices missing out on payments or receiving incomplete paperwork since April but Pulse’s survey of 586 GPs provides a national picture, revealing that almost one in two English GPs is still being affected, with a further 44% being underpaid for services they had already delivered. GP leaders have said the situation is ‘unacceptable’, with GPs having to take real-term pay cuts as result of an ‘over-bureacratic’ system.
NHS England halts re-procurements of NHS 111 contracts (Health Investor: 20 October 2013)
NHS England has blocked clinical commissioning groups (CCGs) from making any re-procurements of NHS 111 contracts until April 2015. A letter from NHS England deputy chief executive Dame Barbara Hakin said: “In order to maintain stability across the system and to give time to agree the optimum service specification for 111 in the future, NHS England has decided that no other 111 contracts should be re-procured to start before April 2015.” The letter went on to say the commissioning body had agreed that “no NHS 111 contract re-procurements should commence until after April 2014”. The majority of existing NHS 111 contracts finish on or after April 2015.
Dying patients are 'lost in NHS system' (The Sentinel: 18 October 2013)
The NHS leaders are now vowing to transform services for dying patients after admitting too many miss out on the best care because the system is so complicated. They say hundreds of residents with cancer or other terminal illnesses are being needlessly admitted to hospital as a last resort and spend their final days on busy wards instead of at home with loved ones. But the county's five NHS bodies which purchase services now hope to change that. They want to streamline the system so every patient is given a key worker to pull together care available for them. The five clinical commissioning groups (CCGs) and Macmillan Cancer Support are to bring in two new organisations to co-ordinate the provision and stop people falling through the net.
One in seven of staff made redundant win back jobs (Health Service Journal: 5 September 2013)
More than one in seven NHS workers made redundant since May 2010 have been re-employed in the service, parliamentary figures show. Health minister Daniel Poulter said 15,700 health service staff have had their contracts terminated after being made redundant since the coalition government assumed power in 2010 and December 2012. Dr Poulter said data up to January 2013 revealed that 2,400 of these workers had been later re-employed within the NHS. In response to a written parliamentary question from shadow Treasury minister Catherine McKinnell, the minister said: “The overwhelming majority of the staff made redundant were from the back office and administrative areas. The number of clinical staff increased by 5,522 during the same period, showing that this government is committed to investing in the NHS frontline. Of those made redundant, 2,400 were subsequently re-employed up to the end of January 2013.” A National Audit Office report into the government’s health reforms, released in July, said redundancy payments had cost more than £435m. It added 2,200 of the workers made redundant between May 2010 and September 2012 were subsequently re-employed in the NHS.
Lords rubberstamps controversial competition regulations (Pulse: 24 April 2013)
Peers voted against a motion to ‘kill’ the Section 75 regulations, which state that CCGs must put all services out to tender unless they can prove it could only be provided by one particular provider, by 254 to 146. The regulations have been criticised by the BMA, NHS Clinical Commissioners and CCG leaders, who fear they will hamper CCGs’ freedoms, while the NHS Confederation warned ahead of the vote that it could create ‘a barrage of bureaucratic procedures’ for CCGs.
NHS Confederation chief executive Mike Farrar said: ‘Where competition is the most effective route to improving care, CCGs need to be able to use it at their own local discretion, rather than have it forced upon them for all services. ‘Using competition in such an arbitrary fashion would potentially create a barrage of bureaucratic tendering and procurement procedures, which would inevitably be paid for at the taxpayers’ expense. This is not in the interest of commissioners or any aspirant new providers.’
Nurses 'drowning in sea of paperwork' (BBC News: 21 April 2013)
A Royal College of Nursing poll of 6,000 nurses found 17.3% of their hours were spent on tasks such as filing, photocopying and ordering supplies, up to one-sixth of their working week. Most reported the amount of paperwork was getting worse and was now stopping them providing direct patient care, despite the government’s intentions to reduce bureaucracy by a third.Health Secretary Jeremy Hunt has already announced a review of bureaucracy, which is being carried out by the NHS Confederation and is due to report back in the coming months. NHS Confederation chief executive Mike Farrar said: "We recognise very much the survey and we are concerned about it. I think it's critical that we make sure our staff have got the maximum amount of time to be with our patients- we're still doing far too much on paper, far too much duplication and it really is taking away the time nurses could have with patients."
