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| Q&A: The NHS shake-up | Q&A: The NHS shake-up |
| (2 days later) | |
| The government is set to reveal proposals for a major shake-up of the NHS system in England. | The government is set to reveal proposals for a major shake-up of the NHS system in England. |
| GPs are expected to be given much more responsibility for spending the budget, while an independent board could be formed to oversee the health service. | |
| The NHS budget is more than £100bn a year in England | The NHS budget is more than £100bn a year in England |
| Who is responsible for the budget now and how could that change? | 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. | About 80% of the budget is held by local managers working for primary care trusts. |
| There are 152 of these in England and they are effectively in charge of commissioning local services, such as hospitals, GPs, mental health units and community clinics. | There are 152 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 have indicated they want to transfer much of that responsibility to GPs working in consortia across the country. | Ministers have indicated they want to transfer much of that responsibility to GPs working in consortia across the country. |
| There could be as many as 500 - although input from managers in some form will still be needed for some specialist services, such as children's intensive care or heart surgery. | |
| Has anything like this been tried before? | 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. | 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 likely to be far more wide-ranging. | The latest model is likely to be 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. | 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. | 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. | 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? | 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. | 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. | 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? | What do the experts think? |
| GPs, unsurprisingly, are keen. The British Medical Association, the profession's trade union, has said it is "ready, willing and able" to meet the challenge. | GPs, unsurprisingly, are keen. The British Medical Association, the profession's trade union, has said it is "ready, willing and able" to meet the challenge. |
| However, doubts do remain about whether there will be enough interest in every area to get effective consortia set up across the country. | However, doubts do remain about whether there will be enough interest in every area to get effective consortia 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. | 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? | 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. | 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 is likely to be given responsibility for overseeing the health service, while 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. | The board is likely to be given responsibility for overseeing the health service, while 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. |
| What happens elsewhere in the UK? | |
| Health is a devolved power and as such the plans only affect England. None of the other countries have 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. |