I will be attending next week the North London LNC Fora and North East London Regional Consultants committee, as co-chair of the first and deputy chair of the second.

Arrangements have been made for two senior members of the North Central London Sustainability and Transformation Plan to attend and discuss the NCL STP with Fora/RCC representatives of all the hospitals involved present.

Those who have read NCL STP October (and other) documents (see my previous blogs giving hyperlinks)  will note the aspiration to “save” about 6.4% per annum in NCL over the next 4 years

It is interesting to note the up coming BMA Consultants Conference in March have a number of motions related to STP’s. The conference motions include the following points of debate relating to STPs :-

  • Adequacy of funding to make the system changes and run a safe clinical service.
  • What is the accountability for providers and commissioners
  • Is there proper representation and involvement of consultants

other motions in the “grey area” may well be debated so I include for reflection

  • Consider the general lack of discussion
  • the task of reorganisation and attempting to save money – is it realistic
  • who do the Trusts follow the CCG or the STP?
  • what Consultants if any are represented on STPs
  • to what extent “affordability gap” = “cuts”
  • to what extent does “consolidation” = “closures”
  • to what extent are these “fictional plans that cannot deliver the needs of the population

For NCL the October 2016 Document does list a number of specialties they “list of services potentially in scope for further work over the 5 year period”and “whether they would benefit from consolidation or networking”

The examples stated are:

. Emergency surgery (out of hours)
• Maternity services, in the context of the Better Births initiative (see section 6.2.1)
• Elective orthopaedics
• Mental health crisis care and place of safety
• Mental health acute inpatient services
• Histopathology
• General dermatology services

further specialties have been identified for “focused pathway design”. :

  • Urology
  • General surgery
  • Colorectal surgery
  • Hepatobiliary and pancreatic surgery
  • Upper gastrointestinal surgery
  • Gynaecology
  • Gynaecological oncology


London seven Day services standards. Nuffield Trust evaluation of London Quality Standards, which formed the basis for national seven day standards, suggests there is very little hard evidence that they have improved outcomes. The think tank urges STP leads not to use seven day standards as “big stick to try and reconfigure services, or decide service cuts”. Forcing hospitals to comply with national seven day working standards, which underpin the government’s seven day NHS manifesto pledge, is unlikely to improve clinical outcomes. The report’s authors warned the findings were “preliminary” and further analysis was required. The LQS were a set of minimum standards for patient care in hospitals in London in 2011, introduced in a bid to reduce excess weekend mortality. They were subsequently distilled into NHS England’s 10 standards for seven day services in 2013, which it said would ensure patients received the same standards of care, seven days a week. The researcher, Dr Vaughan, said there were also “positive lessons to come out of our study; they were successful in focusing minds and organisations on improving the quality of care. In many places, they led to concrete changes in how people worked, often from the bottom up. All this was achieved with very little central financial support.”  The standards also appeared to have negative effects among clinicians. “The introduction of complex patterns of shift working for all medical staff was considered to have triggered a retreat of a number of experienced consultants from the hospital front door, increased reliance on locum staff and contributed to the further fragmentation of clinical teams,” the report said. “The emphasis on consultant delivered care was perceived to adversely impact on the training of junior doctors. Some also felt that the standards encouraged junior doctors to defer decisions until consultant review, delaying care for some patients.”

London STPs. This week the BMA released the results of some research; they sent FOIs to each of the 44 STPs to discover the capital funding required by the plans. The results show that £9.5 billion in upfront funding is needed across England. There’s more information here:


In London the figures required to launch an STP include :

North Central London     £542,000,000

North West London         £435,000,000

North East London           £500,000,000

North Central London STP. Five CCGs (Barnet, Camden, Enfield, Haringey and Islington) have appointed Helen Pettersen, a former commissioning support unit managing director, as the chief officer to lead on the implementation for the whole STP footprint. It is unclear whether the CCGs’ individual chief officers will remain in post. On the announcement Ms Pettersen said: “I am very much looking forward to working closely with staff, partners and local people across the five boroughs in north central London to shape and build outstanding health and health care services for local people and communities that are fit for the future.”

