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 294.

    Corn - tea party whackjobs won't accept the fact that a railway's purpose is not to provide profit - it's infrastructure - it's what allows business to operate when it's part of an integrated network.
    There will always be subsidy

    Same applies to healthcare. WE, the UK population have one simple choice : NHS or Medicaid.

    I wonder what the biggest cause of personal bankruptcy is in the US?

  • rate this

    Comment number 293.

    Want to see what healthcare would be like under a "reformed" NHS, I suggest the gofundme website.

    A not untypical example:

    "I am ... and I am requesting that you contribute whatever you can to cover my medical expenses of approximately $50,000."

    50 million Americans have no heath insurance. More than 60% of bankruptcies are due to catastrophic medical costs.

    Think long & hard about NHS reform.

  • rate this

    Comment number 292.

    Er... Does no-one see the big elephant in the room? Not wishing to denigrate my medical colleagues who have chosen the GP route, BUT.GP practices are NOT NHS employers. They are and always have been (save those who failed and taken back under PCT control for a period) private businesses. So whatever way you look at it its now a private commissioning controlled model. Even Mrs T baulked at that!

  • rate this

    Comment number 291.

    Tories. . . give them enough rope and they'll hang themselves. . . just like last time.

  • rate this

    Comment number 290.

    Please don't wait until you are in the unfortunate position of being in an A&E department waiting for treatment......
    Don't you mean waiting for the accountant?

  • rate this

    Comment number 289.

    1 Hour ago

    The Left has been wrong about everything since its ideology first saw the light of day. To support these changes you need know no more about them than to see they are opposed by the socialists.


    I don`t recall capitalists refusing socialism when it came to bailing out the banks. No ethics and no principals, just profit at any cost and by any means.

  • rate this

    Comment number 288.

    Human nature being as it is, some GPs will inevitably take advantage of an opportunity to enrich themselves, & if they can mask this with altruism, they will.

    And it's true, as many point out, that UK GPs are now GROSSLY over-rewarded for their often self-serving service provision (appts. at a weekend or after work being a case in point. But they do pay quite a lot for the fat pensions: be fair

  • rate this

    Comment number 287.

    We are one more step, one more snip, one more cut from a complete stitch up. It seems, they think, the patient is not worth saving, the corpse, unable and not needing to turn out the light. A great darkness settles, a nuclear winter, with no social nucleus. greed is self, and too many are nothing but self.
    ***If you do not have private health insurance does the govt. want you treated?

  • rate this

    Comment number 286.

    Mix of comments makes our predicament easy to understand. Tories
    attack Labour & vice versa, free-riders attack all. Hardly any seeing that to trust each other we need to be equal partners

    We need to KNOW the doctor has a vocation, NOT a money-fixation

    ALL must be VALUED, from most senior politician to most junior porter

    Pressured, sham democracy gave hobbled NHS: and now closes its iron mask

  • rate this

    Comment number 285.

    So what do I get, should I fall ill, for my 36 years of NI contributions and eye watering PAYE tax as a humble worker having never cost the system a penny since leaving school?

    Do I now simply go to the back of the queue should my GP / Accountant decide?

    Helping the poor is noble but returning the favour once in a while to those who contribute would be nice!

  • rate this

    Comment number 284.

    "No top-down reorganisation of the NHS". Remember that? How could Cameron tell such a blatant lie?

  • rate this

    Comment number 283.

    Right let's all sit back, wait until the who lot goes to pot, then give Downing Street the huge collective 'Told you so' that it deserves.

  • rate this

    Comment number 282.

    If I believed for one minute that these changes will benefit the patient I would be happy, BUT I dont trust Dr's and I dont trust MP's. Its gonna be a disaster for us the patient. I work for the largest health insurer so be interesting to see if more people sign up ! As and insider I shall keep you all updated !

  • rate this

    Comment number 281.

    Opposition parties have been banging on about the 'privatisation' of the NHS for years and guess what? It still hasn't been privatised.
    All governments reform the NHS. Indeed it wasn't the Tories who firstvintroduced private services into the NHS. It was Tony Blair's government. This government is only extending that provision.
    It's still free at the point of use. It hasn't been privatised.

  • rate this

    Comment number 280.

    News just in.... Vodafone has invested £6billion (that's a lot) in a sponsorship deal with Care UK - the latter is to implement a tariff of operations under the strapline "Pay per stitch" using Vodafone's needlessly complex but profit maximising model.Careful what you order folks....

    As the tories say a stitch in time..........boosts the offshores savings enormously

  • rate this

    Comment number 279.

    Toughatthebottom@250,...Yes indeed, come back David, all is forgiven, but we need help and protection, not charity, and you do not need to ride a white horse, or support Sunderland.

  • rate this

    Comment number 278.

    If we let these vile creatures take away our healthcare in the name of profit and greed then our entire generation should hang it's head in shame.

    Some things are worth fighting for, this is one of them.

  • rate this

    Comment number 277.

    263. trebormint
    And where does equality fit into all of this?

  • rate this

    Comment number 276.

    How many posters here mention "American" or "US" as the destination for the NHS; as if all the other health systems, in Europe let alone the world, simply don't exist? How many talk about "NHS employees" as though they are saints, somehow different from any other employees with some sort of special claim on us? How many won't admit the terrible failings of the NHS? Most of them.

  • rate this

    Comment number 275.

    The gravy train that is the NHS could not survive without the billions of pounds that are wasted on it. This is in the name of political priorities and by governments that have no wish to even try to understand the facts. The NHS should be wiped out and replaced by a model that actually works.
    That of course will never happen while the country is governed exclusively by liberal fascists.


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