Minister hails removal of NHS England as way to decentralise healthcare

The decision to fold NHS England into the Department of Health and Social Care (DHSC) is about decentralisation and greater empowerment of those on the front line of healthcare, the primary care minister Stephen Kinnock told Pulse PCN delegates yesterday.

Speaking to delegates at Pulse PCN London, the minister said the decision intended to remove the layer between the department and those on the front line to have greater devolution.

It came in response to a question on how the ambition for neighbourhood healthcare would work in light of significant cuts to ICBs and NHS England.

Mr Kinnock said: ‘It is actually about decentralisation. It’s about removing a layer that sits between the democratically accountable secretary of state and the people on the front line, the ICBs, trusts, PCNs and general practice, and primary care dentists.

‘We need to have a transmission belt that is as clear and direct as possible, and that’s what’s going to foster greater decentralisation, greater empowerment, greater devolution.’

He added that they had taken the view that NHS England was instead promoting centralisation.

Later in the day in a panel session, clinical directors noted that PCNs were not otherwise mentioned in Mr Kinnock’s speech.

Dr Sian Stanley, clinical director at Stort Valley and Villages PCN, Bishops Stortford, said: ‘He didn’t mention them, so I’m not sure even that the powers that be understand primary care at scale and it’s potential.’

However, she noted that it was ‘good to hear’ that the minister acknowledged that primary care needs to be engaged with in the future and she predicted that the 10-year plan from a GP perspective would change things ‘significantly’.

‘The system, in all it’s glory, is going to have to find a way to interact with GPs, and GPs are going to have to find a way of interacting with the system,’ she said. ‘Each place will have its own way of doing that, so when I say we’ve got a lovely federation, PCN or locality, it’s all sitting on one nice footprint and we are something that the ICB can interact with at scale.’

She added: ‘The 10-year plan from a primary care perspective is creating the space and giving support to primary care to evolve into the organisation that it needs to be to truly integrate with the system, whether that becomes releasing GPs to be able to work on trust boards, or with more community providers,’ she said.

‘These are all really important things but we have to break down some barriers and help the system understand what primary care is.’

RCN general secretary and chief executive, Professor Nicola Ranger, added that the changes were an ‘amazing opportunity’ for PCNs and GP networks.

‘You know the system, you know your patients. Step into that space, because otherwise we’re going to have complete paralysis while everybody in those leadership positions worries about their jobs,’ said Professor Ranger. ‘This is a really good space for those who know their community, know their work, for GPs to have that very strong voice of being the solution.’

Former clinical director of Victoria PCN, Dr Mark Gaffney, agreed and said that ICBs were typically ‘risk averse’.

‘If you’re prepared to take the risk, to step up and delivery, then the world is your oyster, the things you can do in medicine, new surgeries, mergers, all of those sorts of things. Economies of scale. They require someone to actually get up and say we’re going to do it and we’ll take the risk,’ said Dr Gaffney.

Dr Waqaar Shah, GP and clinical director for ophthalmology at South West London ICS added that he hoped the upcoming 10-year plan would give patients more dignity, kindness and compassion, for example guaranteeing a time for an appointment while on a hospital waiting list.

‘It’ll be amazingly forward thinking if you can guarantee every patient the time of their appointment, whether it’s an outpatient appointment or an operation,’ he said. ‘I don’t think patients mind waiting as long as they know and there’s some certainty that on this date they will be operated on.

‘The whole system should revolve around the patient,’ he added. It doesn’t cost anything more to reimagine the system but it’s putting the patient front and centre of why we do the stuff we do, and I think it will make a big difference.’

Chair of the National Pharmacy Association, Nick Kaye, said he hoped the 10-year plan would not feature contracts that pitch healthcare clinicians against each other.

‘That’s my biggest fear that [those kind of contracts] are in there,’ he said. ‘It destroys longer collaborative relationships.’

Professor Ranger added that she also did not want to see a big focus on structure.

‘We waste so much time on process and meetings and endless talking, whereas actually let’s get on and put the patient at the centre,’ she said.

But all of the panellists agreed it should address paperwork, with Dr Gaffney calling for an ‘attack on paperwork’ which ‘causes a lot of burnout’.

During his speech to Pulse delegate, Mr Kinnock also committed to the future of the GP partnership model and that the Government was ‘not in the business of trying to micromanage what works best at a local level’.

Last week, PCN leaders shared concerns that there would be loss of local support with the demise of NHS England.

It comes as the Government has appointed GP and former clinical lead for quality and productivity at the Department of Health until 2013, Sir John Oldham, to advise on its efforts to shift more care and resources into the community.

Pulse PCN delivers free-to-attend events taking place in person at various locations across the UK. Check what’s coming out later this year.