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 434.

    @427 Mattmatt81
    You really have missed the point about what these so-called reforms mean about haven't you?
    Semantics aside, what they're doing is handing your taxes over for the private sector to trouser.
    For what? An inferior, shoddier, typically private-sector 'service'.

  • rate this

    Comment number 433.

    Cameron and Clegg were successful in deceiving a lot of voters that the NHS was safe in their hands. They are both liars and the country deserves a lot better. Cameron and Clegg have managed to make terrible changes to the NHS against the wishes of the majority of people in this country. They got voted in under false pretences about the NHS.

  • rate this

    Comment number 432.

    tightheadprop @403
    "tell us how to make it better"

    You really don't know?

    Q: What would it take for anyone, to speak truth unto power?

    A: Young courage without dependents, foolhardiness with


  • rate this

    Comment number 431.

    The NHS is a basket case and has been for years.
    Top heavy with beaurocrats, doctors who can't speak English, nurses too precious or too idle to clean and care for patients.
    Ask Liverpool, Bradford, Stafford, Bristol.
    Don't go into hospital in Britain. It aint healthy

  • rate this

    Comment number 430.

    One of our local GPs is being taken out of the front line to spend two days a week heading up a sub-area of our clinical commissioning team. So how many more GP-days are being wasted on this nonsense?

    Get GPs back on the front line careing for patients and get managers in to manage the commissioning (if you must). Or will that lead to us having to elect Health and Sickness Commissioners?

  • rate this

    Comment number 429.

    This is a good time to refresh memories and take stock of where we are:


    Watch the short video.
    Dave's sincerity is compelling. Look how genuine he is

    He's going to ring fence the NHS - spend more money on it - you can summarise tory policy with 3 letters, N-H-S he says.

    One can only assume the N stands for No in light of his actions.

  • rate this

    Comment number 428.

    The coalition are trying to make it sound like most GPs are in control of commisioning decisions. Most GPs have no say atall, and the minority of GPs who have a small say will just be bullied by administrators above into making cheap contracts with private health providers. Patients and most GPs will have no say or choice atall. There will be less choice for patients and GPs.

  • rate this

    Comment number 427.

    419 passing stranger .

    You do not actually understand what top down means do you .
    these changes are middle out .
    Replacing " do as we say" with " do what you want " but take responsibility .

    423 Billy
    By incentive I do not necessarily mean cash ( it helps ) . But recognition of talent ,effort and professionalism .All failings I have seen have been by those who did not care .

  • rate this

    Comment number 426.

    The NHS has been one of the most cost effective health services in the World. Now NHS funds will be siphoned off into the pockets/profits of several private health care providers waiting greedily and eagerly in the wings , now that Cameron, Clegg and Hunt have given them the go ahead. This is a very sad day for the NHS.

  • rate this

    Comment number 425.

    Why thank you Flop - it's not often one receives a freebie from a tory - it is free isn't it?
    NL irrelevant.
    Reference for measuring standards?
    My preference would be to hand over management of UK healthcare to the German Government to avoid the Medicaid traincrash that is heading our way courtesy of McKinseys and US lickspittle tories like Fox News Anchorman & part time MEP D.Hannan

  • rate this

    Comment number 424.

    @415 - Get them out of poverty and they'll contribute more to society and feel less inclined to smoke.

  • rate this

    Comment number 423.

    Matt, I would dispense with the pretence that unions have meaningful power unless you're referring to the British Bankers Association, or Dave's Line Managers as they should be known.
    Also incentivising the NHS is precisely the wrong approach - we've already been there - but I accept that careful management and scrutiny is a must and would need to be costed into the equation.

  • rate this

    Comment number 422.

    Billythe first - the "derr" is all yours - you still havent told us what you were doing when the last gvt wasted billions and you still havent told us what you would do to get the NHS up to the standards of the best in the world. Your sad Tory bashing will only get you so far until we all realise you dont have an alternative.

  • rate this

    Comment number 421.

    We urgently need to get this government out before they destroy everything in this country- the NHS, the economy, education, peoples' homes and lives etc.

  • rate this

    Comment number 420.

    @339 so you refuse people treatment based on their contribution towards their illness and disregard the underlying condition that leads to them (such as addiction in the first place)? And where does that stop? Close GUM clinics as people had sex? Refuse to treat a broken bone due to misadventure?

  • rate this

    Comment number 419.

    @ 413 - Agreed. Also, these changes were the Tories' (aka LibDems) hidden agenda. They promised an end to top-down changes to the NHS and then embarked upon the most far-reaching 'reforms' ever.
    This shows that they're totally untrustworthy and unprincipled: It's another attack on the Public Sector and the most vulnerable in society, such as we've come to associate with the Coalition

  • rate this

    Comment number 418.

    Cameron is a liar- "no top down reorganisation of the NHS". This is the biggest and worst reorganisation of the NHS! Clegg and co have also voted in these terrible changes to our NHS, against the wishes of most of the people and health workers in this country. Cameron and Clegg are just doing what their rich friends want- to privatise as much of the NHS as possible.

  • rate this

    Comment number 417.

    #403 Flop
    Did these moaners protect about the billions wasted by the last government on IT systems and business consultants?
    Another Derrrr I'm afraid.

    Heard of McKinseys? How about Universal Credits?

    These debacles are unfolding before you right now - colossal tax payer expense to fund inept ideological disasters.

    Why look back? Tory driven tory failure - no one else's fault.

  • rate this

    Comment number 416.

    The NHS is a wasteful mamoth that needs change.I am not talking about the doctors and nurses at the sharp end I am talking about the massive waste in management, IT systems and business consultants that the last government brought in. They thought it was a great idea to throw money at a problem but that money went to big business (IT and consultants) not to patient care, who among you moaned then?

  • rate this

    Comment number 415.

    drinkers and smokers contribute a lot of tax to help pay for the NHS and the revenue from them far excedds £20 billion you claim!"

    Not true. Smoking is largely confined the poorest in society (the mentally ill, prisoners, single mothers) who are mainly funded by the taxpayer in the first place. The middle/higher income smoker who voluntarily pays more taxes is a declining rarity.


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