Royal college of GPs - competition rules (Section 75) - higher costs? (RCOG: 12 April 2013)
The Royal College of Obstetricians and Gynaecologists [has] concerns around how competition will work in the new NHS. The regulations for procurement and competition set out the boundaries for Clinical Commissioning Groups (CCGs) but there is still uncertainty over the obligation on CCGs to put all future contracts out to tender. Unnecessary tendering, particularly when done through legal requirement with no benefit to the patient will create more bureaucracy and increase the financial burden on the taxpayer. Similarly, there is the significant potential for conflicts of interest as the system allows some CCGs to award contracts to themselves.
David Locke QC analyses the impact of the competition rules (Blog post: 22 March 2013)
Procurement processes are hugely expensive and they delay contracts for extended periods. Conservative MPs ought to have learned that from the West Coast Rail tendering debacle which left the Department of Transport with a bill of £50M when just one tender exercise went wrong. These Regulations will impose countless procurement competitions on the NHS, and caused vast resources to move from patient care into administration.
Have the costs been recognised? The Impact Assessment for these Regulations signed off by Earl Howe says “There are negligible direct costs to patients, commissioners or providers”. That statement would be laughable if this were not so serious. Another part of government, the Cabinet Office, has recognised the huge costs of procurement exercises and is complaining that too much cost is imposed by these exercises. This appears to be another case of a total absence of joined up government.
GPs will be hit by legislation requiring CCGs to use competition, warns GPC (Pulse: 26 February 2013)
GPs will be forced to waste time and money defending their practice resources from competition under proposed legislation for the NHS that will require CCGs to put all services out to tender ‘as a default’, warns the GPC. The claims come after the Government published its draft regulations for CCG procurement, giving Monitor new wide-ranging powers to reprimand CCGs that have not ‘considered the full range of options’ before commissioning services.
Hunt promises to reduce NHS bureaucracy by a third (British Medical Journal: 15 February 2013)
The secretary of state for health for England, Jeremy Hunt, has commissioned Mike Farrar, chief executive of the NHS Confederation, to look at how to reduce “bureaucratic burdens” in the NHS by a third. Farrar’s project will involve working with the national regulatory bodies to focus inspections on the outcomes that “matter most” to clinical success and patient care. Other approaches in the project will include ensuring that NHS trusts and regulatory bodies share information, getting trusts to embrace technology, and ending the duplication of paperwork.
In a speech at a conference held by the think tank Reform on 12 February, Hunt quoted 2008 research by the Royal College of Nurses that found that nurses spent a fifth of their time on paperwork."
NHS must tackle ‘tsunami of bureaucracy’ (Pharmafile: 28 August 2012)
The NHS Confederation has expressed concerns that the government’s reform of the health service will lead to a 'tsunami of bureaucracy'.The reforms, which became law in April 2012, created seven new bodies to help run the NHS day-to-day, including the Clinical Commissioning Groups, Public Health Watch, the NHS Commissioning Board and Monitor. Writing in the Health Service Journal, Mike Farrar, chief executive of the NHS Confederation said the new bodies must help, rather than hinder NHS leaders in tackling major financial problems, reducing hospital admissions and moving care closer to people’s homes, but worries that the sheer number of these bodies will lead to a ‘myriad of conflicting policies’ and a ‘tsunami of bureaucracy’.
Over half (57%) of NHS managers who took part in a major survey of NHS chairs and chief executives highlighted a lack of expertise or experience in the new organisations as the biggest risk to the government’s NHS reform, and the survey reveal significant concerns about these new organisations, and the disruption caused by organisational restructuring. Michael Farrar commented that: “to be successful, these new organisations must listen - and keep listening - to NHS leaders. They must avoid overwhelming NHS organisations with complexity and instead focus on the critical overarching concerns that will matter most in the end”.
Royal College of Nursing report (21 April 2013)