Five ways the NHS is changing

Patient on a stretcher The reforms get under way in April

The government's reforms of the NHS in England are coming into force.

Over 200 new organisations are being created, including a network of GP-led groups to manage the budget and NHS England, the national board which will oversee the new system.

It has been dubbed the most radical shake-up in the history of the NHS.

But what will actually be changing?

An end of the 'special relationship'

Ever since the NHS was created GPs have acted as the gatekeepers to the service, referring patients on to the right areas.

The relationship has meant that a special bond is often created between patient and their GP - or family doctor as they are known.

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It is often said GPs will be in charge of the budget, but in fact they will only get about 60% of it. The national board, NHS England, will be responsible for a number of services, including dentistry and specialist hospital care.

Polling consistently places doctors as among the highest trusted professionals.

But under the reforms GPs are getting control of the bulk of the NHS budget, so they can decide what local services to fund.

The theory is that as they are close to patients they will be better placed to know how money should be spent.

But the prospect of them holding the purse strings has caused concern that the "special relationship" could be damaged.

An Ipsos Mori poll for the British Medical Association found nearly three quarters of GPs feared this.

It argued patients could become suspicious if a doctor does not give them what they want as there could be a perception the GP is trying to save money rather than safeguarding their best interests.

The rise of the private sector

Scalpel The private sector is already involved in doing non-emergency operations for the NHS

This is the issue that has caused most controversy.

Critics have claimed the reforms will lead to the privatisation of the health service with health companies swooping in to "cherry pick" the most profitable services and destabilising NHS in the process.

But supporters believe the opportunities for the private sector are being overplayed. They say that if the firms can provide better services, more efficiently it will be good for patients and drive up standards across the whole sector.

Of course, the private sector is already involved in providing NHS care.

Under the Labour government they were invited to bid for contracts to carry out non-emergency operations, such as hip and knee replacements.

They have also got heavily involved in mental health care.

Meanwhile, over the past year, the coalition government has been encouraging them to get more involved in community services.

Estimates suggest £1 out of every £20 spent on health goes to a non-NHS provider, this includes both private sector firms and charities.

New kid on the block

One of the guiding principles for the reforms has been the push to improve the coordination of care for people with chronic conditions.

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There are an estimated 15m people with long-term conditions, but caring for them accounts for £7 in every £10 spent by the health and care sectors.

These are diseases such as diabetes and dementia for which there is no cure.

Instead of bouts of hospital treatment these patients need long-term support from a range of different services, it is widely argued.

But all too often such care is not available and these patients end up in hospitals when they suffer crises and emergencies.

With better planning such problems could be prevented - evidence suggests as many as a third of hospital admissions are avoidable.

If this is to succeed it is likely to see a network of integrated community clinics emerge, which run a variety of services from rehabilitation care to district nursing.

Emptying the bins and getting you fit

A much often overlooked part of the reforms involves public health. The term covers everything that prevents disease and prolongs life and therefore includes promoting physical activity and better diets as well as stop smoking services.

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Councils historically always used to have responsibility for public health - it was only handed over to the NHS in 1974. Past successes included the building of sewers and introduction of modern immunisation programmes.

Responsibility for this will be passed to local government as part of the changes.

The belief is that councils will be better placed to influence people's lives through their powers over planning, education and leisure services.

As part of the overhaul, public health directors who have been working for primary care trusts are being transferred into local authorities.

They will also get a ring-fenced budget of just under £3bn a year to ensure there is money available to get the new arrangements up-and-running - the rest of local government is facing budget cuts of a quarter.

Already councils have started looking at innovative ways of tackling the issue. This includes stopping smoking near to playgrounds to introducing outdoor gyms in parks and green spaces.

The biggest change... no change

Doctor with stethoscope In the short-term, patients will still be using their current services

Perhaps the most noticeable thing will be the fact that there will be little visible change - certainly in the short-term.

That may seem unbelievable given the amount of attention the changes have attracted.

But the upheaval that has taken place so far has largely been to the management structure.

It means as patients move around the new NHS they could be forgiven for thinking nothing has happened.

They will still go to their local GP surgery or hospital when they need help.

Indeed, many of the other factors discussed here are ones that will take some time to have an impact.

This, of course, does not mean what is happening is not important. Virtually everyone agrees - critics and supporters alike - that the NHS stands to rise or fall on the effect of the reforms.

It is just that the NHS, with its 1.4m staff and hundreds of different organisations, really is, has often been said, a bit like a supertanker - a change in direction does not happen immediately.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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