NHS Kill or Cure? Episode 3: More about STPs

Information about “Sustainability and Transformation Plans” continues to filter out, though in a most unsatisfactory way – see our Episodes One and Two and the outline version of the NW London “Footprint” Plan submitted in April, all on this website.

Brent CCG have now published in the Governing Body papers for 6 July an ‘Executive Summary’ of the NW London Collaboration of 8 NHS CCGs draft STP as it applies to Brent. Go to: http://brentccg.nhs.uk/en/publications/cat_view/1-publications/3-governing-body-meeting-papers/416-6-july-2016 . Then go to Item 17 16-06-29 Brent STP Exec Summary.

On 21 July NHS Improvement (the re-named NHS Monitor and Trust Development Authority) published ‘NHS Reset’ – ”Strengthening financial performance & accountability in 2016/17′” . This distributes the £1.8 billion announced beforeChristmas to reduce provider trust and CCG deficits on certain conditions.  (www.england.nhs.uk/publications/performance/ )

The NW London Local Services Transformation draft paper 3.1 dated 27 May 2016 by the NWL Collaboration of CCGs confirms that the NW London STP base case forecasts a £1 billion financial gap in the local Health and Social care system ‘of which just over half is unmitigated against’ (whatever that may mean). It suggests that ‘Analysis of a patient level dataset across NWL has identified an opportunity equivalent to 592 bed reductions due to admissions avoidance’.  [We have not been able to provide a link to this paper but can send out an electronic copy on request.]

NHS Reset classes Brent CCG as in the third class (out of five) – ‘Requires Improvement’ for Performance and for Finance. Brent CCG has agreed a budget cap with NHS Improvement at £424.66m for 2016/17.

The clear policy imperative of NHS Reset is driven by financial constraint to require more expensive hospital healthcare to be provided more cheaply by ‘out of hospital’ community healthcare services. There is a clear contrast between the publication of the detailed financial constraints and the delay in publishing the draft STP detailed healthcare service consequences. Some might ask themselves what have they got to hide ?

The ‘NHS Reset’ financial constraints have emerged from HM Treasury under George Osborne. We have yet to see whether these budgetary constraints will be maintained in the same way by the new Chancellor.

It is evident to Brent Patient Voice that NHS Brent propose to implement the provision of extended community healthcare services through an Accountable Care Partnership (ACP) broadly based on a model developed in the USA. It appears that this will include ‘out of hospital’ specialist services because the new contract model launched by Simon Stevens in April 2016 is called the ‘Multispeciality Community Provider Contract’ (MCP).

We have been told that the 66 Brent GP practices have formed a single ‘Alliance’ merging or linking the 4 NHS Brent locality GP Federations through a new company Brent Care Limited registered on 14 June 2016.   One of the directors of this company is Mr Grahame Bostock who is also the Business Development Director of one of 2 limited companies forming part of the Harness GP co-operative: Harness Limited and Harness Care Co-operative Limited. Three of the Harness GP Co-operative doctors are members of the Governing Body of NHS Brent CCG: the Chair, Assistant Chair and one other member.

In line with the latest NHSE guidance on apparent conflicts of interest Brent CCG has formed a new committee to decide on healthcare provider tenders where there is potential conflict of interest for its Governing Body GP members. This committee comprises lay members of the Governing Body and independent outside appointees. We are bound to ask if this is in the least satisfactory when the Health and Social Care Act 2012, over which so much Parliamentary blood was shed, puts local GPs in charge of local healthcare commissioning.

We have seen nothing yet to explain how these changes will affect the traditional GP family doctor/patient relationship, or even whether the traditional GP NHS contract will survive at all.

Brent CCG has a statutory duty under s.14Z2 of the National Health Service Act 2006 (as amended by the Health and Social Care Act 2006) to involve and consult its public as to its proposals for healthcare commissioning and changes to the healthcare it commissions that will affect patients. This duty remains with Brent CCG not the NW London Collaboration.

In an effort to make a constructive contribution to the process I am serving as a lay representative from Brent Patient voice and as Chairman of Willesden Patient Participation Group on the Collaboration Local Services: New Models of Care group and a related Engagement Workshop. On 22 July 2016 I wrote to Dr Mohini Parmar, the Chair, and other the leaders of the NW London Collaboration STP “Footprint” and Brent CCG calling on them to confirm that Brent CCG has arranged to comply with its statutory duty of public involvement and consultation. A copy of the letter and enclosed document is available from BPV on request.


Peter Latham


27 July 2016

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