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| Version 3 | Version 4 |
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| Q&A: The NHS shake-up | Q&A: The NHS shake-up |
| (40 minutes later) | |
| The government has revealed proposals for a major shake-up of the NHS system in England. | The government has revealed proposals for a major shake-up of the NHS system in England. |
| GPs will be given much more responsibility for spending the budget, while an independent board will be formed to oversee the health service. | GPs will be given much more responsibility for spending the budget, while an independent board will 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 want to transfer much of that responsibility to GPs working in consortiums across the country. | Ministers want to transfer much of that responsibility to GPs working in consortiums across the country. |
| Both primary care trusts and strategic health authorities are to be phased out over the next few years, with funding going directly to GPs. | |
| 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 far more wide-ranging. | 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. | 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. | 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. | 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? |
| The British Medical Association, the medical profession's trade union, has said it is "ready, willing and able" to meet the challenge. | The British Medical Association, the medical 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 consortiums of GPs set up across the country. | However, doubts do 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. | 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. | 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 will be given responsibility for setting standards and holding GPs to account, 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 changes will patients see? | What changes will patients see? |
| Mr Lansley says the reforms set out a vision for an NHS led by patients and professionals, not by politicians. He says patients will be handed more choice over how and where they are treated. | Mr Lansley says the reforms set out a vision for an NHS led by patients and professionals, not by politicians. He says patients will be handed more choice over how and where they are treated. |
| They are promised more information and choice, including the ability to register with any GP they want to. | |
| Charities are calling for more clarity for patients. | |
| Peter Hollins, chief executive at the British Heart Foundation, said: "This radical shake-up has thrown up a kaleidoscope of possibilities and like every GP in the country we will be devouring the detail of the white paper." | |
| John Black, president of the Royal College of Surgeons of England, added: "If these new proposals are to benefit patients having surgery, they must enable GPs the flexibility to make decisions based upon the need of the individual patient and allow them to refer to a single, named consultant who will see their patient through the operation and afterwards. | |
| "We need to hear more detail, especially on the composition of proposed GP consortia and the powerful new independent NHS commissioning board. " | |
| What happens now? | |
| The government says it will be carrying out a consultation, but it already seems to be in a hurry to get going. | |
| The White Paper includes a fairly detailed timescale for action. | |
| Next year will see GPs start piloting the plans, before full roll out starts in 2012. The existing management structure - primary care trusts 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 only affect England. None of the other countries have given responsibility to GPs on this scale. | 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. | 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. | 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. | 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. | Northern Ireland has an integrated health and social care system with four boards in charge of monitoring the performance of NHS trusts. |