Who is responsible for the budget now and how could that change?

 

About 80% of the budget is held by local managers working for primary care trusts.

 

There are 152 of these in England and they are effectively in charge of commissioning local services, such as hospitals, GPs, mental health units and community clinics.

 

Ministers want to transfer much of that responsibility to GPs working in consortiums across the country.

 

Both primary care trusts and strategic health authorities are to be phased out over the next few years, with funding going directly to GPs.

 

 

Has anything like this been tried before?

 

Yes, although not quite on this scale. During the 1990s, the Tories created GP fundholding which allowed doctors to take charge of local budgets. Only half of them signed up in the end and the budget was limited to only the most basic parts of hospital care such as elective operations like knee and hip replacements.

 

The latest model is far more wide-ranging.

 

When Labour came to power, they scrapped fundholding, believing it had divided the profession. But within a few years ministers were launching their own version.

 

This was called practice-based commissioning and encouraged GPs to work in partnership with neighbouring practices.

 

However, many doctors said they have found it too bureaucratic and so it has not taken off across the country.

 

 

Why does the government want to do it then?

 

Health Secretary Andrew Lansley sees it as the key to making the NHS more responsive to patients.

 

He believes GPs know what works best and wants to tap into their entrepreneurial spirit to drive improvement from the front-line.

 

If it is successful, it may also help to save money. The NHS has been told to make up to £20bn of savings by 2014.

 

Getting GPs to take on some management responsibility could help the health service cut the number of managers it employs.

 

 

What do the experts think?

 

The British Medical Association, the medical profession's trade union, has said it is "ready, willing and able" to meet the challenge.

 

However, doubts do remain about whether there will be enough interest in every area to get effective consortiums of GPs set up across the country.

 

It is also acknowledged that the policy is not without risks. Sceptics have questioned whether it is wise to give what are effectively independent businesses - GPs are not employees of the NHS in the same way other doctors are - such vast amounts of money.

 

Some are also critical of the idea because they see it as unnecessary upheaval and reorganisation at a time when the NHS is under pressure to become more efficient.

 

 

What about the independent board?

 

The initiative has long been championed by the Tories. They have hailed it as a way of setting the NHS free from political interference.

 

It is likely to be created from the current NHS management board which sits in the Department of Health and includes regional health chiefs.

 

The board will be given responsibility for setting standards and holding GPs to account, while in the future the Department of Health could be renamed the Department of Public Health to concentrate on issues such as obesity and alcohol abuse.

 

 

What changes will patients see?

 

Mr Lansley says the reforms set out a vision for an NHS led by patients and professionals, not by politicians. He says patients will be handed more choice over how and where they are treated.

 

They are promised more information and choice, including the ability to register with any GP they want to.

 

Charities are calling for more clarity for patients.

 

Peter Hollins, chief executive at the British Heart Foundation, said: "This radical shake-up has thrown up a kaleidoscope of possibilities and like every GP in the country we will be devouring the detail of the white paper."

 

John Black, president of the Royal College of Surgeons of England, added: "If these new proposals are to benefit patients having surgery, they must enable GPs the flexibility to make decisions based upon the need of the individual patient and allow them to refer to a single, named consultant who will see their patient through the operation and afterwards.

 

"We need to hear more detail, especially on the composition of proposed GP consortia and the powerful new independent NHS commissioning board. "

 

 

What happens now?

 

The government says it will be carrying out a consultation, but it already seems to be in a hurry to get going.

 

The White Paper includes a fairly detailed timescale for action.

 

Next year will see GPs start piloting the plans, before full roll out starts in 2012. The existing management structure - primary care trusts and strategic health authorities - is likely to be abolished within three years.

 

All NHS trusts should gain foundation trust status by 2013 as well.

 

 

What is the situation elsewhere in the UK?

 

Health is a devolved power and as such the plans only affect England. None of the other countries have given responsibility to GPs on this scale.

 

They have traditionally relied on more input from the medical profession for the management of local services.

 

In Scotland, there are 14 health boards with doctors given senior roles.

 

Wales has something similar following a restructuring last year which saw 22 health boards and local NHS trusts merged into seven larger health boards in charge of delivering and monitoring services.

 

Northern Ireland has an integrated health and social care system with four boards in charge of monitoring the performance of NHS trusts.

 

 

**

 

 

Health service: The change remains the same

The biggest risk of all is that the NHS will not survive the shock

 

The Guardian, Tuesday 13 July 2010 Article history

 

Nigel Lawson grumbled that the National Health Service was the closest thing the English have to a religion. Its hold over the political class has strengthened since his 1980s heyday, with all three parties now proclaiming their devotion, not least the Cameronite Conservatives, who offer their piety as proof that they have changed. But what was once a unified church has splintered into a faith of many sects. A generation of ceaseless, breathless and often pointless revolution has produced dissent about what is truly sacred. Some venerate the doctors and others the state-owned hospitals. Others again say the only commandment that counts is that care is free at the point of use, and that the market can, perfectly happily, take care of the rest.

