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Health white paper - what nurses need to know


Health secretary Andrew Lansley has set out his blueprint for the future of the NHS in a white paper.

The key changes are:

  • Individual employers will have the right to agree nurse pay deals locally, as foundation trusts can already do, rather than by national agreements like Agenda for Change
  • The Department of Health will have a reduced role in overseeing nurse training and education, with responsibility for agreeing plans and funding passing to local employers and staff
  • Frontline nurses and doctors will be given more control and empowered to use their professional judgement about what is right for patients through bottom up decision making
  • GPs will be asked to take on responsibility for spending a large part of the NHS budget
  • All hospital trusts will become foundation trusts, which will be given greater freedoms than they have now
  • Hospitals are also being encouraged to move outside the NHS to become “vibrant” social enterprises
  • Patients will be given a choice of GP practice, consultant-led team and treatment
  • Strategic health authorities and primary care trusts face the axe

Readers' comments (25)

  • Hurrah - the stumbling block of PCT and non HCP decision making will mean some realistic decisions.

    Doubtlessly it will have bumps - as all the changes in NHS but lets hope the £'s will be directed to wehre it needs to be not sloshing around in the PCT's, SHA's or Specialist Commisioners!

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  • oh dear rerun of GP fund holding on a grand scale. Cheap labour. Nurses really won't have a say nor will the patient!. How will quality be maintained? £££ v's quality and £££$$$ wins all the time. Who will monitor who? Who will maintain standards which will maintain quality and competency. Primary care now has a core standard that is already transparent. WHO will monitor GP's now. I can only forsee the gap between rich and poor getting larger. After all if you can't get what you want on the NHS you can always pay for it!!!! & the people that can pay will also have a voice. The best treatment for one person is not always the same as a slightly lesser treatment that would treat more. Oh what a sad day for the NHS

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  • I agree with this move in principle, but believe that GP's are perhaps not the best people to hold all of the purse strings. Why do they have so much control? Why do senior Nurses and clinicians in secondary care not have a share of the control? Why are Nurses not mentioned more? Are we not considered important enough?

    There are a lot of good points about this move, and overall I am glad it is happening, especially as SHA's and primary care trusts are to be scrapped, but seriosu questions need to be asked before it is fully implemented.

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  • Martin Gray

    Just how are GPs going to find the time to manage budget and commissioning on top of their already extensive workload? By passing the buck to the practice managers and other non clinical staff? They will certainly find ways of increasing their own income either directly or indirectly; and I doubt if any nurses will see any financial gain, probably quite the reverse now employers are being allowed to set the pay scales.

    What is needed is a joint executive, made up of both primary and secondary care clinicians (doctors and nurses) with some representation from the non clinical staff ( clinicians do not do all the work after all, there has to be administartion and management). That way at least there would be some control over how the money is spent to best advantage rather than all being decided by primary care clinicians.

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  • Martin Gray

    But this MUST be the bell toll for all those overpaid managers and clinicians in dubious roles for which their is insufficient ewvidence to warrant their existence. HOORAY!

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  • Absolutely agree Martin.

    First of all I join you in that long overdue Hoorah for the long walk of shame for the non jobs!

    Second you are absolutely right that the responsibility for the purse strings must lie in clinicians from both primary AND secondary care, and be made up of BOTH Doctors and Nurses. I believe that is the only way forward.

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  • I understand and agree, things must change but doubt the logic of giving gps all the power.
    Where are the consultation papers from the Government asking the public who they want spending their money for them and what on. Yet again its the people with money and a voice who will get the lions share and all the SAY!

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  • I have recently been made redundant by my PCT and have over the last 2 days been enraged by the prospective changes being proposed in the 'White Paper'.
    Over the last 20 years or more the NHS has undergone significant costly changes. I am sure that in the recesses of my mind we were promised that the NHS would be left alone and here we have it the new 'White Paper'. I can't believe how angry I feel but I truly am the one thing I love and have loved is being able to proudly state that I am nurse who worked within the NHS and all my colleagues.
    I have been unable to let this lie so I have written to my local MP and I am now going to write also to the Health Secretary. These faceless people in Whitehall really do not understand the processes of health care and those that deliver it. If you feel as half as strongly as I do then let them at Whitehall know. As private citizens we have a right to save Nursing and the NHS.

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  • I'm sorry Maureen but half of this white paper IS about letting clinicians decide how to run the NHS, effectively removing a lot of government/PCT/SHA/Executive meddling.

    I don't agree with a lot of the way it is being implemented (such as the fact that GP's are getting control of the purse strings - why?) But I do think this is essentially a good thing for the NHS.

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  • While I agree in principle that the National Health Service needed to change to the current needs of the modern population, I now believe that the "Service" out of the NHS has been removed.
    The white paper states that greater freedom and accountability will be given to providers of care but contradictory that the pay will be structured at local level. So for nurses, prescribers and nurse practitioners this could mean more responsibility and less pay.
    Will GPs work in consortia? what about nurses providing highly specialist patient care to the small groups of patients' like children on insulin pumps? which GP's will commission that service?
    I would have liked to have seen doctors and nurses working collaboratively in these consortiums. Where is the respect and support for the quality and care nurses' provide, unique to the nursing profession. The nursing profession yet again has to strive for recognition as a profession in it's own right and again another hill to climb nurses so get your walking shoes on........

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