Q&A: The NHS shake-up

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The government is carrying out major reforms to the NHS in England.

GPs will be given much more responsibility for spending much of the budget, hospitals are to be set free from central control and an independent board will oversee services.

It has been dubbed the most radical plan in the history of the NHS.

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 (PCTs).

There are 151 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 will transfer much of that responsibility to GPs working in consortiums across the country. Around 50 have already signed up to the scheme.

Both PCTs and regional bodies known as Strategic Health Authorities are to be phased out over the next few years, with funding going directly to GPs.

The reforms do not affect the health service in Scotland, Wales and Northern Ireland, which are devolved to their national administrations.

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 scheme have been criticised by some doctors, nurses and patient groups. They are concerned about the speed of reforms, and financial pressures on the NHS.

The Commons Health Select Committee has said meeting efficiency savings will test the NHS to the limit.

Doubts 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. It is also expected to take charge of paying for some services which are not being given to the GP consortiums. These include dentistry and specialist services such as paediatric intensive care, which are only done in the largest hospitals.

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.

Are hospitals changing too?

Yes, and potentially quite radically too. The White Paper talked about creating a "vibrant" industry of social enterprises.

Key to this is getting all trusts to attain self-governing foundation trust status - nearly two thirds have so far.

What is more, the cap on private income is to be lifted, allowing them to compete with private firms in a host of areas. This in itself is quite a significant step.

The government has also talked about hospitals going a step further and becoming employee-led bodies as the retailer John Lewis is.

However, that would be complicated to achieve. For one thing, hospitals have considerable assets, such as buildings, which are owned by the state and would need to be bought. This would prove too expensive if they were valued at market prices.

What changes will patients see?

Visually, none. They will still walk through the doors of their local GP surgery and talk to the same staff they always do.

However, if the government achieves its aim they may find themselves with more control over their care.

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

They can already choose which hospital they want to go to for non-emergency operations, such as knee and hip replacements.

In the future, this choice is to be extended to GPs. Practice boundaries will be scrapped, enabling a patient to register with any family doctor they wish to.

Patients have been promised more and clearer information. Central to this will be HealthWatch, a patient body which will collate information on performance and feedback from patients themselves.

What happens now?

This year will see GPs start piloting the plans, before full roll out is completed by April 2013. The existing management structure - PCTs 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 affect only England. Scotland, Wales and Northern Ireland have not 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.

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