 

The new health secretary, Andrew Lansley, yesterday set out his own particular doctrine, in the form of a white paper. It was clearer about the sort of health service he is against than the sort of health service he is for. Out goes what remains of Aneurin Bevan's nationalised vision, and out too is New Labour's one-time belief in a regime of targets and terror. Forget the emerging academic evidence that targetry worked wonders on waiting times – for both good and bad reasons, doctors resented them. Always more trusted by voters than ministers, the medics who had already persuaded the last government to cut the number and iron out the undoubted perversities in many targets, have now won a more thorough victory.

 

There were other points, too, on which Mr Lansley's opposition strategy of hugging the British Medical Association close appeared to have been carried into government. Separating service purchasers from service providers is the orthodoxy in public sector reform, but this is being turned on its head by the plan to hand family doctors control of the NHS purse strings. Even if many GPs do not seek this control, it is striking that the very part of the profession that Labour threw most money at is about to become more powerful again. The Conservatives have also effectively crushed Liberal Democrat proposals to strengthen the voters' voice in the service, through elections to primary care trusts. Instead, PCTs will be abolished, and the junior coalition partner has settled for a new co-ordinating role for town halls in health, a mere face-saving gesture towards democratisation.

 

The Lansley doctrine, however, is about more than doctor worship. The supremacy of the medics will be challenged, and perhaps outdone, by that of market forces. Buried in yesterday's small print was a proposal to turn Monitor, the body that currently superintends the foundation trusts, into a full-blown economic regulator to oversee a healthcare market in the same way that Ofcom and Ofgem oversee the markets in communications and energy. Crucially, it will be required to go out of its way to attract corporate challengers to the NHS. Once the shift to a market system is made, European law may make it irreversible. Family doctors may, perhaps, be gaining enough power to shelter themselves from the full gales of competition, but the hospital sector will feel its force as never before. Mr Lansley's decision to remove the cap on foundation hospitals' private work will only aggravate fears about where all this is leading.

 

The biggest risk of all, however, is that the service will not survive the shock. With the baby boomers moving into their 60s, the near-freezing of health expenditure – which is all the health service's much-vaunted protection affords it – will feel like a deep cut. That makes this a dangerous time to go through yet another great upheaval, which – for all their ambiguities – is the one thing that the Lansley plans will certainly produce. In opposition, the Tories rightly damned Labour for reorganising the service too often. Now that they are in office, its weary staff must worry that the only thing that never changes in the political theology of the NHS is the demand for change itself.

Edited July 13, 201015 yr by Danny

Quite simply, these reforms will potentially be an unmitigated disaster... GPs simply do NOT have the time or skills to do the managerial work the government now expects them to.

 

One of three things will happen: either the GPs will simply re-hire the managers that the government will be sacking, which means we'll waste money (the public will have to fund their redundancy payments, and then on top of that resume paying their salaries when they're re-hired by the GPs); or the NHS will completely crumble due to the fact GPs won't be able to cope with this extra responsibility; or the NHS will effectively be privatised, the poor won't be able to afford decent healthcare - which I suspec t is what the ConDems want. Just disgusting.

Edited July 13, 201015 yr by Danny

God bless the Scottish government.

 

I never thought i'd say that.

These reforms are totally barmy. People currently have some choice in what hospital to go to. Most people don't take advantage of that. It seems that I was right all along in thinking that most people aren't interested in choosing a hospital, they just want to get on with their treatment. These proposals can only lead to any reduction in management numbers being offset by an increase in marketing jobs and loads of glossy brochures nobody wants to read.

 

As for their changes to the role of the GP, when I go to see a doctor, I want to see a doctor, not a part-time accountant.

Private health companies funded Lansley's office in 2009.

 

http://www.telegraph.co.uk/news/newstopics...e-provider.html

 

I think everyone knows though that the Tories do NOT believe in a social health care system ... no more than they believe in a good social education system. Conserve, Conserve, Conserve ... is what the Tories (and obviously now the Lib Dems) are about. Everyone should pay for their own healthcare, their children's education, their own policing and security, everything really. I just don't know why Cameron and his gang are so cagey about it ... why don't they just say ... 'hey ... if you can't afford it ... kill yourself 'cause we don't care'.

 

In fact ... I have a brilliant proposal to put to Cameron and Clegg to reduce the number of unemployed. I'm going to suggest that they line up all the unemployed ... and ask every third person to kill themselves ... thus making the competition for any jobs out there a little less stiffer. If that doesn't work within a year ... then ask every second person. Hell ... it worked for Peter Cook in Whoops Apocalypse!

