NHS structure changes come into force

Doctor's equipment, a sphygmomanometer and stethoscope The changes have proved extremely controversial

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Government reforms of the NHS in England have come into force and health leaders warn of a tough year ahead.

Monday marks the first day of the new structures.

GP-led groups have taken control of local budgets and a new board, NHS England, has started overseeing the day-to-day running of services.

The NHS Confederation said the reforms represented a big opportunity but should not be seen as a "silver bullet" for the challenges ahead.

Mike Farrar, chief executive of the confederation, which represents health managers, said the squeeze on finances and the need to rebuild public confidence after the Stafford Hospital scandal meant the NHS was facing a critical period.

He said the reforms would bring clinical expertise to the fore of decision making, which would be a "huge asset".

Start Quote

Because GPs have face-to-face contact with patients every day... they are really well-placed to be able to make decisions about how healthcare should be delivered best”

End Quote GP Catherine Briggs

But he warned: "We need to recognise the huge challenges facing the health service. New structures alone won't enable us to tackle these challenges, and we should not see them as a silver bullet.

"Those doing the day-job face major pressures in trying to keep the NHS's head above water, while focusing on making the new world work."

The start of the new system comes nearly three years since the changes were put forward.

The publication of the plans in the summer of 2010 sparked a long and, at times, damaging battle for the government to push through with its changes.

Ministers even had to take the unprecedented step of halting the progress of the bill through Parliament amid criticism from medical bodies, academics and unions.

In particular, concerns have been expressed about what many believe is a greater role for the private sector.

'Compassionate care'

Some have also questioned whether introducing such major changes - they have been dubbed the most radical overhaul since the NHS was created - at a time when money is so tight makes sense.

Start Quote

Far from letting 'doctors decide', ministers are forcing the medical profession to open up all NHS services to the market”

End Quote Andy Burnham Shadow health secretary

But as the new bodies take up control - and the old organisations, including 152 primary care trusts, are scrapped - the government maintained the changes would put the NHS on a firm footing for the 21st century.

Health Minister Anna Soubry said: "The health service will improve, work smarter and, importantly, build an NHS that delivers high quality, compassionate care for patients."

But shadow health secretary Andy Burnham predicted the changes would have the opposite effect.

"Far from letting 'doctors decide', ministers are forcing the medical profession to open up all NHS services to the market.

"Hundreds of new private companies now risk fragmenting patient care when more integration is needed."

GP Catherine Briggs said she would welcome more control over how budgets are spent.

"Because GPs have face-to-face contact with patients every day and because they know their patients and their communities really well," she said.

"That means they are really well-placed to be able to make decisions about how healthcare should be delivered best."

But GP John Hughes said he had reservations.

"The GPs aren't really free to do what they like with the money as a lot of people seem to think," he said.

"Most of the directions as to what happens to that money and what should be bought or commissioned locally is coming from the Department of Health."


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  • rate this

    Comment number 174.

    The trouble is these changes are about making the NHS cheaper to run not better, the raising of the 10% cap on private income will allow hospitals to run more private services, the cap will be set at 50% and Trusts will do all they can to earn as much money as possible privately, We will get a two tear service for the rich and poor, this is what the government wants the writing is on the wall.

  • rate this

    Comment number 173.

    There's none so blind than those that won't see. I remember the damage thatcher did to the NHS. Nurses, Doctors redundant, patients sleeping on trollies in corridors, because she closed wards. Long waiting lists, privatizing the cleaning, what a mess that proved to be. When labour took control in 1997 they had to spend so much money just to restore it, let alone improve it.

  • rate this

    Comment number 172.

    6 Minutes ago
    Doctors will be lobbied by reps from all sorts of 'medical' companies and bribed to choose certain medicines over others.
    So nothing has changed, because that is exactly how GP surgeries have operated for the past 30 years!!!

  • rate this

    Comment number 171.

    The largest betrayal of our people in recent history by an unelected elite.

    The darkest day I can remember.

  • rate this

    Comment number 170.

    It won't be long before we end up with a two tier melt service, one where you get treatment if you are prepared to pay and the rest of us having to rely on charities to provide a patched you up service.
    This government promised to protect our world renowned nhs, yet has created a structure that will increase the overhead cost, reducing the money on front line services.

  • rate this

    Comment number 169.

    "I think most people agree that the monolithic NHS is in dire need of reform."

    Really? You think that about the NHS and it's automatically what "most people" think?

    Well you're wrong - and you surely don't speak for ME.

  • Comment number 168.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 167.

    From 147. tightheadprop:
    "The people who dont want change are the same people who thought British Leyland made good cars. Give us your suggestions on how to make teh NHS better dont just reject other peoples."

    Illogical and weak thought. How are they the 'same' people? As for ideas: Look for private AND public services that help old people at home. Co-ordinate and pay for them within the NHS.

  • rate this

    Comment number 166.

    I think most people agree that the monolithic NHS is in dire need of reform. Things like N.I.C.E., which at a cost of several millions a year tells us the NHS cannot afford lifesaving drugs. Nurses given a degree in machine monitoring, but not trained to see the elderly patients do not die of malnutrition. Get the basics right first please.

  • rate this

    Comment number 165.

    Doctors are doctors not accountants. This is a recipe for disaster.

  • rate this

    Comment number 164.

    When the powers that be finaly get their way and privatise the NHS, what will they spend our money on they should save?
    My guess is it will go into the pockets of ceo's and mp's for services rendered to corrupt elitist capitalism.
    Anyone notice an increase in private health insurance adverts?
    The country is being run aground. Wake up you sheep!

  • rate this

    Comment number 163.

    And now this government cuts with real knives, like a 19th century royal navy surgeon, unclean, unhygienic, unjust. Every man, woman, child must do their duty, unless they are wealthy enough not to. They are within a whisker of acheiving their most dastardly, underhand, manoeuvre against the people of Britain in many, many years. They are without emotion, without decency, barbarians, destroyers.

  • rate this

    Comment number 162.

    If, as the government say, GP's know what is best for their patients, why are many patients being reassessed for fitness to work by private companies? Afterall it was the GP who knows the patient best, who diagnosed that the patient was unfit for work.

    This is all about political ideology, and nothing to do with providing what is best for the patient.

  • rate this

    Comment number 161.

    Generally speaking anything that disbands a client-state, such as the NHS, is a good thing. The scare stories about privatisation are nonsense, as the Dutch system (rated No 1 in the EU) proves on a daily basis - it's entirely privatised with compulsory health-insurance (free for >65s and

  • rate this

    Comment number 160.


    Sadly you have hit the nail on the head.

  • rate this

    Comment number 159.

    Doctors will be lobbied by reps from all sorts of 'medical' companies and bribed to choose certain medicines over others. It's all downhill from here...

    Nothing changed since 1948 then

  • rate this

    Comment number 158.

    The only way these reforms will work is if they sack all the nurses/doctors and employ more managers. What we need is PowerPoint presentations, targets and corporate dinners! Not medicine.

  • Comment number 157.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 156.

    I trust my GP to guide and advise me on what treatment I need and where I should have it. Routing more of the NHS budget through GPs should mean more patients get what their doctors think is best for them, rather than what some politician or bureaucrat thinks is best for them.

  • rate this

    Comment number 155.

    We had a case in York where a doctors surgery told patients that some ops where not available on the NHS but they could have the op privately in there clinic but in fact these ops where available on the NHS
    so lets see how long doctors only allow ops to be done in there clinics or there companies


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