Yesterday marked the end of GP fundholding and the beginning of a huge transfer of power and resources from hospitals to family doctors, backed by a series of measures designed to increase quality in the NHS.
The most important of these is the National Institute of Clinical Excellence (Nice), a national agency introduced to appraise new treatments and ensure those that are valuable are spread around the NHS. Taxol, the drug for advanced ovarian cancer that has been the focus of allegations of "postcode prescribing", is expected to be one of the first to be considered by the agency.
Ministers have said they expect Nice to give "a big nod" to Taxol, which some health authorities have refused to supply because of its pounds 6,000- a-year cost per patient. The drug has been shown in trials to extend survival by 12 months.
Nice, which is expected to issue its first guidance in the autumn, will look at the cost as well as the effectiveness of new treatments and surgical techniques and is seen by doctors as a tool for rationing NHS care.
Quality of care will also be monitored by the new Commission for Health Improvement, an NHS inspectorate that will ensure hospitals are implementing a system of "clinical governance" - checking standards of care and identifying poor doctors.
The biggest change is the abolition of GP fundholding and its replacement by 481 "primary care groups" - local groups of GPs and nurses - who will have responsibility for spending 90 per cent of NHS resources.Reuse content