 

Norma

In fact ... I have a brilliant proposal to put to Cameron and Clegg to reduce the number of unemployed. I'm going to suggest that they line up all the unemployed ... and ask every third person to kill themselves ... thus making the competition for any jobs out there a little less stiffer. If that doesn't work within a year ... then ask every second person. Hell ... it worked for Peter Cook in Whoops Apocalypse!

 

Atleast it will cut the deficit!!!!11111

Atleast it will cut the deficit!!!!11111

OMG WE ONLY HAVE TO DO THIS TO CLEAR UP THE MESS LABOUR ELFT US IN

In fact ... I have a brilliant proposal to put to Cameron and Clegg to reduce the number of unemployed. I'm going to suggest that they line up all the unemployed ... and ask every third person to kill themselves ... thus making the competition for any jobs out there a little less stiffer. If that doesn't work within a year ... then ask every second person. Hell ... it worked for Peter Cook in Whoops Apocalypse!

 

Norma

 

 

What a ridiculous and horrible suggestion. :angry: I assume you're just joking Norma? :rolleyes:

What a ridiculous and horrible suggestion. :angry: I assume you're just joking Norma? :rolleyes:

 

Well ....

 

 

Watch out for Loretta Swit's line at 1.12!

 

Norma

 

Edit: Upon reflection though Chris ... it does seem a little extreme. Perhaps the Condems could consider returning that good old-fashioned institution .... the Workhouse for the poor. At the same time they could handle the education problem by sending those kids who have no hope of being educated up chimneys again.

Edited July 14, 201015 yr by Norma_Snockers

What a ridiculous and horrible suggestion. :angry: I assume you're just joking Norma? :rolleyes:

:manson:

The NHS is never going to be safe under the Tories.. They undermined it when they were last in power, creating the "Trusts", which led to more bureucracy and waste and mindless levels of management tiers.. Nu Labor didn't have the guts to overturn that situation however, to really bring it back under state control as it had been, and they ended up spending money on an IT system which was an unmitigated disaster because they tendered it out to a company who was incompetent, so, really, neither Tory nor "Labour" over the past 30 years has done good by the NHS..

 

Frankly, I wouldn't put it past some factions in the Tory party to come up with Norma's ideas tbh.... :lol:

BBC poll shows that only 25% of GPs feel they'd be capable of doing the extra work that these reforms would require. Personally, I doubt these reforms will ever actually come to fruition, so I'm not too concerned.

The reforms have faced a savaging from pretty much every health union and NHS-related body on the country, and even from some Tory MPs - yet the Tory-led government are continuing to press ahead. Cameron today insulted everyone's intelligence by saying these reforms were "unavoidable", and then insulted all NHS staff by saying it was currently "second-rate", despite the fact it's rated as the second best in the world and the most efficient. And this all comes despite neither the Tory manifesto or the Coalition Agreement mentioning this - yet another broken promise. Quite why the Lib Dems are gormlessly sitting there, letting the Tories renege on so many areas of the Agreement (bank bonuses, NHS), while they themselves are expected to toe the line on things like tuition fees, I don't know.

I find the Lib Dems' position on this harder to understand than tuition fees. As Danny has implied, the Tories ruled this out before the election and the Coalition Agreement specifically ruled it out. What is worse is that the initial proposals were announced within weeks of the government being formed. That means one of two things. Either the reforms were planned before the election and the Tories lied to the electorate and then lied to the Lib Dems in the coalition negotiations. Alternatively, they were drawn up on the back of a fag packet in just a few weeks.

I find the Lib Dems' position on this harder to understand than tuition fees. As Danny has implied, the Tories ruled this out before the election and the Coalition Agreement specifically ruled it out. What is worse is that the initial proposals were announced within weeks of the government being formed. That means one of two things. Either the reforms were planned before the election and the Tories lied to the electorate and then lied to the Lib Dems in the coalition negotiations. Alternatively, they were drawn up on the back of a fag packet in just a few weeks.

 

Well dude, we all know the Tories would NEVER lie to the electorate.... :lol:

Well, it seemed yesterday that this was going to be the first policy from the Tory-led government that Cameron was actually going to take some responsibility for... but it seems old habits die hard for Human Shield Clegg, who today defended the NHS reforms, saying the Lib Dems agreed with them and that the NHS was currently a "play-thing of bureaucracies". Chris Huhne sitting next to him looked mortified.

Good LORD, whatever happened to him trying to distance himself from anything not covered by the agreement?!

Cameron's claims to support the NHS always remind me of why I despise him so much. He likes to talk about what the NHS did for his disabled son. But look at what he's really saying. He is implying that his support for the NHS was less than overwhelming while he didn't need it and could rely on the private sector. That changed when his family needed something insurance companies wouldn't pay for. So he wasn't particularly supportive when he was a net contributor but suddenly decided it was a good thing when he became a net beneficiary. Typical selfish Tory.