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Failing to get the basics right

‘So big it can be seen from space’ is how Sir David Nicholson famously described the top-to-bottom reorganisation prompted by the NHS reforms - but in truth he could have been referring to his role as chief executive of NHS England.

The organisation formerly known as the NHS Commissioning Board officially took charge on 1 April with an astonishingly broad remit. Among its tasks: overseeing fledgling CCGs; achieving unprecedented efficiency savings; directly commissioning billions of pounds worth of services; rethinking urgent care; and leading an IT revolution.

Officials have embraced the challenge. Mission statements have been drawn up, ‘vision flow-charts’ designed. A blizzard of consultations, policies and reviews has been published. Thinking has mainly been of the blue-sky variety.

And yet when it comes to the mundane administrative chores that keep the NHS running smoothly - such as processing payments to GP practices - NHS England has been found badly wanting.

Our investigation this month reveals practices across England are grappling with cash flow problems caused by late, unidentified or missing payments. Partners have been forced to cut drawings, bills have gone unpaid.

Unfortunately, the difficulties caused by unreliable book-keeping are symptomatic of a wider malaise.

Whole departments of experienced PCT staff no longer work for the NHS, and understaffed local area teams are struggling to cope in their stead. There is a yawning gap in institutional memory on the frontline. LMCs talk of being ignored. Practices complain of woeful communication.

Pulse has struggled even to speak to local area teams, to the extent we were forced to submit a Freedom of Information request asking for their contact details in mid-April. We’re still waiting.

Teething problems with a transition this size are inevitable. But what is frustrating is that NHS England appears to be expending so much energy on the big picture while failing to get the basics right. It has at least seven reviews relating to GPs running in parallel. Should it really be planning an overhaul of contractual incentives when it’s struggling to pay practices their due under the current contract? Is the idea that patients ought to be able to see their GP at four hours’ notice - as NHS England’s London team suggested - really helpful given the pressure on practices?

And is NHS England’s plan to train 100,000 patients to use the internet really the best use of its limited resources?

Ambitious, adventurous leadership is needed at this crucial juncture, and NHS England should be applauded for its enthusiasm. But GPs might prefer it to spend a bit more time on the day job.

Charm offensive

The GPC’s election of Dr Chaand Nagpaul as its new chair marks a definite change of direction.

Where his predecessor Dr Laurence Buckman was direct, forthright and occasionally blunt, Dr Nagpaul is congenial and persuasive.

It remains to be seen if Dr Nagpaul’s charm offensive can improve the profession’s fortunes. but ministers underestimate him at their peril. An experienced negotiator and GPC veteran, he can show real steel when required.

We wish him all the best.