NHS plans to be rewritten following review

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Media captionProfessor Steve Field GP, who led the forum: 'Competition isn't the be all and end all'

The government is to accept large swathes of its plans for the NHS in England need to be rewritten, the BBC has learnt.

Concessions will be made over the pace of change and the powers given to GPs, as demanded by an independent review.

More details - including about the role of competition in the health service - will be unveiled on Tuesday in the government's response to the review.

Ministers hope a quick response will allow them to restart stalled changes.

In April, the government took the unprecedented move of halting the parliamentary progress of the Health and Social Care Bill underpinning the changes amid mounting criticism from academics, health unions and MPs.

A panel of experts, called the NHS Future Forum, was set up to review the policy.

Its report on Monday recommended a wide-range of changes be made.

The BBC understands many of those will now be accepted, including:

  • The legal responsibility of the health secretary for the NHS to be reinstated
  • The 2013 deadline for the new arrangements to be relaxed. Commissioning groups will have to be established, but those not ready will not have to take on responsibility for the budget. Instead, the national board in London will take charge in those circumstances
  • The power of health and well-being boards, which are being set up by councils, to be beefed up. Patients also given a greater role on them to ensure the patient voice is heard
  • GPs will still take the lead in making decisions through the commissioning groups, but other professionals such as hospital doctors and nurses to be consulted more

However, it is not yet clear what the government will do about the recommendations the forum made about competition.

Patient choice

Ministers had originally wanted to hand GPs control of much of the NHS budget, while opening up the health service to greater competition.

But the BBC's Laura Kuenssberg understands the government will not be explicit on whether all GP groups in England will be compelled to take on control of budgets and planning.

It means GP commissioning will therefore still be voluntary.

The forum had suggested that, while GPs should remain in the driving seat, they should consult with other professionals.

The review also proposed a greater balance between competition and co-operation among NHS hospitals, charities and private firms.

The focus on competition - perhaps the most controversial element of the plans - needed to be "significantly diluted", it said.

Originally, the regulator - Monitor - was to have a primary duty to promote competition, but that should be dropped along with the term "economic regulator", which the forum said made the NHS sound too much like the gas or electricity industry.

Instead, the regulator should focus on ensuring patients have choice to drive up standards. While competition had a role to play, so did collaboration and integration, the forum said.

Sir Richard Thompson, president of the Royal College of Physicians, said the forum's changes to competition were a "step in the right direction".

Dr Hamish Meldrum, chairman of British Medical Association, said the government's approach during the listening exercise had been "refreshing", but this needed to be maintained in the coming months.

"Obviously, the critical factor is now how the government responds."

Professor Steve Field, the former head of the Royal College of GPs who led the forum, said while the principle of putting doctors in charge was well supported, he had heard "genuine and deep-seated concerns" from many.

"If the substantial changes we propose are accepted by government then I think the resulting framework will place the NHS in a strong position."

Speaking ahead of the full government response, Health Secretary Andrew Lansley said the group had been an "invaluable source of expert advice".

The BBC understands that ministers are hopeful the NHS Future Forum report and the government response will allow them to press ahead almost immediately with the programme.

Officials are working on the basis that amendments could be made to the bill within weeks, allowing the government to kick-start the parliamentary process before the summer.

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