Doctors are to be given sole responsibility for overseeing front-line care to patients under Coalition plans described as the biggest revolution in the NHS since its foundation 60 years ago. About £80billion will be distributed to family GPs in a move that will see strategic health authorities and primary care trusts scrapped. The plan, contained in a white paper to be published next week, is designed to place key decisions about how patients are cared for in the hands of doctors who know them. Tens of thousands of administrative jobs in the health service will be lost as a result. At present, funds are given by the Government to primary care trusts, which pay for patients from their area to be treated in hospital.
Tens of thousands of administrative jobs in the health service will be lost as a result
Under these plans, GPs - who are currently not responsible for paying for hospital referrals - would receive the money instead and pay the hospitals directly. The change will be compulsory. The Coalition hopes the new system will be less bureaucratic and give doctors and patients more control over treatment. GPs will also have to organise out-of-hours services, which may see family doctors offering 24-hour care once again.
The decision represents a victory for Andrew Lansley, the Health Secretary. He has been backed by David Cameron in his fight with the Treasury over his decision to give taxpayers’ cash directly to doctors.
George Osborne, the Chancellor, raised serious concerns about putting such a vast sum of money, thought to be between £60-£80billion, back in the hands of GPs. Health spending has been ring-fenced by the Coalition and will not be subject to the severe cuts that will hit other Whitehall departments. However, it is understood that Mr Osborne has been assured by Mr Lansley that there will be safeguards in place to ensure GPs do not “waste” the money. The acting chief executive of the NHS Confederation, Nigel Edwards, warned this morning that the changes will be difficult to implement: "In transition to this new system there are some quite significant risks," he said. "Obviously it is going to take time to implement this and the PCTs at the moment are the people who keep the lid on the performance and financial management of the system."
The move to scrap the 150 primary care trusts and strategic health authorities, which cover a range of NHS trusts and supervise local NHS services, will come as a shock to Conservative and Liberal Democrat MPs. The Coalition agreement explicitly vowed to “stop the top-down reorganisations of the NHS that have got in the way of patient care”. Rather than talking about scrapping trusts, the document explained the role they would continue to play. However, Mr Lansley will point to the commitment in the joint Tory-Lib Dem document which states: “We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf.”
Some campaign groups are dismayed at the plans as the Conservatives had pledged not to introduce top-down reorganisations. Civitas said based on previous reorganisations the Government's plans would lead to a "one year dip" in overall performance. Civitas has compared the performance of primary care trusts that were merged during the last reorganisation in 2006/7 with the performance of those that were unaffected. It was found that the merged trusts lagged behind those that were unaffected and took three years to catch up in their performance. Civitas said the plans could cost the NHS the £20 billion of efficiency savings it has been told to make by 2014 because of the time taken for the reorganisation to take effect and start improving services.
James Gubb, director of the health unit at Civitas, said: "The NHS is facing the most difficult financial times in its history. "Now is not the time for ripping up internal structures yet again on scant evidence base, but for focusing minds on the task ahead and really getting behind the difficult decisions PCTs, as commissioners, will have to make."
the Daily Telegraph
the Daily Telegraph
