NHS faces major overhaul as GPs given more powers

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A major shake-up of the National Health Service under which up to £80bn for patient care will be passed to family doctors is to be announced next week by the coalition Government.

The plans, heralding the biggest NHS shake-up for decades, would lead to the abolition of strategic health authorities and primary care trusts, with the loss of thousands of administrative posts.

Responsibility for directing patients' care would be transferred to about 500 consortia of GPs covering 8,000 doctors' practices in England. They would receive £70bn to £80bn annually to cover the cost of hospital and community treatment for patients.

The moves will be set out in a health White Paper to be published on Monday by Andrew Lansley, the Health Secretary. His plans to pass power and money into GPs' hands comes after weeks of wrangling within the coalition Government over its merits.

He believes the new structure will cut red tape and give new power to doctors and their patients.

It is anticipated that the new system, which will see family doctors gaining responsibility for commissioning out-of-hours services, would lead to groups of GPs offering the evening and weekend call-outs that were once a routine feature of doctors' practices.

George Osborne, the Chancellor, had raised anxieties about handing such large sums to doctors. Sir David Nicholson, the NHS chief executive disclosed last week that the Treasury was worried about "financial performance" if the plans were put in place.

With Liberal Democrat ministers also raising question marks over the scheme, publication of the White Paper was delayed.

But it emerged last night that Mr Lansley's proposals had been finally approved after he gained David Cameron's backing. The Health Secretary was reported to have reassured Mr Osborne that safeguards would be put in place to prevent GPs from wasting public money. They are likely to be required to sign new contracts to make them more accountable.

Although spending on frontline healthcare has been ring-fenced by the coalition, ministers have made clear that they are still seeking savings from backroom and administrative costs. Mr Lansley has indicated he wants the changes in place by early 2012, although the scale of the planned restructuring could make that an ambitious target.

The 150 primary care trusts and strategic health authorities, which oversee NHS trusts and supervise health services, would be phased out with their responsibilities passing to groups of family doctors.

The moves are likely to face tough opposition from public sector trade unions. They would also depend on persuading GPs to accept radical new contracts. Detailed negotiations with the British Medical Association would be required before the consent of doctors could be obtained.

However, the coalition intends to make the scheme compulsory – a crucial difference from voluntary GP fund-holding schemes attempted by the governments of John Major and Tony Blair. The Daily Telegraph today quotes a government source as saying: "This is pushing through the whole lot of policy that either Tory or Labour governments have tried in the NHS's history but have never gone through with properly."

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