This week, NHS England has published a document setting out the next steps for the Five Year Forward View and the development of STPs across England. The Government has also triggered Article 50 and published a White Paper on the Great Repeal Bill, which will repeal the European Communities Act 1972 and transpose EU law into UK law.
The Government has also announced a 1% pay increase for NHS staff, which has been criticised as – because it is below inflation – essentially amounting to a real-terms pay cut. The number of full-time GPs has fallen, and the NHS has made the decision to limit some prescribed medications and products which can be purchased elsewhere.
NHS England publishes next steps for Five Year Forward View
Following the publication of the Five Year Forward View (FYFV) in 2014 and the development of Sustainability and Transformation Plans across England over the last year, NHS England has developed a document setting out the next steps for the Five Year Forward View, and how its key ambitions will be delivered. The headline developments in the document include the abandonment of the 18-week waiting time target for elective operations such as hip and knee replacements; the creation of 150 urgent treatment centres across England to ease pressure on A&E departments; and the requirement for GPs to offer evening and weekend appointments by March 2019.
In coordination with the launch of the plan, the Chief Executive of NHS England gave a speech at Aldershot Centre for Health, taking questions from the media primarily on the removal of the 18-week elective surgery target. He was questioned on whether the NHS needs further funding and why he is not asking the Government for this: in responding to this, he framed the announcements in the plan as “trade-offs” and said “these are the actions we can take with the funding we’ve got.” His reticence in answering these questions, when compared with his forthright discussion of government funding for the NHS in recent months, was also reflected in the document’s statements on NHS finances, saying that “growth in NHS funding has closely followed the ups and downs of wider economy cycles.”
The Royal College of GPs welcomed the re-commitment to the GP Forward View embodied in the document, with Professor Helen Stokes-Lampard saying that “There is a lot of promise and potential in today’s announcement that, if delivered, will be good news for general practice.” She also praised the confirmation that general practice will receive additional funding this year as anticipated. By contrast, the Shadow Health Secretary Jonathan Ashworth endorsed the ambitions on cancer and mental health care contained in the document, but highlighted that “The plan admits the public are ‘concerned’ for the future of the NHS and that the health service is under ‘real pressure’ to cope with rising demand within the current spending envelope.”
Government triggers Article 50
After formally triggering Article 50 on Wednesday, the Government has published a White Paper on the Great Repeal Bill, which will be formally introduced to Parliament in the Queen’s Speech in May. The Great Repeal Bill will revoke the European Communities Act 1972, which gives EU law supremacy over UK national law.
The Bill will create a power to correct elements of domesticated EU law which are perceived to pose problems after leaving the EU, and leaves open the option of having to create a “complete and functioning statute book” if the UK leaves the EU without any deal. Directly applicable EU law where there is no need for secondary legislation (i.e. EU Regulations) will be converted into domestic law, while domestic law that already gives effect to EU law will be preserved (this includes EU Directives). It does say that if a conflict arises between EU-derived law and new primary legislation passed after Brexit, the new legislation will take precedence over the laws preserved, ending the general supremacy of EU law. However, EU-derived law will continue to have priority over UK law passed before Brexit.
As expected, a vast number of statutory instruments will be required to make these elements of EU-derived law work, estimated to be between 800 and 1,000. But ultimately the Government has said that “it is not possible to be definitive at the outset about the volume of legislation that will be needed, as it will be consequent on the outcome of negotiations with the EU and other factors.” Concerns have been raised about the impact of using statutory instruments to implement the changes on the ability of Parliament to effectively scrutinise the process. The White Paper says the Government is looking to balance “the need for scrutiny and the need for speed”, and that the White Paper marks “the beginning of a discussion between Government and Parliament as to the most pragmatic and effective approach to take” in implementing these statutory instruments.
Government announces 1% pay increase for NHS staff
The Government has decided to increase wages for NHS staff by 1% this year, making it the seventh successive year that wages have either been frozen or only increased by 1%. The decision has been criticised by health unions, as it means a real-terms pay cut for NHS staff as inflation is greater than 1% (according to the retail price index, inflation is currently running at 3.2%). The 1% pay cap is due to stay in place until the current parliament ends in 2020.
The latest annual report from the National Health Service Pay Review Body (PRB) stated that “It is clear that current public sector pay policy is coming under stress.” The report implied that pay restraint is resulting in “significant supply shortages in a number of staff groups and geographical areas. There are widespread concerns about recruitment, retention and motivation that are shared by employers and staff side alike.” Janet Davis, chief executive and general secretary of the Royal College of Nursing (RCN), shared the sentiment of the PRB and called the policy a “bitter blow” that will “deter new people from joining the nursing profession as the very moment it is failing to retain staff and European colleagues in particular head for the door.”
The shadow health minister Justin Madders highlighted that the pay cap could unintentionally result in hospitals spending more on agency staffing, despite recent efforts to reduce this area of NHS spending. Meanwhile, the Department of Health has stated: “The dedication and sheer hard work of our NHS staff is absolutely crucial to delivering world-class care for patients. We are pleased to announce that all NHS staff will receive a 1% pay increase.”
Number of full-time GPs falls
While Health Secretary Jeremy Hunt had pledged to recruit 5,000 more GPs by 2020 in the run up to the 2015 general election, figures released by NHS Digital on Wednesday showed the total number of GPs now stands at 34,500 – representing a 0.3% decrease. Despite an increase in other healthcare professionals in general practice, the number of GPs working full time in England has fallen and the overall numbers are stagnating.
The BMA’s education, training and workforce GP lead, Krishna Kasaraneni, said: “There is a great deal of uncertainty as Article 50 is triggered about the future status of doctors and other healthcare professionals from the EU. With almost half of the 10,000 EEA doctors working in the NHS considering leaving the UK because of the referendum result this could further reduce the number of GPs delivering care in the NHS.”
The figures on GP recruitment came in the same week that a Freedom of Information request from the RCN showed that the number of EU nurses registering with the Nursing and Midwifery Council has fallen to fewer than 200 each month, compared to 800 each month in the same period before the EU referendum. The RCN criticised the Prime Minister’s failure to clarify her policy on EU nationals working in the NHS, stating that “Her failure to guarantee their right to remain is leaving soaring numbers heading for the door.”
NHS to limit some prescribed medications and products
The NHS will stop prescribing patients a range of medications and treatments which can be accessed elsewhere in a bid to save money. The treatments which will be impacted include travel vaccinations, cough medicine and medication for upset stomachs. The Chief Executive of NHS England, Simon Stevens, said that spending money on this type of treatments results in a significant amount of waste, which is thought to amount to around £128 million a year. The NHS will instead use the money saved to fund new treatments and therapies.
Next month, NHS England will start reviewing 10 items that it says are “ineffective, unnecessary, [and] inappropriate for prescription on the NHS, or indeed unsafe”, which could include gluten-free foods, treatments for underactive thyroids and high blood pressure, painkillers and suncream. The Department of Health is expected to advise GPs that these treatments are not prescribed.
Professor Helen Stokes-Lampard, the Chair of the Royal College of General Practitioners, said that she “cautiously” welcomed the proposals, as “a blanket ban might well introduce some unfair problems”, particularly for patients who are entitled to free prescriptions. She added: “GPs don’t want to be rationing. It is time that country needs these difficult conversations but we mustn’t put at risk the health of the vulnerable.”