Across the border

The horizon looks set for interesting times in the English NHS. The coalition agreement Our Programme for Government has no less than 30 pledges on the NHS and 4 for Public Health. Additional policy messages are also coming thick and fast, including promises this week to get tough on emergency readmissions.

There are already immediately tangible signs of the new broom. The proposed reconfiguration of services in London has been halted, all major DoH capital spending commitments have been called in for review and there’s confirmation that SHA’s will be gone by 2012.

Other themes have emerged. Patients must be “at the heart of everything we do”; this includes greater engagement in service redesign, directly elected representatives on PCT Boards, ability to choose your GP and hints at the possibility of patient-held budgets for long term conditions.

GPs are also coming back centre stage; given a pivotal voice on service reorganisation and a role as ‘patient’s expert guides’ through the healthcare system. The phrase ‘GP commissioner’ abounds, but more details on what this means in practice (particularly in relation to hard budgets) are still awaited. We’re no longer talking the language of targets, but outcomes and national quality measures will be the new performance barometer. Watch this space for more on these, we’re told. The customary messages about reduced bureaucracy are there, with promises of no more top-down re-organisation, but the responsibility for appointing PCT CEs now lies not with PCTs themselves, but with the SoS, advised by a new independent NHS Board.

There’s much more, but already questions are begged; what’s the detail of GP commissioning ? With any changed commissioning landscape (and no SHAs), what’s the accountability structure ? How can we deliver difficult service reshaping, increased efficiency and savings as well as effective engagement and achieving public and clinical support ? It promises to keep us all exercised and invigorated.

Written by Dr Paul Worthington

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