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. Patients in neighbouring streets but differing health authorities have found while one has got it free on the NHS, the other has had to pay for it, exposing local inequalities in provision.
Nice, which is a 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. Ann Widdecombe, shadow Health Secretary, said its principal aim would be to control costs. But Frank Dobson, the Secretary of State for Health, said that for the first time, doctors in the NHS would be given authoritative advice on the best treatments.
"It will bring an end to a situation where adjacent health authorities look at different evidence in different ways and come to different conclusions," Mr Dobson said.
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, however, 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 the NHS's resources.