STPs. Simon Stevens told the NHS England board this week that STP leaders will be given the right to “recommend” member trusts and commissioners reorganize, where the “veto power or inertia” of individual organisations is holding up change. Rather worrying for unaccountable, non-statutory bodies to be given that much power. STP leaders were chosen by a few national leads and no effort was made to work out if they had the skills to be system leaders. However, legally it would be very difficult to enforce anything so this may just be scare tactics to drive STPS on.  Meanwhile, HSJ reported that after the first nine months of 2016-17, CCGs have forecast a year-end overspend of £370m, compared to £190m forecast after six months. NHS England have a new webpages with all the information on STPs: https://www.england.nhs.uk/stps/

 Guys & St Thomas’ has agreed to lease the top four floors of its new cancer Centre to an American private healthcare provider, the London Bridge Hospital (run by HCA),  in a deal intended to cut running costs for the new NHS facility. The lease will be for 25 years. Negotiations are underway to offer NHS patients access to private robotics theatre. The £160m, 14 storey NHS cancer Centre opened at Guy’s Hospital near London Bridge in September. The private facility will cost £38m to set up. It will host a robotics theatre with a Da Vinci robot for keyhole surgery, 40 inpatient beds, an intensive care unit and four operating theatres. It will offer surgical provision in urology, Gynaecology, breast, ENT, maxillofacial, and head and neck cancer, as well as reconstructive surgery for those specialties. The unit will be “clinically and operationally separate” from the NHS cancer centre. The private centre will employ NHS consultants who also work at Guy’s and St Thomas’ – but consultants will not be permitted to “pop up” to the private cancer centre while they are working NHS shifts, the Trust has said.  HCA Healthcare’s international arm runs 17 hospitals and clinics, mainly in London, including The Lister Hospital, The Portland Hospital, The Wellington Hospital and a private patient unit at The Christie in Manchester. It claims to be the world’s largest independent hospital company, with a turnover of £30bn, 164 hospitals and 106 outpatient centres, treating 14 million patients a year. London Bridge Hospital was last week rated outstanding by the Care Quality Commission.


There was continuing coverage of Monday’s press release which showed STPs require £9.5bn of capital funding to be delivered successfully in Nursing Times and Pharma Times.

Commenting on the findings, BMA council chair Dr Mark Porter said: “These plans are fast becoming completely unworkable and have instead revealed a health service that is unsustainable without urgent further investment, and with little capacity to ‘transform’ in any meaningful way other than by reducing the provision of services on a drastic scale.”

GPC deputy chair Dr Richard Vautrey spoke with The Times about NHS England plans to relieve pressure on family doctors by having one in four GP appointments conducted by pharmacists or nurses.

Dr Vautrey said: “Nurses, pharmacists and other healthcare professionals could play a vital role in supporting GPs to deliver care in the community. This is needed particularly at present as the government has so far failed completely to deliver the much needed 5,000 new GPs they promised. While expanded teams can be beneficial, they should not be seen as a replacement for GPs, as it remains essential that patients can access a GP when they need to.”

Dr Krishna Kasaraneni commented in The Yorkshire Post on a report from the Royal College of GPs looking into how STPS will affect the way GP surgeries operate in the region.

He said: “We are facing the cliff edge of a significant proportion of GPs retiring in the next five to ten years. The reality is the amount of work in general practice has increased significantly in the last few years. The workload is going up and you need a workforce to deliver it. But there are certain aspects that only a GP can do. You can’t replace a GP with two nurses and a pharmacist.”

BMA council deputy chair Dr David Wrigley remarked in The Blackpool Gazette on the millions of pounds from NHS budgets paid to management consultants to advise on how to draft STPs nationwide.

He said: “This money will just be the tip of the iceberg – and it is millions of pounds lost from the NHS which could have been spent on doctors and nurses.”


STPs will be hamstrung by lack of capital funding, warn health unions
Nursing Times, Wednesday 15 February 2017,(Dr Mark Porter)

Delivering STPs will need capital funding of £9.5bn, says BMA
Pharma Times, Wednesday 15 February 2017, (Dr Mark Porter)

Complete overhaul of Yorkshire GP surgeries planned as part of £2bn savings
The Yorkshire Post, Thursday 16 February 2017, (Dr Richard Vautrey/Dr Krishna Kasaraneni)

Dr David Wrigley: Private consultancy costs
Blackpool Gazette, Wednesday 15 February 2017, (Dr David Wrigley)

Other news

English social care system for older people facing ‘complete collapse’
The Guardian, Thursday 16 February 2017

Maternity units across England face the axe under plans to transform NHS care
The Daily Mirror, Wednesday 15 February 2017