Biggest revolution in the NHS for 60 years
GPs and 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 £80 billion 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 this 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.
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 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 and £80 billion, 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 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.”
Commentators are calling the changes “the most revolutionary in the NHS since 1948”. Mr Lansley hopes to have the changes in place by next April, although NHS managers believe that may be over-ambitious. Under the reforms, primary care trusts will not be scrapped immediately, but will be phased out as power is passed to doctors.
A new contract which makes GPs more accountable is likely to be part of the package of measures included in the white paper.
Responsibility will be handed to GPs working in local groups, who will commission services or provide them by working in rotas through co-ops. Mr Lansley believes that if GPs are responsible for their own budgets and have to commission out-of-hours care, most will decide to go back to offering weekend and evening cover themselves or in local groups.
The loss of jobs, which The Daily Telegraph has been told will run into tens of thousands, is also likely to lead to outcry from public sector trade unions. Ministers are already braced for industrial action over plans for severe cuts in the Whitehall workforce.
The fierce dispute over the plans has led to a delay in the publication of the white paper. However, it has been resolved in the past 48 hours.
A source said: “In the end, the Prime Minister clearly said to George Osborne that this was not one he should go to war on.”
Handing over so much power to GPs will revive memories of reforms by the last Conservative government to give control back to the local level through GP fund-holding. Labour, under Tony Blair, attempted a similar plan but fell short.
However, a senior government source told The Daily Telegraph last night that the Coalition’s attempt will succeed because of the political will behind it.
The source said: “GP fund-holding was voluntary. This is going to be compulsory. This is pushing through the whole lot of policy that either Tory or Labour governments have tried in the NHS’s history but have never gone through with properly.”
The reaction of GPs to the changes will be crucial if the Coalition is to avoid confrontation. Ministers will hope that they embrace the opportunity, but some are likely to oppose the moves. Labour failed to drive through public service reforms in the face of opposition from unions and vested interests, as well as opposition from the party’s own MPs.
But Mr Cameron is determined to put his stamp on reform. In a speech to civil servants yesterday, he said his time at No?10 would not be defined solely by cuts and the deficit reduction plan.
Tags: Andrew Lansley, Conservatives, Doctors, GPs, National Health Service, NHS, out of hours