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GPs 'to get control of NHS funds' NHS 'to undergo radical overhaul'
(about 6 hours later)
By Nick Triggle Health reporter, BBC News By Nick Triggle Health reporter, BBC News The plans have been unveiled in a white paper
GPs will be given responsibility for much of England's NHS budget, under proposals being put forward on Monday. The NHS in England is to undergo a major restructuring in one of the biggest shake-ups in its history, the government has announced.
Ministers want doctors to get together in groups to take charge of billions of pounds of funds for mental health, hospital and community services. Hospitals are to be moved out of the NHS to create a "vibrant" industry of social enterprises under the proposals.
It would represent a major change but they believe GPs are better placed than managers to respond to patient need. And, as expected, GPs are to take charge of much of the budget.
But some experts question whether GPs have the skills to take it on. The move will lead to the abolishing of all 10 strategic health authorities and the 152 management bodies known as primary care trusts.
'Empower' doctors The new structure will be held accountable by an independent NHS board which would be free from political interference, the government said.
The NHS budget stands at £105bn. About 80% of this is given to local health managers working for 152 primary care trusts which in turn commission services for their areas. Meanwhile, responsibility for public health will be passed to local authorities.
But the White Paper, which will be published later, is expected to call for much of this to be handed to GPs working together in formal partnerships in what would be a major shake-up of the NHS structure. 'Challenging'
The White Paper is also expected to make reference to the creation of an independent NHS board to oversee health services. In many ways, the plans outlined in a White Paper go further than expected. The coalition agreement had promised no top-down reorganisations.
Prof Chris Ham, chief executive of the King's Fund health think tank, said the proposals were part of the "biggest organisational upheaval in the health service, probably, since its inception". But Health Secretary Andrew Lansley said he had decided to go further than first envisaged to rid the health service of bureaucracy.
He said giving GPs additional responsibilities was a "good idea", although there were possible pitfalls. He said the proposals would be challenging and turn the NHS "upside down" but in doing so help reduce management costs by nearly a half within four years.
Prof Ham said: "GPs know their patients and their needs very well. They are, therefore, well positioned to take decisions on the use of resources and improve patient care and patient outcomes. He added: "The government's ambition is for health outcomes - and quality services - that are among the best in the world."
"The risk is that not all GPs have the motivation to do so - many don't have the skills either - and to implement this across the whole of England, without some degree of testing and piloting, could be a risky thing for the government to do." The GP move had long been championed by Mr Lansley - and in recent months the British Medical Association had indicated it was willing to work with him on the idea.
The GP move has long been championed by Health Secretary Andrew Lansley - and in recent months the British Medical Association has indicated it is open to working with the government on the idea. The plans mean GPs working in groups will be in charge of a vast collection of hospital, mental health and community services - although specialist services and dentistry will not fall under their remit.
Mr Lansley said the proposals would "empower" doctors and tackle the "frustrating" bureaucracy which plagued the health service. Under the new system, the independent board will sit above as many as 500 consortiums of GPs to set standards and hold the groups to account.
"We have got to design services better and save money. GPs are best placed to do this." Another key aspect of the changes involves giving patients more information and choice. To achieve this, a new body, HealthWatch, will be set up to compile data on performance, while GP boundaries will be abolished to allow patients to register with any doctor they want.
But some experts have expressed concerns about the idea. Mr Lansley also announced he expected all NHS trusts, which run hospitals and mental health units, to get foundation status by 2013.
A report by the Civitas think tank said there was little evidence that GPs would be better than the current system and even warned the restructuring could set the NHS back by three years. 'Experiment'
He also said he would be relaxing the rules which cap the amount of income a trust can make outside the NHS, opening the door to them seeing more private patients.
He said this would allow them to innovate and widen the scope of what they did, but he also admitted it would mean those which were not financially viable could go under.
The government will now consult on its plans before rolling them out over the next three years.
Professor Chris Ham, chief executive of the King's Fund think-tank, said: "It is a very radical programme. We have never seen anything like this since the inception of the NHS in 1948."
But he said the moves were not without risk, pointing out some GPs would not have the skills to manage the budget.
Shadow health secretary Andy Burnham went further, describing the changes as a "political experiment".
"It is a huge gamble with a NHS that is working well for patients."
Are you a GP? Do you work in the medical profession? What is your response to the proposals?Are you a GP? Do you work in the medical profession? What is your response to the proposals?