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Your guide to the NHS reforms


The government last week published proposals to amend the Health and Social Care Bill, following a “listening exercise” on its NHS reforms. Below are the key changes that will impact on nurses. Further details of changes to the legislation are due to be published this week.

GP consortia

GP consortia have been rebranded as “clinical commissioning groups” to reflect the wider involvement of health professionals other than GPs in NHS decision making.

Commissioning groups must have a registered nurse, a hospital doctor and two lay members on their board. These boards will have to meet in public, publishing their minutes and details of contracts.

The geographical boundaries of these groups should “not normally” cross those of local authorities. Their names must include the initials “NHS” and have a “clear link to their locality”.

Duty of candour

There will be a new contractual requirement on NHS trusts and other providers to be “open and transparent” in admitting mistakes.

Strategic health authorities

SHAs will be clustered in the same manner as primary care trusts have been grouped together. This process is expected to take place later this year. There are expected to be four SHA clusters. SHAs are set to disappear in April 2013.

Clinical senates and networks

Clinical networks will be expanded in number to take in more disease areas. Doctors and nurses will be invited to form “clinical senates” in local areas to advise commissioning groups and scrutinise their plans.

NHS Commissioning Board

The board will establish “close links” with the royal colleges and other professional bodies to “firmly entrench” expert partnership working. It will have both a nursing director and medical director.

The board will also have “local arms”, which will reflect current PCT clusters.

Clinical research

Clinical commissioning groups will have a new duty to promote research, as will the health secretary and the NHS Commissioning Board.

Health and wellbeing boards

These boards, made up of councillors and representatives of social care, will have more influence over commissioning groups than previously planned. They will have a “clear right” to send plans back to groups or the NHS Commissioning Board if they are not in line with other local strategies.

The boards will be able to “insist upon” elected councillors making up the majority of their members, potentially handing a greater say over healthcare commissioning decisions to local authorities than before.

Public health

The new body Public Health England will be an “executive agency” of the Department of Health, ensuring the advice it provides is independent.

Patient choice, competition and privatisation

The core duty of the regulator Monitor will be to protect and promote patients’ interests rather than to “promote” competition within the NHS - representing a significant change from the current bill.  

Instead the NHS Commissioning Board will be issued with a “choice mandate”, setting out clear expectations to promote choice.

The mandate will make it a priority to extend the use of personal health budgets.

The government will “narrow” Monitor’s powers over anti-competitive purchasing behaviour, so the focus is more on preventing abuses rather than promoting competition. Existing rules on competition will be retained and policed by the Cooperation and Competition Panel, which will become part of Monitor.

The new patient watchdog HealthWatch England will have the power to establish a “citizens’ panel” to look at how choice and competition are being implemented.

Education and training

Details on the transfer to the new system for education and training, which will see responsibility for funding move from SHAs to trusts and other providers, will be published in the autumn.

The health secretary will be given an “explicit duty” to maintain a system for education and training.

Foundation trust status

The April 2014 deadline for all trusts to achieve foundation status has been dropped. However, the 116 trusts that are non-FTs will be expected to become foundations “as soon as clinically feasible”.

Secretary of state

After planning to remove it, the health secretary will continue to have a duty to provide a comprehensive NHS.

NHS Constitution

Clinical commissioning groups and the new NHS Commissioning Board will have a duty to “take active steps to promote” the NHS Constitution.   


Readers' comments (5)

  • Are you sure about that?

    Liz Kendall MP:
    'Just read Govt's Health Bill amendments. Total mess. Huge centralisation, mass of new red tape, Monitor & competition virtually unchanged'.

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  • Doctors issue open letter: It looks to me as if this is deception on an industrial scale. The Bill is hardly changed?

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  • article and the open letter:

    You're misleading people NT.

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  • apologies NT, you may not be consciously misleading people, that may be what this govt want us to believe however please read the above pieces to start a balanced presentation of the info.

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  • 'Delegates at the BMA's Annual Representative Meeting have voted for the health bill to be scrapped, despite the array of amendments proposed by the Government.

    Rejecting an appeal from BMA chair Dr Hamish Meldrum urging delegates not to risk losing the concessions that had been won, a majority voted for the association to call for the scrapping of the whole reform package'



    28 June 2011 1:36PM

    JUST IN CASE YOU MISSED IT here is a cut and paste job of a contribution I made on this subject a week or so ago:

    I have freinds/relatives employed in the USA in the first tier medical profession one of whom is a fervent Bushite and has amassed a huge, huge fortune which is derived not just from his very succesfull pratice but pricipally from stock ownership of health care providers in the US.

    When I saw the "breaking news" of the proposed NHS reform I immediately alerted him (seeing as he has made a huge fortune himself from health care insurance and provisions) and asked him to give me his interpretation of how the proposal might work in practice.

    He explained his view of how it might work to me and concluded thus :

    " ....... The money makers will therefore be the healthcare management consortiums, thier consultants and possibly insurance companies. And guess how they will make money? Denial of care by refusing to pay for certain services! And they will be able to get away with it because with the billions paid to them by government, they will have no problem buying politicians and judges or shall we say, "sharing" the loot with them. "

    Fine I said, so why not grab a piece of the action yourself by setting up in the UK as a provider/insurer? Afterall, I said, that is what neo-liberals do - they make money regardless of the provenance of the loot.

    He replied, in part

    "... It is almost impossible to buy into this new scheme for a variety of reasons. The foremost reason is that the entities that will make money are already defined. These entities, with the help of lobbyists and at considerable expense, drew up the new scheme for government health care reform and then did "a great sales job" to the powers that be of how their plan would be a win-win scenario for the party and the people. By the time Cameron and his team spoke about the new scheme, these boys had already staked their place and are now waiting for the windfall. There is a lot more behind the scene activity than meets the eye when something like this comes along. If you think about it, what the heck does Cameron know about the running of the NHS or even the healthcare industry? He could never have come up with something as complex as this. And just to put everything in perspective, the set up is no different from an outsider going to ZANU-PF chefs and asking for a permit to mine diamonds in Marange! We would all say "Good luck"!

    The freind that has passed this on to me worked in the NHS for about 4 years after leaving his African home where we were childhood freinds. By his own admission he left the NHS because he wanted to get very, very rich very, very quickly. In comparing the NHS with the US system he states catgorically that the NHS is excellent for patients but not quite so for doctors, specialists, consultants and so on. The US system, on the other hand, is awful for patients etc....... and it is also HEAVENLY for the intemedaries standing between patients and health professionals.

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