What is in Sajid Javid’s in-tray?

Covid

The middle of a pandemic is not the ideal time to be changing health secretaries (but probably not the best time to be having a non-socially distanced affair, either).

But that is the situation Sajid Javid is in, and getting back to ‘normal’, as he puts it, is of course the priority.

He said on his first day in position:  ‘We are still in a pandemic and I want to see that come to an end as soon as possible, and that will be my most immediate priority – to see that we can return to normal as soon and as quickly as possible.’

On the plus side, the vaccine programme is progressing well – including for under-30s – in no small part thanks to GPs. There remain fears around new variants, but the vaccines are holding their own.

Javid was vocal last year about re-opening society quickly to support the economy, in contrast to predecessor Matt Hancock’s more cautious approach.

In an interview with Sky – highlighted by its political correspondent Rob Powell– Mr Javid said in May 2020: ‘We’re going to have to co-exist with this virus for I think many months, if not potentially years. But we’ve got to find a way forward and that does mean you’re relaxing, as much as you can.

‘As well as listening to the scientists we also need to think carefully about the impact on the rest of society and the economy and jobs and wider social impacts and that does mean, I think, that when it comes to opening up you want to go as far and as quick as you can.’

GP relations with NHS England

He also comes in during a stand-off between NHS England and the BMA over the edict for GPs to ‘open up’ – the GPC has received no response from NHSE.

NHS England’s letter, sent on 13 May, tells practices they must also open their receptions to walk-ins within three days, with patients being triaged at reception.

‘Practices should respect patient preferences for face-to-face care unless there are good clinical reasons to the contrary.’

Following the letter, the BMA’s GP Committee agreed a motion expressing a vote of no confidence in NHS England’s executive team, and voted to cease all formal meetings with NHS England until the disagreement is resolved.

Pulse revealed that the BMA is still waiting for a response that will ‘restore confidence’ in NHS England following the fallout around GP face-to-face appointments.

On 18 June, Pulse reported that Mr Hancock has written to the BMA, asking it to ‘return to negotiations’ with NHS England ‘immediately’,.

In a letter to the BMA, Mr Hancock said he ‘welcomed’ a meeting held on 27 May to discuss the BMA’s ‘concerns’ but asked it to ‘restore relationships’ with NHS England.

Since then, there has been little movement. However, NHS England has announced two new enhanced services – one dealing with long Covid, which will be worth 50p per registered patients, and another on weight management services – which the BMA has condemned.

Digital revolution           

Much of GPs’ anger at NHSE’s tone can be placed at Mr Hancock’s door. His legacy, outside Covid, will be around his push for further digital services, and especially remote consultations.

It shouldn’t be forgotten that the main reason GPs began operating a ‘total triage’ model in March 2020 was because that was NHS England’s own guidance, implemented to reduce face-to-face care and minimise infection risk. 

Although Covid made this essential, this was in keeping with Mr Hancock’s direction of travel. In a speech in July last year about the move to remote consultations, Mr Hancock said: ‘The feedback from this transformation has been hugely positive and especially valued by doctors in rural areas who say how it could save long travel times both for doctors and patients.

‘So from now on, all consultations should be teleconsultations unless there’s a compelling clinical reason not to.’

He added: ‘Of course, if there’s an emergency, the NHS will be ready and waiting to see you in person just as it always has been.

‘But if they are able to, patients should get in contact first via the web or by calling in advance. That way, care is easier to manage and the NHS can deliver a much better service.’

There are indications that Mr Hancock wanted to take this further. Pulse revealed his trip to University Hospitals Birmingham to see its Babylon-powered triage service was swiftly followed by a high-profile delegation from NHS England and NHSX visiting the hospital, suggesting that this is an idea that health chiefs are keen on.

Data-sharing scheme

Mr Hancock left his successor with a bit of a hospital pass in the new data record sharing scheme, the General Practice Data for Planning and Research scheme. It will see patient records extracted from practices, pseudonymised by the GP IT system and sent to NHS Digital, which will pass the packaged data to interested third parties.

It has already been delayed by the Government after concerns around privacy from campaigners that the data can be identified, and from the BMA and RCGP around the short time span given to GPs to inform all their patients that they have the right to opt out.

It is now set for 1 September, at which point the data on every patient who hasn’t opted out will be extracted from systems.

NHS restructuring

Worryingly for Mr Javid, he is coming in just as the chief executive of NHS England, Simon Stevens, is leaving. It is unclear who will take over, but we know that the head of the test and trace scheme, Dido Harding, has applied.

At the same time, the NHS is in the process of going through a restructuring. CCGs are being replaced by ICSs, and there are concerns about what this will mean in terms of primary care having a voice.

Non-primary care brief

As always, it is likely that primary care will be below secondary care in terms of a new health secretary’s priorities. The hospital sector is, of course, struggling. There is a backlog of cases in the millions, with waiting lists worse than ever – partly due to Covid, but it can’t be forgotten that they were struggling pre-pandemic.

But perhaps Mr Javid’s biggest focus will need to be on social care – and about time. The number of deaths in care homes during the pandemic showed how much needs to be done. The Government has promised detailed plans for the reform of social care by the end of 2021. But it feels as though we have been here before.